Oral Minoxidil Informational Handout

Oral minoxidil was first approved by the FDA for the treatment of high blood pressure in 1979 under the trade name Loniten.  It was used at doses of 10-20mg daily to treat recalcitrant hypertension.  Serendipitously, patients treated with oral minoxidil were observed to have significant hair growth.  Therefore, Johnson and Johnson elected to develop it as a topical treatment for hair loss ( Rogaine).  This was first approved as a 2% solution, then a 5% solution, and more recently as a 5% foam.  For many years it was exclusively used topically for hair loss with success.  over the past several years, clinical trials have been published confirming the efficacy in low dose oral minoxidil for treating hair loss.  The use of oral minoxidil for hair loss is strictly off-label.  This means that the manufacturer has not performed rigorous clinical trials seeking FDA approval for the specific treatment of hair loss.  However, doctos in the US and around the world have been successfully using it for several years in this application.  When taken by mouth, it may be more effective through 1) increased absorption and 2) increased compliance over topical formulations.

How does it work?

Oral Minoxidil is a vasodilator, meaning that it helps relax the blood vessels and thereby increase the vascular supply to the hair follicles.  This also means it can slightly lower blood pressure and may slightly increase fluid retention in the extremities (hands or feet). 

What if I have high blood pressure or heart disease?

We recommend anyone with high blood pressure or any cardiovascular disease not to take oral minoxidil.  In addition, any patient with pheochromoctyomam renal failure, any history of cardiac disease (ie atrial fibrillation, heart attack ,or heart failure) should not take oral minoxidil.

Who can benefit from oral minoxidil?

Presently, it appears that the best responders are patients with androgenetic alopecia (male/female pattern hair loss).

What are the side effects?

In a retrospecive, multicenter review of 1,404 patients taking low dose oral minoxidil, the most common side effects were unwanted facial or body hair or hypertichosis (15%), light-headedness from low blood pressure (1.7%), fluid retention/weight gain (1.3%), rapid heart rate (0.9%), headache(0.4%), fluid around the eyes (0.3%) and difficulty sleeping (0.2%).  There are reports of pericardial effusion or pericarditis (fluid around the heart) but these occurred almost exclusively in patients with pre-existing congestive (heart) failure or renal (kidney) failure.  Since there are no long-term studies pericardial effusion must be assumed can rarely occur even in a healthy patient.  Severe allergic reaction or hives has been observed in some patients taking oral minoxidil.

Other potential side effects include:

-Temporary shedding of your hair

-headaches

-nightmares/insomnia

-nausea/vomiting

-breast tenderness

If you have rapid weight gain it could be from retained fluid.  if this occurs, stop the medication and inform the office.

Can i continue to use both the topical and oral minoxidil?

That is fine, so long as you are ok with possibly having some unwanted facial hair.

Can I combine oral minoxidil with other hair loss therapies?

Yes, oral minoxidil appears safe in combination with other treatments for hair loss such as finasteride, platelet rich plasma therapy, low level laser light therapy, or hair surgery.  However, if you noticie any unusual side effects, please contact the office right away.

Can oral minoxidil be used in children?

So far, there are a few publications demonstrating that it appears to be safe in persons under the age of 18.  For best outcomes, we recommend consulting your child's pediatrician.

Since oral minoxidil can impact your cardiovascular system it is required that all patients contact their primary physician before beginning the use of this medication.  This is for your safety.