From the Guidelines
Oral minoxidil can be safe for treating androgenetic alopecia when used under medical supervision at low doses, typically 0.25-5 mg daily, with proper patient selection and regular monitoring of potential side effects. The use of low-dose oral minoxidil (LDOM) for androgenetic alopecia (AGA) has been evaluated in recent studies, including a review of 435 patients who were prescribed LDOM for AGA from January 2017 to May 2020 at 3 hair clinics in Brazil 1. This study aimed to assess the adverse effects (AEs) of LDOM and correlate them to the dose, weight, sex, and skin color.
Key Considerations
- Common side effects of oral minoxidil include increased heart rate, fluid retention, unwanted body hair growth, and headaches.
- More serious risks, though rare at lower doses, include hypotension, heart rhythm abnormalities, and pericardial effusion.
- Safety depends on proper patient selection, with individuals requiring normal blood pressure, no history of cardiovascular disease, and no contraindications to minoxidil.
- Regular monitoring of blood pressure, heart rate, and potential side effects is essential for safe use.
Evidence and Recommendations
The study referenced 1 provides insight into the tolerability and adverse effects of LDOM for AGA, highlighting the importance of careful patient selection and monitoring. While the study does not directly compare the safety of oral minoxidil to other treatments for androgenetic alopecia, it supports the use of LDOM as a viable option under medical supervision. The key to safe use is adherence to low doses and close monitoring, which can mitigate the risk of serious side effects.
Clinical Implications
In clinical practice, the decision to prescribe oral minoxidil for androgenetic alopecia should be made on a case-by-case basis, considering the patient's medical history, current health status, and potential risks versus benefits. Patients should be thoroughly informed about the potential side effects and the necessity of regular follow-ups to ensure safe use. Given the potential for oral minoxidil to effectively treat hair loss when other options are ineffective or impractical, its use under medical supervision can be a valuable treatment strategy for appropriate candidates.
From the Research
Safety of Oral Minoxidil for Androgenetic Alopecia
- The safety of oral minoxidil for treating androgenetic alopecia has been evaluated in several studies 2, 3, 4, 5, 6.
- A multicenter study of 1404 patients found that low-dose oral minoxidil had a good safety profile, with the most frequent adverse effect being hypertrichosis (15.1%) 2.
- Systemic adverse effects, such as lightheadedness, fluid retention, and tachycardia, were infrequent and led to treatment withdrawal in only 1.2% of patients 2.
- A review of oral minoxidil as a treatment for hair disorders found that it was a successful and well-tolerated alternative for patients with hair loss, including those with poor adherence to other therapies 3.
- An international modified Delphi consensus statement recommended the use of low-dose oral minoxidil for patients with hair loss, with guidelines for dosing, contraindications, and monitoring 4.
- A review of oral minoxidil treatment for hair loss found that it was an effective and well-tolerated treatment alternative for healthy patients having difficulty with topical formulations 5.
- A study of 100 male patients with androgenetic alopecia found that low-dose oral minoxidil had a good safety profile, with the most incident side-effect being related to hypertrichosis, and no life-threatening adverse effects were observed 6.