What is the recommended dosage and application instructions for MINOXIDIL (Minoxidil) 5% solution for a patient with androgenetic alopecia?

How to Write a Prescription for Minoxidil 5%

Prescribe minoxidil 5% topical solution with instructions to apply 1 mL directly to the affected scalp area twice daily (morning and evening), with each bottle lasting approximately one month when used as directed. 1

Prescription Details

Dosing Instructions

• Apply exactly 1 mL twice daily (morning and night) directly onto the scalp in the hair loss area using the dropper applicator 1
• The nighttime application should occur 2-4 hours before bedtime to allow adequate drying time 1
• Each 60 mL bottle should last approximately one month when used as directed 1
• Do not exceed twice-daily application - more frequent use does not improve results and may increase side effects 1

Application Technique

• Part the hair in the area of thinning/loss 1
• Use the dropper applicator: squeeze the bulb, insert into bottle, release to fill to the 1 mL line 1
• Place the dropper tip near the scalp and gradually release the solution, applying small amounts at a time to prevent runoff 1
• If applying with fingers, wash hands immediately with soap and water 1
• Allow the solution to remain on the scalp for at least 4 hours before washing 1

Critical Patient Counseling Points

Contraindications and Precautions

• Do not prescribe for women - the 5% formulation is FDA-approved for men only 1
• Contraindicated if the patient has cardiovascular disease without proper screening 2
• Do not use if scalp is red, inflamed, infected, irritated, or painful 1
• Not indicated for frontal baldness or receding hairline 1
• Flammable product - keep away from fire or flame 1

Expected Timeline and Outcomes

• Results may be seen as early as 2 months, but some patients require at least 4 months of twice-daily use before seeing results 1
• Initial increased shedding for up to 2 weeks is normal and indicates the medication is working by shedding old hairs to make room for new growth 1
• The American Academy of Dermatology emphasizes that treatment must be continued indefinitely to maintain results - discontinuation leads to reversal of hair growth benefits within 3-4 months 3, 1

Common Side Effects to Monitor

• Most common: itching and scalp irritation (if persistent, discontinue and refer back) 1
• The solution contains alcohol which may cause burning if it contacts eyes - rinse immediately with cool tap water if this occurs 1
• Unwanted facial hair growth can occur but is rare and reversible with discontinuation 1

When to Stop and Seek Medical Attention

• Stop immediately if: chest pain, rapid heartbeat, faintness, dizziness, sudden unexplained weight gain, hand/foot swelling, persistent scalp irritation, or unwanted facial hair growth occurs 1
• Discontinue if no hair regrowth is seen after 4 months of consistent use 1

Lifestyle and Styling Considerations

Hair Care Compatibility

• Use mild shampoo if washing scalp before application 1
• Hair sprays, gels, mousses, and styling products may be used after minoxidil has soaked into the scalp 1
• Hair coloring, perming, and relaxers are permitted but require precautions: ensure minoxidil is completely washed off before chemical treatment, do not apply minoxidil on the same day as chemical treatment, and wait 24 hours after chemicals before resuming minoxidil 1

Missed Doses

• If one or two doses are missed, simply continue with the next scheduled dose - do not double up or make up for missed applications 1

Enhanced Treatment Options

Combination Therapy for Suboptimal Response

• If response to minoxidil monotherapy is inadequate after 6 months, consider adding platelet-rich plasma (PRP) therapy, which shows superior efficacy compared to minoxidil alone 3, 4
• The American Academy of Periodontology recommends combining topical minoxidil 5% twice daily with PRP injections monthly for at least 3 sessions, then maintenance every 6 months 3
• Combination therapy achieves 57% median increase in terminal hair density versus 48% with minoxidil alone at 32 weeks 3

Sample Prescription Format

Rx: Minoxidil 5% Topical Solution

• Dispense: 60 mL bottle (one month supply)
• Sig: Apply 1 mL to affected scalp area twice daily (morning and evening)
• Refills: 11 (for one year of treatment)
• Patient counseling: Must continue indefinitely for maintained results; allow 2-4 hours drying time before bed; flammable - keep away from flames