Oral Minoxidil

Oral Minoxidil for Hair Loss

Minoxidil is a successful hair treatment as an oral medication – even though most will be more familiar with it as a scalp foam or tonic. There are certain circumstances in which Minoxidil can be taken orally as a tablet, and increasingly this is being recognized as an effective and convenient way of treating hair concerns.

Topical Minoxidil is minoxidil applied on the skin. Oral minoxidil is minoxidil in tablet form that is taken by mouth.

When is oral Minoxidil given for hair loss?

Oral Minoxidil can be considered for hair loss if:

Topical Minoxidil preparations cause a rash, irritation, or allergy
There is a lack of benefit from topical Minoxidil after 6 months of diligent use
Topical Minoxidil causes poor hair texture
Other difficulties using topical Minoxidil cause compliance problems

Hair loss conditions that may improve with Minoxidil

Oral Minoxidil is mainly used for male and female pattern hair loss. However, it can benefit other types of hair loss, including telogen effluvium, traction alopecia, and loose anagen syndrome.

Why would oral Minoxidil work when topical Minoxidil has not worked?

Some people may not respond to topical Minoxidil as they lack the correct enzyme in their hair follicles to activate the medication from Minoxidil to Minoxidil Sulphate. The enzyme that activates Minoxidil (sulfotransferase) is present in the liver and will activate oral medication.

How effective is oral Minoxidil?

The studies are small but indicate that about one-third of patients will notice a reduction in shedding, and a third will notice improved growth in 6 months or more. Up to 2 in 3 people may notice benefits from oral Minoxidil. It is best to take treatment for 6 to 12 months to give it enough time to work.

What are the side effects?

Side effects are uncommon at the low doses used to treat hair loss. The largest study looking at side effects (Vañó-Galván et al. 2021) showed that 0.5% of men had to stop treatment because of a side effect.

Excessive hair (Hypertrichosis): The most common side effect is hypertrichosis for both men and women- excess hair growth elsewhere on the face and body. Excess growth is more likely to occur at higher doses. 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. Hypertrichosis may affect 10-25% of those on low doses (<4mg) and up to 50% of those on higher doses (> 5mg). Vañó-Galván et al showed that 20% of women and 6% of men experienced hypertrichosis. Of those that experience this side effect, only 5% of women and 0% of men find it necessary to stop treatment.
Temporary shedding: CTemporary shedding is very common at the onset of starting oral or topical Minoxidil. This side effect occurs within the first 6 weeks and can be of significant concern. However, it is important to continue with the medication as this will stop after 4 weeks. Swelling of the lower legs can occur in up to 3% people. This is usually at higher doses. Fluid retention can also sometimes show up around the eyes as puffy eyes, which are worse in the morning. Vañó-Galván et al showed that 1.3% get ankle swelling (25% of these individuals stop treatment), and 0.3% experience swelling around the eyes (0% need to stop treatment for this).
Low blood pressure and lightheadedness:Minoxidil is also used to control high blood pressure, usually at doses of 10-40mg per day – much higher than the doses used for hair loss. However, even lower doses can sometimes cause a reduction in blood pressure. 2% of people may get postural hypotension with low doses of Minoxidil. 8% may have general symptoms of lightheadedness. This leads to dizziness when getting up quickly. 1.7% of those on low-dose Minoxidil experience lightheadedness, and of these, only 11% need to stop treatment.
Fast heart rate:Minoxidil can also cause a fast heart rate, but this is usually at higher doses. You should alert your doctor if you are taking other medications, such as asthma inhalers which can also increase the heart rate. 0.9% of those on low-dose oral minoxidil appear to experience this side effect, and 33% of these individuals need to stop treatment.
Headaches: Headaches may occur in as many as 9% of people, but again, this seems to get better with time. 0.4% experience this side effect, and of these 44% need to stop treatment.
Uncommon side effects include – nightmares, insomnia, pericarditis, skin rashes, nausea, vomiting, and breast tenderness.

It is important to report side effects to your doctor. However, if there is a rapid increase in pulse rate, palpitations, feeling dizzy, shortness of breath, chest pain and fainting, then you are advised to go to contact your doctor.

Changes in lifestyle when taking oral Minoxidil

It is helpful to cut down on alcohol as alcohol can also reduce blood pressure. It is also helpful to cut down on caffeine as caffeine can cause the heart to race and cause palpitations.

Minoxidil is available in 2.5mg, 5mg and 10mg tablets. A common starting dose is 1.25mg per day for men. You should get a tablet cutter from your pharmacy and cut a 2.5mg tablet into quarters or halves to get this dose.

The optimum dose for hair loss is not entirely clear. It may be in the region of 0.625mg to 2.5 mg daily. For men, a slightly higher dose may sometimes be required. You may be asked to take the medication daily or every other day.

Doses of minoxidil for hair loss are considered ‘low dose’. This is because the doses used for hair loss are a lot lower than the doses which are used for conditions such as hypertension. The doses used for hypertension are 10-40mg per day.

Collection: Hair Loss

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