Oral Minoxidil 2.5 mg pills (90 count)

Oral minoxidil is becoming more and more popular as an alternative to topical minoxidil as research has identified a treatment range that maximizes the benefits and minimizes the side effects of minoxidil.  Oral minoxidil was initially developed as a medication to treat hypertension but side effects limited its widespread use.  However, the doses used to treat hypertension are usually in the range of 10 to 40 mg per day.  LDOM for hair loss is prescribed at 0.25 to 5 mg per day achieving excellent rates of hair regrowth with a much lower side effect profile.

A very large review of 10 studies compromising 19,218 patients (215 women and 19,003 men) who were prescribed LDOM in doses from 0.25 to 5 mg once or twice daily found 61-100% of androgenetic alopecia patients and 18-82.4% of alopecia areata patients demonstrated objective clinical improvement. (Sharma AN, Michelle L, et al. Low dose oral minoxidil as treatment for non-scarring alopecia: a systematic review. Int J Dermatol 2020 Aug; 59(8):1013-19).  Their findings were consistent with many other studies including a September 2020 study by Beach et al finding 1.25 mg daily for 3 months increased scalp hair in 65% of patients (Beach RA, McDonald KA et al. Tolerated, Effective, Successful: Low Dose Oral Minoxidil for Treating Alopecia, A 3 Year North American Retrospective Case Series. J Am Acad Dermatol 2020 Oct 21: S0190-9622.

Side effects are typically dose dependent and most commonly are tachycardia (fast heart rate), hypertrichosis (increased hair growth – but not exactly where you are wanting it), and pedal edema (foot swelling).  At the low doses prescribed for hair loss, the drug actually has a minimal hypotensive effect although postural hypotension can be seen (low blood pressure when going from sitting or lying to standing).   The most concerning side effect related to high dose oral minoxidil is the potential for a cardiac effusion resulting in cardiac tamponade.  LDOM dosing is such that cardiac tamponade has not been seen in studies evaluating LDOM for hair loss.  Nevertheless it is important to keep this possible side effect in mind and persistent changes in blood pressure or heart rate should be reported immediately.

A combined analysis of 14 different studies showed that hypertrichosis was seen in 24% of patients usually appearing in the first 3 months and primarily affecting sideburns and temples.  Pedal edema occurred in 2% of patients.  Tachycardia was seen in 1.3%.  And postural hypotension was seen in 1.1%.  (Randolph M, Tosti A.  Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2020 Jul Epub ahead of print.)

Requires physician consultation.