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Low-Dose Oral Minoxidil, a New (Old) Solution for Hair Loss?

Updated: May 26, 2022


Could minoxidil pills be an easy solution for hair loss?

And most importantly, is this revolutionary treatment safe? Let 's find out!


Minoxidil is a drug that had its oral use approved in the United States in 1979 for the treatment of severe hypertension, with oral dose ranging from 10-40mg. During the clinical trials for the approval of the drug it was noticed that the patients presented hypertrichosis, which is the excessive hair growth on different parts of the body, as a side effect.

Although the precise mechanism through which minoxidil promotes hair growth is not completely clear, studies have shown that minoxidil can shorten the “resting” phase of the hair follicles, called telogen phase, and can also induce the transition to the “growing” phase, the anagen phase, making the hair increase in length and diameter.

Hair follicle’s change during treatment.

In 1987, a solution containing minoxidil for topical application on the scalp was developed for the treatment of hair loss in men and women. Solutions containing minoxidil have been widely used since then for the treatment of different diseases that result in hair loss. Despite its efficacy as a drug, the topical treatment with minoxidil has its disadvantages. Many patients end up stopping the use of the product due to the undesired hair texture, high cost and possible scalp irritation that comes from the alcohol-based solution and its components.

Recently, many dermatologists have been evaluating the use of off-label low-dose oral minoxidil to stimulate hair growth in their patients in different countries of the world. Ranging from 0,25-2,5mg for women and from 1,25-5mg for men, the low-dose oral treatment has been showing good efficacy. Published studies have demonstrated impressive effect on the treatment of diseases like androgenetic alopecia, alopecia areata, chronic telogen effluvium, monilethrix, permanent chemotherapy-induced hair loss, among others.

Hair loss affects the patient not only physically, but also emotionally.


One of the biggest advantages of the oral treatment, in comparison to the topical one, is the higher adherence achieved by the patients. We must keep in mind that a treatment is only effective if the patient utilizes the medicine correctly, be it a solution or a pill. Now ask yourself, what do you prefer: to apply twice a day on your scalp a solution that is going to leave your hair with a very unpleasant feel or do you prefer to take a very small pill once a day? Also, the oral treatment presents a better cost benefit when compared to the topic one.


As a drug for hypertension treatment, the safety of the oral use of minoxidil, even in lower doses, must be evaluated. The adverse events most frequently reported by the clinical studies are lightheadedness, hypertrichosis, tachycardia, and fluid retention, in most cases not severe enough for patients to suspend treatment. Contraindications are limited, including allergy to the drug, severe kidney or liver failure or women planning to get pregnant.

Even though minoxidil is a potent antihypertensive drug with possible severe side effects, due to the lower doses used for hair growth treatment, this new oral approach seems to be safe and effective, when well supervised by a dermatologist. Beyond that, it represents an important alternative for patients that suffer from diseases that not only cause external damage, but mostly harm their self-esteem and quality of life.


If you got interested in the subject, feel free to contact me!


Artur Stramari de Vargas

Pharmacist - Master student - EMOTION

My email: 20042850@studenti.uniupo.it


References

[1] Villani A, Fabbrocini G, Ocampo-Candiani J, Ruggiero A, Ocampo-Garza SS. Review of oral minoxidil as treatment of hair disorders: in search of the perfect dose. J Eur Acad Dermatol Venereol. 2021;35(7):1485-1492. DOI: 10.1111/jdv.17216

[2] Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2021;84(3):737-746. DOI: 10.1016/j.jaad.2020.06.1009

[3] Sharma AN, Michelle L, Juhasz M, Muller Ramos P, Atanaskova Mesinkovska N. Low-dose oral minoxidil as treatment for non-scarring alopecia: a systematic review. Int J Dermatol. 2020;59(8):1013-1019. DOI: 10.1111/ijd.14933

[4] Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, et al. Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients. J Am Acad Dermatol. 2021;84(6):1644-1651. https://doi.org/10.1016/j.jaad.2021.02.054

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