Oral Minoxidil: Therapeutic Guidelines
Minoxidil received FDA approval for the treatment of high blood pressure in 1979. It was quickly discovered that one of the side effects of oral minoxidil was increased hair growth, which led to the development of topical minoxidil formulations for treating hair loss (approved for men in 1988 and for women in 1991). While the primary hair-growth formulation of minoxidil is intended for topical use, subsequent studies have explored the effectiveness of low-dose oral minoxidil for hair loss treatment.
Oral minoxidil 0.25mg-5mg daily has been studied for off-label use to treat male and female pattern hair loss, alopecia areata, chronic telogen effluvium, as well as other non-scarring and scarring alopecias. The goal of oral minoxidil is decreased shedding, increased hair density, increased volume, and reduced hair breakage in 2-5 months.
Dosing:
Women: Start with 1.25mg daily and slowly increase to 2.5mg
Men: Start with 1.25mg daily, can increase by 1.25mg increments to 5mg, allowing 3 months between dose escalations.
*While different hair experts may have varied dosing and tapering regimens with oral minoxidil, these recommendations come from the published data referenced in this blog.
Treatment monitoring:
Baseline: BP, pulse, weight, scalp exam, hair pull test, photos. Lab monitoring is not required but a CMP can be checked intermittently
Follow-up: 6 months - recheck values above. Low threshold for CMP if patient on diuretic or developing edema
Adverse Effects:
Hypertrichosis, light-headed peripheral edema, rapid weight gain, decrease in BP, palpitation, SOB, insomnia
Caution in use in patients with a history of:
Angina, CHF, HTN, prior heart surgery, irregular heart rate/palpitations, syncope, peripheral edema, known EKG abnormality, cardiotoxic medications, or renal disease
Those with significant cardiovascular issues should get approval from their cardiologist or PCP before starting treatment.
References:
Vañó-Galván, S., Pirmez, R., Hermosa-Gelbard, et al. (2021). Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients. JAAD, 84(6), 1644–1651. https://doi.org/10.1016/j.jaad.2021.02.054
Villani, A., Fabbrocini, G., Ocampo-Candiani, J., Ruggiero, A., & Ocampo-Garza, S. S. (2021). Review of oral minoxidil as treatment of hair disorders: in search of the perfect dose. JEADV, 35(7), 1485–1492. https://doi.org/10.1111/jdv.17216
Madeline June MSN, APRN-CNP is a dermatology nurse practitioner at the Cleveland Clinic in Cleveland, Ohio. Madeline sees patients 5 years and older and treats a variety of different dermatological disorders. Madeline grew up on a farm in Michigan and is passionate about skin cancer prevention, especially within the farming community.