From the Guidelines
Elderly females taking certain medications, such as anticoagulants, antidepressants, cholesterol-lowering medications, beta-blockers, and hormone-related medications, are at risk of developing alopecia. According to the most recent study 1, polypharmacy is a common issue in older adults, with 1 in every 6 adults in the United States being 65 years or older and accounting for 33% of prescription and 40% of nonprescription drug consumption. This study highlights the importance of medication review and deprescribing in older adults to prevent adverse drug events, including alopecia.
Some specific medications that can cause hair loss in elderly females include:
- Anticoagulants like heparin and warfarin, which can disrupt hair growth cycles
- Antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) that may cause hair thinning
- Cholesterol-lowering medications, particularly statins like atorvastatin (Lipitor) and simvastatin (Zocor), which are associated with hair loss
- Beta-blockers used for hypertension, including metoprolol, propranolol, and atenolol, that can contribute to hair loss
- Hormone-related medications, including thyroid medications when improperly dosed, and certain hormone replacement therapies, that may affect hair growth
The mechanism of hair loss from these medications typically involves pushing hair follicles prematurely from the growth phase into the resting or shedding phase. Hair loss from medications is usually diffuse rather than patchy and often reversible when the medication is discontinued or adjusted. As noted in the study 1, chronological age alone should not preclude a patient from receiving beneficial treatment, but a thorough medication review is essential to minimize the risk of adverse drug events, including alopecia.
In the context of polypharmacy, it is crucial to consider the potential interactions between medications and the risk of adverse drug events. The American Geriatrics Society Beers Criteria for potentially inappropriate medication and the STOPP (Screening Tool of Older Persons’ [potentially inappropriate] Prescriptions) tool can be useful resources for assessing the safety of medications in older adults 1. If an elderly female experiences new-onset hair loss, a medication review with her healthcare provider is recommended before stopping any prescribed medications.
From the FDA Drug Label
Alopecia5.24.4 The medication tamoxifen can cause alopecia in elderly females, with an incidence of 5.2% in the tamoxifen group compared to 4.4% in the placebo group 2.
From the Research
Medications Associated with Alopecia in Elderly Females
- The following medications have been associated with alopecia in elderly females:
- Adalimumab
- Infliximab
- Budesonide
- Interferon β-1α
- Tacrolimus
- Enoxaparin
- Zoster vaccine
- Lamotrigine
- Docetaxel
- Capecitabine
- Erlotinib
- Imatinib
- Bortezomib 3
- These medications were identified through a search of PubMed, Embase, and Web of Science, and were found to have strong levels of evidence supporting their association with alopecia.
Risk Factors for Alopecia in Elderly Females
- Insulin resistance has been linked to an increased risk of alopecia in elderly females, with studies showing that women with markers of insulin resistance have a higher risk of female androgenic alopecia (AGA) 4
- Paternal history of alopecia has also been found to be a risk factor for female AGA, with one study showing that women with a paternal history of alopecia had a significantly increased risk of developing AGA 4
Treatment Options for Alopecia in Elderly Females
- Finasteride has been used as a treatment for hair loss in women, including those with female pattern hair loss and hirsutism, with some studies showing improvement in hair loss 5
- However, more research is needed to fully assess the efficacy and safety of finasteride in elderly females, particularly in terms of long-term use and potential consequences 5