From the Guidelines
Minoxidil is indicated for the treatment of resistant hypertension.
Key Points
- Minoxidil is a potent vasodilator that can be effective in lowering blood pressure in patients with resistant hypertension 1.
- It is typically considered a fourth-line or later addition to the treatment regimen due to its potential for adverse effects, such as fluid retention and tachycardia 1.
- The use of minoxidil is often reserved for patients who have not responded to other treatments, including combination therapy with other antihypertensive agents 1.
- When used, minoxidil is often combined with other medications, such as beta-blockers and diuretics, to mitigate its adverse effects 1.
Evidence Summary
The 2024 ESC guidelines for the management of elevated blood pressure and hypertension recommend minoxidil as a last-line treatment option for resistant hypertension 1. The 2018 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults also supports the use of minoxidil in patients with resistant hypertension 1. The ASH/ISH guidelines suggest that minoxidil should only be considered as a fourth-line or later addition to the treatment regimen due to its potential for adverse effects 1. Overall, the evidence suggests that minoxidil is a potent antihypertensive agent that can be effective in lowering blood pressure in patients with resistant hypertension, but its use should be carefully considered due to its potential for adverse effects.
From the Research
Indications for Oral Minoxidil
The indications for oral minoxidil are varied and include:
- Androgenetic alopecia: Oral minoxidil has been shown to be effective in treating androgenetic alopecia, with studies demonstrating significant increases in hair counts and hair diameter measurements 2, 3
- Alopecia areata: Oral minoxidil has been used to treat alopecia areata, with some studies showing promising results, although the response rate may be lower than for androgenetic alopecia 2, 4
- Female pattern hair loss: Oral minoxidil has been used to treat female pattern hair loss, with studies showing significant improvements in hair growth and density 2, 5
- Chronic telogen effluvium: Oral minoxidil has been used to treat chronic telogen effluvium, with some studies showing promising results 2
- Monilethrix: Oral minoxidil has been used to treat monilethrix, a rare genetic disorder characterized by brittle hair, with some studies showing significant improvements in hair growth and strength 2
- Permanent chemotherapy-induced alopecia: Oral minoxidil has been used to treat permanent chemotherapy-induced alopecia, with some studies showing promising results 2
Dosage and Administration
The dosage of oral minoxidil used in these studies varied, but typical doses ranged from 0.25 to 5 mg daily, taken once or twice daily 2, 3. The most common side effects of oral minoxidil included hypertrichosis and postural hypotension 2, 3.
Efficacy and Safety
The efficacy and safety of oral minoxidil have been evaluated in several studies, with most showing significant improvements in hair growth and density, and a good safety profile 2, 3, 5. However, oral minoxidil should be used carefully in patients with severe hypertension and increased risk for cardiovascular events 3.