After the propranolol revolution of 2008 (7) other beta-blockers have been used as anti-angiogenic factors in an attempt to decrease the side effects of propranolol, both those related to its activity on beta 2 receptors as hypoglycemia, bronchospasm, and those related to the lipophilicity of propranolol and its ability to cross the blood-brain barrier, such as sleep disorders and possible long-term effects on memory and cognitive activity (6). Atenolol is a beta 1 selective beta blocker medication, then in normal doses does not act on the bronchial muscles.
A fundamental difference compared to propranolol is its strong hydrophilicity that significantly reduces its penetration into the brain. After oral administration it is absorbed and enters the bloodstream without being metabolized in the liver unlike propranolol, whose hepatic metabolism, significantly different from subject to subject, could affect its plasma concentration. Another difference compared to propranolol is its longer plasma half-life - 5-8 hours - that allows once-daily dosing.
So far in the literature (1, 2, 3, 4, 5, 8, 9, 10, 11) were treated 213 cases of infantile hemangioma with atenolol at the average dosage of 1-1,5mg kg / per day as a single daily administration. In all cases in which atenolol and propranolol were compared, atenolol showed equivalent efficacy, better compliance (single dose) and reduced side effects or similar incidence of them as compared to propranolol.
The point in favor of atenolol are administration once a day and minor side effects related to low activity on beta 2 receptors and no exceedance of the blood-brain barrier; the points in favor of propranolol are is more frequent use in children and increased vasoconstrictor peripheral activity related to its action on beta 2 receptors.