What is the use of oral minoxidil (Minoxidil)?

From the Guidelines

Oral minoxidil should be prescribed with caution for androgenetic alopecia due to potential adverse effects, and patients should be closely monitored, especially those with cardiovascular conditions. When considering oral minoxidil for hair loss, it's essential to weigh the benefits against the risks, as the medication can cause significant side effects. The typical dosing for hair loss ranges from 0.25mg to 5mg daily, with lower doses often preferred to minimize adverse effects 1. Common side effects include fluid retention, increased heart rate, unwanted hair growth, headaches, and dizziness.

Key Considerations

• Blood pressure monitoring is crucial when starting treatment, as oral minoxidil can cause hypotension.
• Patients with cardiovascular conditions should use this medication with caution and only under close medical supervision.
• The medication generally takes 3-6 months to show noticeable hair growth results, and the effects will reverse if the medication is discontinued.
• Unlike topical minoxidil, the oral form affects the entire body, explaining both its increased effectiveness for hair growth and its broader range of potential side effects.

Adverse Effects

• A study evaluating the adverse effects of low-dose oral minoxidil in 435 patients found that tolerability and adverse effects are still a concern, highlighting the need for careful patient selection and monitoring 1.
• The study correlated adverse effects with dose, weight, sex, and skin color, providing valuable insights for clinicians prescribing oral minoxidil.

Clinical Implications

• Clinicians should carefully evaluate the risks and benefits of oral minoxidil for each patient, considering factors such as medical history, current medications, and potential side effects.
• Close monitoring and regular follow-up appointments are essential to minimize adverse effects and ensure the safe use of oral minoxidil for androgenetic alopecia.

From the Research

Oral Minoxidil Efficacy

• Oral minoxidil has been shown to be effective in treating various types of alopecia, including androgenetic alopecia, alopecia areata, female pattern hair loss, and chronic telogen effluvium 2, 3, 4.
• The strongest evidence for oral minoxidil exists for androgenetic alopecia and alopecia areata, with 61-100% and 18-82.4% of patients demonstrating objective clinical improvement, respectively 2.
• Oral minoxidil has also been found to be effective in treating other conditions, such as monilethrix, loose anagen hair syndrome, and permanent chemotherapy-induced alopecia 2, 4.

Oral Minoxidil Safety

• The most common adverse effects of oral minoxidil include hypertrichosis and postural hypotension 2, 5.
• Systemic adverse effects, such as lightheadedness, fluid retention, tachycardia, headache, periorbital edema, and insomnia, are infrequent and rarely lead to treatment discontinuation 5.
• A multicenter study of 1404 patients found that oral minoxidil has a good safety profile, with no life-threatening adverse effects observed 5.

Comparison to Topical Minoxidil

• Oral minoxidil may have practical advantages over topical minoxidil, including improved patient compliance 2.
• A study found that oral minoxidil 5 mg/day was significantly more effective than topical 5% and 2% minoxidil in male androgenetic alopecia 3.
• However, topical minoxidil is FDA-approved for androgenetic alopecia, while oral minoxidil is not 3, 6.