From the Research
To discontinue oral minoxidil safely and avoid rebound hypertension, the medication should be tapered over a period of 12 weeks, as rapid withdrawal can lead to hypertensive encephalopathy, especially in patients who have received high cumulative doses of minoxidil 1. When considering the discontinuation of oral minoxidil, it's crucial to prioritize a gradual tapering schedule to mitigate the risk of rebound hypertension. The evidence suggests that the total cumulative dose of minoxidil and the rapidity of its withdrawal are significant factors in the occurrence of rebound hypertension 1. Key considerations for tapering oral minoxidil include:
- Gradual reduction of the minoxidil dose over 12 weeks to minimize the risk of rebound hypertension 1.
- Maintenance of concurrent beta-blocker and diuretic therapy during the tapering period and for at least 1-2 weeks after minoxidil is completely stopped to control reflex tachycardia and fluid retention 2, 3.
- Frequent monitoring of blood pressure during the transition, ideally daily at home and with clinical follow-up within 1-2 weeks, to promptly identify and manage any significant increases in blood pressure 1.
- Patient education on symptoms of rebound hypertension, such as severe headache, chest pain, or visual disturbances, which would warrant immediate medical attention 1. Given the potential for severe side effects, including hirsutism and pericardial effusions, and the availability of other effective antihypertensive agents with fewer side effects, the use of minoxidil should be limited to patients with severe hypertension who are resistant or intolerant to other treatments 2, 4.