Is 1.25 milligrams of oral minoxidil (minoxidil) therapeutic?

From the Guidelines

Oral minoxidil at a dose of 1.25mg can be therapeutic for certain conditions, particularly hair loss and hypertension, though this is considered a low dose. For androgenetic alopecia (pattern hair loss), low-dose oral minoxidil ranging from 0.25mg to 5mg daily has shown effectiveness, with 1.25mg falling within this therapeutic range 1. This dose may provide benefits while minimizing side effects like fluid retention, tachycardia, and unwanted hair growth that are more common at higher doses.

Key Points to Consider

• The medication works by widening blood vessels and stimulating hair follicles through its active metabolite, minoxidil sulfate.
• Results typically take 3-6 months to become noticeable, and the medication must be continued indefinitely to maintain benefits.
• Patients should be aware that an initial shedding phase may occur in the first few weeks of treatment.
• Blood pressure should be monitored when starting treatment, especially in patients with cardiovascular concerns, as even low doses can cause hypotension in sensitive individuals.
• A healthcare provider should always supervise this treatment to ensure appropriate dosing and monitoring, as minoxidil is associated with hirsutism and requires a loop diuretic, and can induce pericardial effusion 1.

Important Considerations

• The usual dose range for minoxidil in hypertension treatment is 5–100 mg/day, with a daily frequency of 1-3 times, according to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
• However, for hair loss, lower doses are often used to minimize side effects while still promoting hair growth.
• It's crucial to weigh the benefits against the potential risks and side effects, especially in patients with pre-existing medical conditions or those taking other medications.

From the Research

Therapeutic Effects of 1.25 Milligrams of Oral Minoxidil

• The therapeutic effects of 1.25 milligrams of oral minoxidil are supported by several studies 2, 3, 4, 5, 6
• Low-dose oral minoxidil has been used off-label for hair loss treatment in adults, with doses ranging from 0.25 to 5 mg daily to twice daily 3
• A systematic review of 10 articles comprising 19,218 patients found that oral minoxidil is a safe and successful treatment for androgenic alopecia and alopecia areata, with 61-100% and 18-82.4% of patients demonstrating objective clinical improvement, respectively 3
• Another study found that low-dose oral minoxidil has a favorable safety profile in patients with hypertension or arrhythmia, with systemic adverse effects detected in 6.8% of cases 4

Safety Profile of 1.25 Milligrams of Oral Minoxidil

• The safety profile of 1.25 milligrams of oral minoxidil is generally considered good, with infrequent systemic adverse effects 4, 6
• A multicenter study of 1404 patients found that the most frequent adverse effect was hypertrichosis (15.1%), which led to treatment withdrawal in 0.5% of patients 6
• Systemic adverse effects included lightheadedness, fluid retention, tachycardia, headache, periorbital edema, and insomnia, leading to drug discontinuation in 1.2% of patients 6
• A study of 264 patients with hypertension or arrhythmia found that prior treatment with doxazosin or with three or more antihypertensive drugs was associated with a higher risk of discontinuation of low-dose oral minoxidil 4

Dosage and Efficacy of 1.25 Milligrams of Oral Minoxidil

• The dosage of 1.25 milligrams of oral minoxidil is within the range of doses used in previous studies, which have demonstrated efficacy in treating hair loss 3, 4, 6
• A study of 19,218 patients found that oral minoxidil doses ranging from 0.25 to 5 mg daily to twice daily were effective in treating androgenic alopecia and alopecia areata 3
• Another study found that low-dose oral minoxidil was effective in treating female pattern hair loss, chronic telogen effluvium, monilethrix, and permanent chemotherapy-induced alopecia 3