From the Guidelines
Oral minoxidil can be considered for hair loss treatment, but should only be used under medical supervision due to potential side effects. According to the most recent evidence 1, minoxidil can be considered to stimulate hair growth after chemotherapy-induced alopecia (CIA) or endocrine therapy-induced alopecia (EIA). Typically prescribed at low doses of 0.25-5mg daily, it works by increasing blood flow to hair follicles and prolonging the growth phase of hair.
Before starting treatment, patients should undergo cardiovascular screening as minoxidil was originally developed as a blood pressure medication and can cause hypotension, tachycardia, fluid retention, and rarely, pericardial effusion. Common side effects include increased body hair growth (hypertrichosis), which occurs in up to 80% of users, headaches, dizziness, and ankle swelling.
Some key considerations for using oral minoxidil include:
- Potential side effects, which can be significant
- Need for medical supervision
- Importance of cardiovascular screening before starting treatment
- Potential for increased body hair growth and other common side effects
- Need for patience, as visible results typically take 3-6 months
It's also important to note that hair loss will resume if treatment is discontinued, making it a long-term commitment. While topical minoxidil (2-5%) remains the first-line treatment with fewer systemic effects, oral minoxidil may be more effective for some patients, particularly those with poor response to topical formulations or with adherence issues. However, the evidence for oral minoxidil is not as strong as for other treatments, such as platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), which have shown promising results in recent studies 1.
From the Research
Considerations for Using Oral Minoxidil for Hair Loss
- The primary concern with using oral minoxidil for hair loss is the potential risk of systemic adverse effects, such as hypertrichosis, lightheadedness, fluid retention, tachycardia, headache, periorbital edema, and insomnia 2.
- Oral minoxidil has been found to be an effective and well-tolerated treatment alternative for healthy patients having difficulty with topical formulations, with a good safety profile and infrequent systemic adverse effects 2, 3.
- The dose of oral minoxidil can be titrated, and doses ranging from 0.25 to 1.25 mg daily are usually used for female-patterned hair loss, while doses ranging from 2.5 to 5 mg/day are used for male-patterned hair loss 4.
- A randomized controlled trial found that 1 mg daily oral minoxidil may be as effective and safe as standard topical minoxidil in female and male pattern hair loss, with significant improvement in hair diameter and patient satisfaction 5.
- A comparison of oral minoxidil, finasteride, and dutasteride for treating androgenetic alopecia found that oral minoxidil predominantly causes hypertrichosis and cardiovascular system symptoms/signs in a dose-dependent manner, while oral finasteride and dutasteride are associated with sexual dysfunction and neuropsychiatric side effects 6.
Efficacy and Safety of Oral Minoxidil
- Oral minoxidil has been shown to be effective in promoting hair growth, with a probable efficacy ranking of dutasteride 0.5 mg/d, finasteride 5 mg/d, minoxidil 5 mg/d, finasteride 1 mg/d, followed by minoxidil 0.25 mg/d 6.
- The safety profile of oral minoxidil is generally good, with infrequent systemic adverse effects and no life-threatening adverse effects observed in a multicenter study of 1404 patients 2.
- However, oral minoxidil can cause hypertrichosis, which led to treatment withdrawal in 14 patients (0.5%) in a retrospective multicenter study 2.
Comparison with Other Treatments
- Oral minoxidil may be a safe and effective alternative to topical minoxidil, with the advantage of enhanced cosmesis, cost-savings, and the possibility of co-therapy with other topical formulations or topicals used for camouflage 4.
- A comparison of oral minoxidil, finasteride, and dutasteride found that dutasteride suppresses DHT levels more than finasteride in the serum and scalp, while minoxidil acts through multiple pathways to promote hair growth, including vasodilation, anti-inflammatory effects, and Wnt/β-catenin signaling induction 6.