Low dose Oral Minoxidil for hair loss in men and women

What is oral minoxidil?

Oral minoxidil is an FDA approved treatment for high blood pressure. Typical dosing of Minoxidil for high blood pressure is between 10 and 40 mg a day. It was discovered fortuitously that approximately 80% of patients taking oral minoxidil developed hair growth as a side effect. Therefore, the topical version of minoxidil (Rogaine ™) was subsequently FDA approved for use in male and female pattern hair loss.

What is low dose oral minoxidil (herein known as “LDOM”)?

LDOM is a much lower dose than traditional Minoxidil. It is prescribed anywhere between 0.25 mg a day to as high as 5 mg a day (which is well below what is typically used for high blood pressure). Over the past several years, it has been studied as a novel treatment for various forms of hair loss, most commonly male and female pattern hair loss. Several studies have demonstrated excellent response to LDOM in those people who either cannot tolerate or have no response to topical minoxidil. It has also been shown to improve hair density in some people with chronic shedding (telogen effluvium).  Currently, LDOM is not FDA approved, but it does appear to be safe in those under 55 years old.

What are the side effects of low dose oral minoxidil?

The most frequent side effect is excessive hair growth (usually fine peach fuzz hair but occasionally coarse hair) occurs in 15% of patients. However less than 1% of people discontinue LDOM because of this side effect. Most were able to deal with the excessive hair growth either through shaving, waxing, or laser.

Lightheadedness (2%), increased heart rate (1%) with no meaningful drop in blood pressure.

Fluid retention with swelling of the ankles (1.3%). -Reduction in sodium intake is helpful in minimizing this side effect. Swelling around the eyes is very rare occurring in 0.3% of patients). This side effect can take several months to develop.

 There may be some transient hair shedding for the first six weeks which will spontaneously resolve.

All side effects are reversible upon discontinuation.

Who should not take oral minoxidil?

Anyone with the following medical condition should likely avoid LDOM:

  • kidney disease
  • heart disease
  • high blood pressure (unless cleared by PCP)
  • Autoimmune disease such as lupus

 

How should I take oral minoxidil?

Tablets come only as 2.5 mg strength so you will need to purchase a pill cutter.

Females: ¼ tablet (0.625 mg) for three months, and if no side effects, increase to ½ tablet (1.25 mg) daily for six additional months. If no side effects, but no improvement, increase to one full tablet of 2.5 mg daily.

Males: ½ tablet (1.25 mg) for three months, and if no side effects, increase to 2.5mg a day for six additional months. If no side effects, but no improvement, increase to 5 mg daily.

Do I need any monitoring while I’m on LDOM?

Yes, we recommend baseline blood pressure and pulse as well as repeat measurements after increasing dosing.