From the Guidelines
Minoxidil is contraindicated in patients with pheochromocytoma, known hypersensitivity to minoxidil, unstable coronary artery disease, recent myocardial infarction, severe or uncontrolled hypertension, and pregnant or breastfeeding women.
Key Considerations
- Patients with pheochromocytoma should avoid minoxidil due to the risk of exacerbating catecholamine-related effects 1.
- Those with known hypersensitivity to minoxidil or any component of the formulation should avoid it to prevent allergic reactions.
- For patients with unstable coronary artery disease or recent myocardial infarction, minoxidil is contraindicated as it can increase cardiac workload through reflex tachycardia.
- Severe or uncontrolled hypertension represents another contraindication, as minoxidil's vasodilatory effects may cause unpredictable blood pressure changes in these patients.
- Pregnant or breastfeeding women should avoid minoxidil due to limited safety data and potential risks to the fetus or infant.
- Patients with scalp abnormalities like sunburn, irritation, or open wounds should not apply topical minoxidil until the skin heals, as it may increase systemic absorption and irritation.
Evidence Summary
The evidence from 1 and 1 suggests that minoxidil has various contraindications that need to be considered before use. While 1 discusses the use of minoxidil in alopecia areata, it does not provide information on contraindications. In contrast, 1 provides a comprehensive list of medications, including minoxidil, and their corresponding contraindications.
Clinical Implications
These contraindications exist because minoxidil works as a potassium channel opener causing vasodilation, which can worsen certain cardiovascular conditions and potentially interact with other medical issues in harmful ways. Therefore, it is essential to carefully evaluate patients before prescribing minoxidil to ensure safe and effective use.
From the FDA Drug Label
Who should NOT use minoxidil topical solution 5%? • Women should not use minoxidil topical solution 5% because studies have shown it works no better in women than minoxidil topical solution 2%. Some women may also grow facial hair In addition, minoxidil topical solution 5% may be harmful if used during pregnancy or breast-feeding. • Minoxidil topical solution 5% should not be used on babies or for children under 18 years old
The contraindications for minoxidil topical solution 5% are:
- Women, as it may be harmful during pregnancy or breast-feeding and can cause facial hair growth
- Children under 18 years old
- Individuals who are not sure of the reason for their hair loss 2
From the Research
Minoxidil Contraindications
- Minoxidil is contraindicated in patients with pheochromocytoma and paraganglioma, as it may exacerbate cardiovascular complications associated with these conditions 3.
- Patients with severe hypertension should be treated with caution, as minoxidil can cause tachycardia and fluid retention, which may worsen hypertension 4, 5.
- Minoxidil is not recommended for patients with left ventricular hypertrophy, as it can aggravate this condition 4.
- Patients with a history of pericardial effusion should be monitored closely, as minoxidil has been associated with this condition 4.
- Minoxidil should be used with caution in patients with arrhythmia, as it can cause tachycardia and other cardiac side effects 6.
- Patients taking multiple antihypertensive drugs or doxazosin should be monitored closely, as they may be at higher risk of discontinuing minoxidil due to side effects 6.