MINOXIDIL FOR HAIR LOSS

Minoxidil was FDA-approved in 1979 for the treatment of high blood pressure. Since then, it was found to grow hair in many patients, presumably by dilating blood vessels and causing more blood to be delivered to the hair root. Topical minoxidil was FDA-approved for the treatment of male pattern baldness in 1988 and for female patterned hair loss in 1991. The use of oral minoxidil to treat hair loss is off-label (not FDA-approved). Topical minoxidil is over the counter. The pill is by prescription only.

What are the chances that Minoxidil will help with Hair Loss?

It is hard to say exactly but one study of oral minoxidil found that after 6 months of use, 1/3 of patients saw some regrowth, 1/3 experienced less shedding and 1/3 saw not much benefit. Another important point is that any beneficial effects will be lost if the minoxidil is stopped. It is best to consider Minoxidil a long-term or lifelong treatment.

Topical Minoxidil

Topical minoxidil (usually 5% concentration) has been around a long time as a treatment for hair loss. It comes in both a liquid and a foam and is applied to the scalp twice a day. The liquid comes in a bottle with a dropper or as a spray. The spray is more convenient for larger areas, whereas the dropper allows for more precision application to smaller areas. Concentrations vary but the 5% is the most common. Many love the liquid, saying it is cheaper, gets more directly to the scalp, is easier to put in a small bottle for travel, and that the foam too easily gets stuck on the hair. Others love the foam, saying it doesn't make the hair as greasy as the liquid and is less irritating.

Which is more effective? There is some evidence that the foam has a slight edge over the solution, but efficacy rates are very close.

Whichever you use, be careful with dogs and cats. Minoxidil can be highly toxic to pets.

Oral Minoxidil

The off-label use of low-dose oral minoxidil to treat hair loss has exploded over the last few years. It is well-tolerated and only about 2% of patients discontinue treatment due to side effects.

Some choose the pill for convenience or because they can't tolerate topical minoxidil. Others have used the topical without benefit and so switch to the oral, hoping for a better outcome--which does occur in some of patients.

What are some of the side effects of Oral Minoxidil?

• Excessive Hair Elsewhere (15%). The most common side effect is excess hair growth elsewhere on the face or body. While this side effect is bothersome, it can usually be managed with hair removal methods and is not a common reason for someone to stop.
• Temporary Shedding (32%). Oral minoxidil can commonly cause temporary hair shedding, often referred to as a "dread shed", when first starting treatment, which is considered a normal side effect and usually subsides within a few weeks as the medication starts to work on hair growth; this shedding may actually be a good sign as it is usually followed by thicker, fuller hair growth. Temporary shedding has been reported to occur in 32% of patient using oral minoxidil and 18% of those using topical minoxidil.
• Ankle swelling and fluid retention (3%) Swelling of the lower legs can occur in up to 3% people. Rarely, there can be puffiness around the eyes.
• Lightheadedness (2%) Minoxidil at doses of 10-40 mg per day is used to control high blood pressure. This is much higher than the usual 2.5-5 mg/day used for hair loss. However, even lower doses can sometimes cause a reduction in blood pressure. Rarely, this can cause lightheadedness or dizziness when getting up quickly.
• Fast heart rate (1%). Tachycardia (fast heart rate) may occur. The peak is 1 hour after dosing, so check then. Some use their Apple watch to monitor.
  
• Headaches (1%) Headaches may occasionally occur with oral minoxidil but this seems to get better with time.
• Uncommon side effects Nightmares, insomnia, pericarditis, skin rashes, nausea, vomiting, and breast tenderness.

It is important to report these or any other side effects to your doctor

Before going on oral minoxidil, tell your doctor if you have any history of

• Heart problems (e.g. recent heart attack or heart failure) , high blood pressure, low blood pressure, arrythmias (abnormal heart rhythms), angina (chest pain).
• Pheochromocytoma
• Pulmonary hypertension with mitral stenosis
• Severe liver disease

Dosing for Oral Minoxidil for Hair Loss

For men, the starting dose is usually 2.5 mg/day followed by 1.25 mg increments every 3 months depending on response and tolerability up to a maximum dose of 5 mg once per day.

For women, the starting dose is ususally 0.625 mg/day (1/4 of a 2.5 mg tablet) followed by increments every 3 months depending on response and tolerability up to a maximum dose of 2.5 mg once per day.

Oral minoxidil is available in 2.5 mg, 5 mg and 10 mg tablets.