What are the indications for oral minoxidil (vasodilator)?

From the Guidelines

Oral minoxidil is primarily indicated for the treatment of resistant hypertension, and only considered if all other pharmacological agents prove ineffective, as stated in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. When used for hypertension, oral minoxidil is typically prescribed at doses ranging from 5-100 mg daily, with frequent monitoring of blood pressure and potential side effects such as fluid retention, tachycardia, and hypertrichosis (unwanted hair growth in other body areas) 1. Some key points to consider when prescribing oral minoxidil for hypertension include:

• The need for concomitant use of a diuretic and beta blocker to mitigate side effects 1
• The potential for pericardial effusion and hirsutism 1
• The importance of careful patient selection and monitoring, given the potential for significant side effects and the availability of alternative treatment options 1 It's also worth noting that oral minoxidil has been used off-label for the treatment of androgenetic alopecia (pattern hair loss) in both men and women, typically at lower doses ranging from 0.25 mg to 5 mg daily [@Example@]. However, in the context of the provided guidelines and evidence, the primary indication for oral minoxidil is the treatment of resistant hypertension, and its use should be guided by the principles outlined in the 2024 ESC guidelines and other relevant clinical guidelines 1.

From the Research

Indications of Oral Minoxidil

• Oral minoxidil is used for the treatment of symptomatic hypertension, or refractory hypertension associated with target organ damage, that is not manageable with a diuretic and two other antihypertensive drugs 2
• It is also used to stimulate hair growth, particularly in women with female pattern hair loss (FPHL) 3, 4, 5, 6
• Combination therapy with low-dose oral minoxidil and spironolactone has been shown to be effective in treating FPHL 3
• Oral minoxidil has been used off-label as an alternative modality of treatment for FPHL, including in cases where topical minoxidil is not effective 5

Specific Patient Populations

• Women with FPHL, particularly those with Sinclair stage 2-5 hair loss, may benefit from oral minoxidil therapy 3
• Patients with hypertension who are not responding to other antihypertensive medications may be candidates for oral minoxidil therapy 2

Important Considerations

• Oral minoxidil can cause serious dermatologic reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) 2
• Patients receiving oral minoxidil therapy should be monitored closely for signs of adverse reactions, including skin rash, bullous eruptions, and hypertrichosis 2