Oral Minoxidil for hair loss - fact sheet and definitive guide

Minoxidil is available in 2.5mg, 5mg and 10mg tablets. We use the Loniten brand (Pfizer Ltd). A common starting dose is 0.625mg per day for women and 1.25mg ... HomeConsultationsAppointmentguideHairlossconsultationOnlineconsultationFollowupappointmentsRepeatprescriptionsWhatisadermatologistConditions&ServicesAcneAcnePerioraldermatitisFungalacneHormonalacneIsotretinoin(Roaccutane)SpironolactoneHowtouseatopicalretinoidHyfrecationofcomedonesAcnescarsSubcisionforacnescarsTCACrossforacnescarsHairlossHairlossHairLossConsultationHairFactsMalepatternhairlossFemalepatternhairlossAlopeciaAreataFinasterideforMaleHairLossOralMinoxidilSteroidInjectionsMoles&SkinCancerMolechecksbySpecialistDermatologistMoleremovalinBirminghamSkinCancerBasalCellCarcinomaMelanomaSkinCancerSurgeryMohsMicrographicSurgeryDermatologyHyperhidrosisMelasmaRashesandItchySkinRosaceaRednessandThreadVeinsSeborrhoeicKeratosisSurgicalproceduresSkinSurgeryConsultationsandProceduresSamedayproceduresMoleremovalinBirminghamMiliaremovalSeborrhoeickeratosisremovalSkintagremovalGenitalskintagremovalCystremovalLipomaremovalSebaceousglandhyperplasiaremovalThreadveinremovalSkinCancerSurgeryMohsMicrographicSurgeryinBirminghamFibrouspapuleremovalAestheticBotoxandFillersFeesandTermsTermsandConditionsMakeapaymentBlogSerumContactusOralMinoxidilforHairLossOurDermatologistswillbeabletoadviseyouonthebesttreatmentssuitableforyourhairlossAdefinitiveguidetoOralMinoxidilforHairLossbyaDermatologistMinoxidilisasuccessfulhairtreatmentanditisappliedontoscalpasascalptonicorfoam.ThisisthepreferredandfirstchoiceofMinoxidiltreatmentastopicalMinoxidilproductsarewellestablishedfortheirsafetyandeffectiveness.TherearecertaincircumstancesthatMinoxidilcanbetakenorallyasatablet.MakeanappointmentCallusnowWhenisoralMinoxidilgivenforhairloss?OralMinoxidilcanbeconsideredforhairlossif:TopicalMinoxidilpreparationscausearash,irritationorallergyThereisalackofanybenefitfromtopicalMinoxidilafter6monthsofdiligentuseTopicalMinoxidilcausespoorhairtexture–sometimesMinoxidilcancausedry,tangledhairthatispronetobreakageThereareotherdifficultiesusingtopicalMinoxidil–andthiscausescomplianceproblems.HairlossconditionsthatmayimprovewithMinoxidilOralminoxidilismainlyusedformaleandfemalepatternhairloss.However,therecanbebenefitwithothertypesofhairlosstooincludingtelogeneffluvium,tractionalopeciaandlooseanagensyndrome.WhywouldoralMinoxidilworkwhentopicalMinoxidilhasnotworked?SomepeoplemaynotrespondtotopicalMinoxidilastheylackthecorrectenzymeintheirhairfolliclestoactivatethemedicationfromMinoxidiltoMinoxidilSulphate(sulfotransferase).Thisenzymeispresentintheliverandwillactivatetheoralmedication.Howeffectiveisoralminoxidil?Thestudiesareverysmallbutindicatethataboutonethirdofpatientswillnoticeareductioninshedding,andathirdwillnoticeimprovedgrowthin6monthsormore.Thismeansthatupto2in3peoplemaynoticebenefitsfromoralMinoxidil.Itisbesttotaketreatmentfor6to12monthstogiveitenoughtimetowork.TheonlyheadtoheadstudycomparingoralminoxidiltotopicalminoxidilinwomenwithFemalePatternHairLossshowedthat1mgofminoxidilgavecomparableeffectsto5%solution(1ml)onceaday(Ramosetal2020).Inthisstudy26womenreceivedoralminoxidiland26womenreceivedtopicalminoxidil.After24weeksoftreatment,therewasa12%increaseinhairdensityforwomenonoralminoxidiland7.2%increaseforwomenapplyingtopicalminoxidil.Thedifferencewasnotstatisticallysignificantbuttheoralminoxidilgroupalsohadlesshairshedding.Whatarethesideeffects?Sideeffectsareveryuncommonatthelowdoseswhichareusedtotreathairloss.Thelargeststudylookingatsideeffects(Vañó-Galvánetal2021)showedthatin943womenand461men, 2.5%ofwomenand0.5%ofmenhadtostoptreatmentbecauseofasideeffect.Excessivehair(Hypertrichosis).Themostcommonsideeffectishypertrichosisforbothmenandwomen-excesshairgrowthelsewhereonthefaceandbody.Excessgrowthismorelikelytooccurathigherdoses.Whilethissideeffectisbothersome,itcanusuallybemanagedwithhairremovalmethodsandisnotacommonreasonforsomeonetostop.Hypertrichosismayaffect10-25%ofthoseonlowdoses(<4mg)andupto50%ofthoseonhigherdoes(>5mg). Vañó-Galvánetalshowedthat20%ofwomenand6%ofmenexperiencedhypertrichosis.Ofthosethatexperiencethissideeffect,only5%ofwomenand0%ofmenfinditnecessarytostoptreatment.Temporaryshedding.TemporarysheddingisverycommonattheonsetofstartingoralortopicalMinoxidil.Thissideeffectoccurswithinthefirst6weeksandcanbeofsignificantconcern.Howeveritisimportanttocontinuewiththemedicationasthiswillstopafter4weeks.Ankleswellingandfluidretention.Swellingofthelowerlegscanoccurinupto3%people.Thisisusuallyathigherdoses.Fluidretentioncanalsosometimesshowuparoundtheeyesaspuffyeyes,whichareworseinthemorning. Vañó-Galvánetalshowedthat1.3%getankleswelling(25%oftheseindividualsstoptreatment)and0.3%experienceswellingaroundtheeyes(0%needtostoptreatmentforthis).Lowbloodpressureandfeelinglightheaded.Minoxidilisalsousedtocontrolhighbloodpressureusuallyatdosesof10-40mgperday–muchhigherthanthedosesusedforhairloss.Howeverevenlowerdosescansometimescauseareductioninbloodpressure.2%ofpeoplemaygetposturalhypotensionwithlowdosesofMinoxidil.8%mayhavegeneralsymptomsoflightheadedness.Thisleadstodizzinesswhengettingupquickly.1.7%ofthoseonlowdoseMinoxidilexperiencelightheadednessandofthese,only11%needtostoptreatment.Fastheartrate.Minoxidilcanalsocauseafastheartrate,butthisisusuallyathigherdoses.Youshouldalertyourdoctorifyouaretakingothermedicationssuchasasthmainhalerswhichcanalsoincreasetheheartrate.0.9%ofthoseonlowdoseoralminoxidilappeartoexperiencethissideeffect,andofthese33%needtostoptreatment.Headaches.Headachesmayoccurinasmanyas9%ofpeoplebutagainthisseemstogetbetterwithtime.0.4%experiencethissideeffectandofthese44%needtostoptreatment.Uncommonsideeffectsinclude–nightmares,insomnia,pericarditis,skinrashes,nausea,vomiting,breasttendernessItisimportanttoreportsideeffectstoyourdoctor.However,ifthereisarapidincreaseinpulserate,palpitations,feelingdizzy,shortofbreath,chestpaidandfaintingthenyouareadvisedtogototheA&Edepartmentorcalltheemergencyservices.ChangesinlifestylewhentakingoralMinoxidilItishelpfultocutdownalcoholasalcoholcanalsoreducebloodpressure.Itisalsohelpfultocutdowncaffeineascaffeinecancausethehearttoraceandcausepalpitations.DosesoforalMinoxidilMinoxidilisavailablein2.5mg,5mgand10mgtablets.WeusetheLonitenbrand(PfizerLtd).Acommonstartingdoseis0.625mgperdayforwomenand1.25mgperdayformen.Youshouldgetatabletcutterfromyourpharmacyandcuta2.5mgtabletintoquartersorhalvestogetthisdose.Theoptimumdoseforhairlossisnotentirelyclear.Itmaybeintheregionof0.625mgto2.5mgperday.Formen,aslightlyhigherdosemaysometimesberequired.Youmaybeaskedtotakethemedicationdailyoreveryotherday.Dosesofminoxidilforhairlossareconsidered‘lowdose’.Thisisbecausethedosesusesforhairlossarealotlowerthanthedoseswhichareusedforconditionssuchashypertension.Thedosesusedforhypertensionare10-40mgperday.BrandoforalMinoxidil–LonitenWesupplyLonitenbrandedMinoxidiltablets.ThesearemanufacturedbyPfizer.WhenMinoxidilshouldbeavoidedTherearecertaininstanceswhenitisnotsafetohaveoralminoxidil.Thesearelistedbelowandyoushouldensureyourdoctorisawareofanyunderlyinghealthconditionsyoumayhave.Minoxidilshouldbeavoidedifyouhave:drugallergy–NBitappearsthatoralminoxidilissafeifyouhavereactedtotopicalminoxidilevenifyourpatchtestsshowsyoureacttominoxidilandnottothepreservativessunpropyleneglycol(Thearinouetal2020)pheochromocytomapulmonaryhypertensionwithmitralstenosisseverehepaticimpairmentanginaorrecentmyocardialinfarction(heartattack)leftventricularhypertrophyheartfailureOralminoxidilforhairlossisanunlicensedmedicationWhilethereareanumberofmedicalreportstoshowthatoralMinoxidilhelpshairloss,andthisisalsoourexperience,thequalityofevidencecomparedtotopicalMinoxidilorotherhairlossmedicationsislacking.ControlledclinicalstudiesonoralMinoxidilarealsolacking.Lowqualityevidence,nomatterhowsignificantitis,meansthatsuchmedicationsarenotincludedinnationalguidelines.OralMinoxidilissuchamedication.Untilmorelarger,morestatisticallysophisticatedstudiesarecarriedout,oralMinoxidilforhairlosswillremainunlicensedintheUK.Thismeansthatyoucanonlyreceiveaprescriptionfromadoctorwhohasexperienceinusingthismedication,andwhohasassessedyoutodeemthebenefitsoutweightherisks.Youmustalsotakethetimetoreadinformationonunlicensedmedications(suchasthisfactsheet)andagreethatyoufeelthebenefitsoutweightherisks.ManymedicationsareusedoutsidealicenseintheUK,especiallyinDermatologicalpractice.WhilewehavealargenumberofpatientsonoralMinoxidil,yourDermatologistmaynotsuggestthistreatmenttoyouiftheydonotbelieveyoursituationfulfilsthecriteriaforthemtoprovideyouwithanunlicensedmedication.ForthosepatientsreceivingoralMinoxidilallmonitoringtests,prescribingandfollowupconsultationswillneedtotakeplaceattheClinicasNHSGPsareundernoobligationtocontinueprescribingormonitoringunlicensedmedications.ThismeansthatifyouelecttogoonoralMinoxidilyoucannotcontinuethisunderthecareofyourGP.HowdoIpreparetostartoralMinoxidil?Pleaseadviseyourdoctorofallthemedicationsyouareon.OralMinoxidilshouldbeusedwithcautionifyouareonothermedicationsthatreducethebloodpressure.Werecommendyouobtainanathomebloodpressuremonitor.Youshouldhaveabloodpressureandheartratereadingbeforeyoustartandsendthisin.Werecommendyoucheckyourbloodpressureandheartrateonceaweekandkeepachartwhichyoushouldbringwithyoutoyourappointments.DoesMinoxidilcurehairlossforgood?ItimportanttoconsiderMinoxidil,bothtopicalandoral,asatreatmenttoslowdowntheprogressionofhairloss.ItisprobablethathairlosswillstillproceedwhiletakingMinoxidil,howeveritwillbeataslowerpace.TheeffectsofMinoxidilareonlyactiveifthemedicationiscontinued.Theeffectsarelostifmedicationisstopped.ItisbesttoconsiderMinoxidilalongtermorlifelongtreatment.PatientInformationLeafletWerecommendthatyoualsoreadthepatientinformationleafletproducedbythemanufacturerswhichwillaccompanythemedicationwhichcanbefoundhere.CombiningoralMinoxidilwithFinasterideYourdoctormaydirectyoutocombineMinoxidilwithFinasteride.Youcanreadmoreaboutfinasteridehere.HairconsultationandprescriptionofMinoxidilOralminoxidilisprescribedafterafacetofaceassessmentbyaspecialistdermatologistataninitial hairlossconsultation.Youcanmakeanenquireforahairconsultationappointmenthere.Medicationsareonlyprescribedduringaconsultationonceyourdoctorhasanadequateknowledgeofyourhealthandcondition.Aparticularmedicationisonlyprescribedifthemedicationissuitableforapersonintheircurrentsituation.Weaskthatyoudonotassumethataparticularmedicationwillbeprescribedataconsultation,asthiswillbedowntothemedicalassessmentmadebyyourdoctor.Further,wealsodonotnecessarilycontinueprescriptionsformedicationsyoumayhavebeenprescribedelsewhereincludingfromoverseasorfromonlineprovidersasthesamecriteriaforprescribingareapplied.FollowupconsultationsYouwillbeaskedtoattendforfollowupevery3monthsinitiallyandthenevery6monthsonceyouhavebeenestablishedonastabledose.Individualrecommendationsmayvaryandyoumaybeaskedtoattendforfollowupconsultationsooner.ReferencesRandolphM,TostiA.Oralminoxidiltreatmentforhairloss:Areviewofefficacyandsafety.JAmericanAcadDermatol2020.https://doi.org/10.1016/j.jaad.2020.06.1009BeachR,McDonaldK,BarrettB.Tolerated,Effective,Successful:LowDoseOralMinoxidilforTreatingAlopecia,A3-YearNorthAmericanRetrospectiveCaseSeries.JAmAcadDermatol2020doi:10.1016/j.jaad.2020.10.032.BaltazarSanabria,TamaradeNardoVanzela,HélioAmanteMiot,PauloMüllerRamos. AdverseEffectsofLow-doseOralMinoxidilforAndrogeneticAlopeciain435patients. JournaloftheAmericanAcademyofDermatology,2020. https://doi.org/10.1016/j.jaad.2020.11.035.Ramos,P.M.,Sinclair,R.D.,Kasprzak,M.&Miot,H.A.Minoxidil1 mgoralversusminoxidil5%topicalsolutionforthetreatmentoffemale-patternhairloss:Arandomizedclinicaltrial. JAmAcadDermatol 2020; 82: 252–253Vañó-Galván,S. etal. Safetyoflow-doseoralminoxidilforhairloss:Amulticenterstudyof1404patients. JAmAcadDermatol 2021; 84: 1644–1651.TherianouA,VincenziC,TostiA,Howsafeisprescribingoralminoxidilinpatientsallergictotopicalminoxidil?,JournaloftheAmericanAcademyofDermatology(2020),doi:https://doi.org/10.1016/j.jaad.2020.04.027AuthorinformationAuthor:DrSajjadRajparDatelastreviewed:1Oct2021ConflictofinterestanddisclaimerThisinformationisbasedontheviewsofaUKConsultantDermatologist(adoctorwhoisonthespecialistregisterforDermatology,theequivalentofwhichis‘Boardcertified’intheUSA)whohassupervisedmanypatientssuccessfullyonoralMinoxidil. ThisinformationisintendedforpatientsofthisClinicandunderourcareonly.PracticesvarynationallyandinternationallyandwedonotwishtocontraveneadviceyouhavebeenprovidedbyyourownPhysician.Makeanappointment 38HarborneRoad,BirminghamB153HE 53ChurchRoad,BirminghamB153SJ +44(0)1212854540©2022MidlandSkin.