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Common mistakes in prescribing oral Minoxidil for women’s hair loss 

Common mistakes in prescribing oral Minoxidil for women’s hair loss 

Common mistakes in prescribing oral Minoxidil for women’s hair loss 

When it comes to hair loss treatment, what is considered new is also popular. This may not be the absolute truth, but it is always what happens, especially for oral minoxidil. Many physicians are increasingly prescribing this drug to their patients. oral minoxidil was commonly used in the early 70s and 80s.

It was mainly used to treat high blood pressure with dosses ranging from 20-60 mg. A huge percentage of patients using the drug to treat their high blood pressure conditions reported that hair grew on their bodies and head. This is what led to research and later development of another form of minoxidil for treating hair loss problems.

The use of oral minoxidil has generally increased over the past few years. However, its use is entirely ‘off label’ since it hasn’t been approved by FDA for hair loss treatment. Many patients who have used the drug have reported significant changes. Nonetheless, the treatment comes with side effects, particularly if certain rules are not adhered to.

Just like any other medicine, failure to follow the dosage requirements will lead to negative side effects. This is the same case with oral minoxidil. Below are 5 common mistakes in prescribing oral minoxidil for women’s hair loss:

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1. Starting the patients on a too high dose of oral minoxidil

It has emerged that many patients are always started out with excessive doses of oral minoxidil. While there are no specific dosage rules as such (because the treatment is off-label), many women are started at a dose of about 2.5 mg. Most women can tolerate up to 1.25 mg without having any issues but not all. As soon as you exceed 1.25 mg, that’s where the chances of having negative side effects increase. One common and noticeable side effect is the increase in oily hair and scalp.

A study conducted in 2020 revealed critical information with regards to the type of side effects to expect when a female patient uses more than one mg of oral minoxidil to treat hair loss. The study showed that 4 percent of those how used more than 1 mg of oral minoxidil experienced fit swelling while another 27 percent developed excessive hair.

In other words, the use of doses of more than 1.25 mg can increase the chances of patients developing negative side effects. That’s when you may start to experience fluid retention as well as dizziness. As such, it is advisable to start at lower dosages of about 0.625 within the first two weeks and increase to 1.25.

2. Increasing the oral minoxidil dosage too quickly

It is important to understand that there are no specific guidelines with regards to the dosage of oral minoxidil. If you are young and healthy with a normal baseline blood pressure, then you can start from ¼ of a 2.5 mg pill and later increase to up to ½ a pill. There’s no problem increasing your dosage after at least two weeks.

However, most patients tend to increase the dosage too quickly than expected without paying attention to the consequences. Before increasing your dosage, you should understand when and how side effects happen. Is it after a few hours or after several weeks? Well, studies show that various side effects show up at different times.

For example, issues with the heart rate occur in a matter of hours or days (if they will ever occur). Slight headaches happen between 5-10 days while dizziness can be experienced within the first month.

This is why you should not rush to increase the dosage after a few days or weeks. Try to monitor how your body reacts to the treatment before you decide to go to an extra level of the drug.

3. Underestimating the probability of side effects from oral minoxidil

It is a fact that oral minoxidil has helped many women with their hair loss problems. It is always the wish of every physician that the treatment works with little or no side effects. But the excitement and expectations from oral minoxidil are at times not realistic.

It is important for both patients and physicians to appreciate the side effects that come with the use of oral minoxidil. Evidence has shown that even minimal dosages of oral minoxidil have side effects. If you have used the drug and never experienced any side effects, then chances are you are not prescribing enough of it.

Although there is not enough evidence with regards to all the side effects, the reality is that all oral minoxidil prescriptions have some form of side effects. It is always good to have an open mind when going for treatment and be ready for anything. The side effects may be mild or severe depending on your current health standing. As such, you should work closely with a physician during the entire treatment period.

4. Stopping the oral minoxidil too soon

Oral minoxidil is a type of treatment that respects the rules of hair growth. It normally takes between 4 to 6 weeks for you to experience results. It doesn’t matter how long it may take, the truth of the matter is that you will see some results in one way or the other.

The problem is that some patients become get impatient too soon. They expect to see results a few days or weeks after taking the drug and when that doesn’t happen, they conclude that oral minoxidil doesn’t work. According to physicians and other drug experts, it takes approximately four or six months to determine whether oral minoxidil works or not.

5. Decreasing the dose of oral minoxidil instead of increasing it

This is another common mistake that women make when using oral minoxidil to treat hair loss. Most of them start with high dosages and as soon as they start experiencing results, they reduce the dose. This is not recommended as it can render the drug ineffective.

If you are going to use oral minoxidil to treat androgenic hair loss, then you should have a proper plan. But deciding to reduce the dose after you have experienced some positive results may have a negative effect in the end.

In general, oral minoxidil is increasingly becoming popular drug for the treatment for hair loss. While the drug has shown some positive results, it is important to use it in the right manner. Besides, you should not assume the side effects caused by the treatment. 

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A definitive guide to Oral Minoxidil for Hair Loss by a Dermatologist

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, which Dermatologists increasingly recognize as an effective and convenient way of treating hair concerns.

Topical Minoxidil is Minoxidil that is 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 any benefit from topical Minoxidil after 6 months of diligent use.
  • Topical Minoxidil causes poor hair texture – sometimes topical Minoxidil can cause dry, tangled hair prone to breakage.
  • There are other difficulties using topical Minoxidil – and this causes compliance problems.

Hair loss conditions that may improve with Minoxidil

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

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

Some people may respond to something other than 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 is called sulfotransferase). This enzyme is present in the liver and will activate the oral medication even when it is.

How effective is oral Minoxidil?

The microscopic studies 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. It means up to 2 in 3 people may notice benefits from oral Minoxidil. Treating for 6 to 12 months is best to give it enough time to work.

The only head-to-head study comparing oral Minoxidil to topical Minoxidil in women with Female Pattern Hair Loss showed that 1mg of Minoxidil gave comparable effects to a 5% solution (1ml) once a day (Ramos et al., 2020). In this study, 26 women received oral Minoxidil, and 26 received topical Minoxidil. After 24 weeks of treatment, there was a 12% increase in hair density for women on oral Minoxidil and a 7.2% increase for women applying topical Minoxidil. The difference was insignificant, but the oral minoxidil group also had less hair shedding.

What are the side effects?

Side effects are uncommon at the low doses used to treat hair loss. The most extensive study looking at side effects (Vañó-Galván et al., 2021) showed that in 943 women and 461 men, 2.5% of women and 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. Temporary shedding is widespread 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 essential to continue the medication as it will stop after 4 weeks.
  • Ankle swelling and fluid retention. Swelling of the lower legs can occur in up to 3% of people. It 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 feeling lightheaded. Minoxidil is also used to control high blood pressure, usually at doses of 10-40mg daily – 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. It leads to dizziness when getting up quickly. 1.7% of those on low-dose Minoxidil experience lightheadedness; 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% need to stop treatment.
  • Headaches. Headaches may occur in as many as 9% of people, but again, this improves with time: 0.4% experience this side effect, and 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, suppose there is a rapid increase in pulse rate, palpitations, dizziness, shortness of breath, chest pain and fainting. In that case, you are advised to go to the A&E department or call the emergency services.

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 reduce caffeine as caffeine can cause the heart to race and cause palpitations.

Doses of oral Minoxidil

Minoxidil is available in 2.5mg, 5mg and 10mg tablets. We use the Loniten brand (Pfizer Ltd). A standard starting dose is 0.625mg daily for women and 1.25mg for men. It would help if you got 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’. It is because the doses used for hair loss are much lower than those used for conditions such as hypertension. The doses used for hypertension are 10-40mg per day.

Brand of oral Minoxidil – Loniten

We prescribe Loniten-branded Minoxidil tablets. Pfizer manufactures these.

Please note that we do not dispense medications, and the provision of this medication is subject to local and national availability – which we do not have any control over.

When Minoxidil should be avoided

There are certain instances when it is not safe to have oral Minoxidil. These are listed below, and you should ensure your doctor is aware of any underlying health conditions you may have.

Minoxidil should be avoided if you have the following:

  • drug allergy – NB it appears that oral Minoxidil is safe if you have reacted to topical Minoxidil even if your patch tests show you react to Minoxidil and not to the preservatives sun propylene glycol (Thearinou et al., 2020)
  • pheochromocytoma
  • pulmonary hypertension with mitral stenosis
  • severe hepatic impairment
  • angina or recent myocardial infarction (heart attack)
  • left ventricular hypertrophy
  • heart failure

Oral Minoxidil for hair loss is an unlicensed medication.

While several medical reports show that oral Minoxidil helps hair loss, and this is also our experience, the quality of evidence compared to topical Minoxidil or other hair loss medications could be better. Controlled clinical studies on oral Minoxidil still need to be included. No matter how significant it is, low-quality evidence means that such medications are not included in national guidelines. Oral Minoxidil is such a medication.

Until more significant, statistically sophisticated studies are conducted, oral Minoxidil for hair loss will remain unlicensed in the UK. It means that you can only receive a prescription from a doctor who has experience using this medication and has assessed you to deem the benefits outweigh the risks. You must also take the time to read the information on unlicensed medications (such as this fact sheet) and agree that you feel the benefits outweigh the risks.

Many medications are used outside a license in the UK, especially in Dermatological practice. While we have many patients on oral Minoxidil, your Dermatologist may only suggest this treatment to you if they believe your situation fulfils the criteria for them to provide you with an unlicensed medication.

For those patients receiving oral Minoxidil, all monitoring tests, prescribing and follow-up consultations will need to occur at the Clinic, as NHS GPs are not obligated to continue prescribing or monitoring unlicensed medications. It means that if you elect to go on oral Minoxidil, you cannot continue this under the care of your GP.

How do I prepare to start oral Minoxidil?

Please advise your doctor of all the medications you are on. Oral Minoxidil should be used cautiously if you are on other medications that reduce blood pressure.

We recommend that you obtain an at-home blood pressure monitor. You should have blood pressure and heart rate reading before you start and send this in. We recommend you check your blood pressure and heart rate once a week and keep a chart that you should bring with you to your appointments.

Does Minoxidil cure hair loss for good?

It is essential to consider Minoxidil, both topical and oral, as a treatment to slow down the progression of hair loss. Hair loss will still proceed while taking Minoxidil. However, it will be at a slower pace. The effects of Minoxidil are only active if the medication is continued. The effects are lost if medication is stopped. It is best to consider Minoxidil a long-term or lifelong treatment.

Patient Information Leaflet

We recommend that you also read the patient information leaflet produced by the manufacturers, which will accompany the medication found here.

Combining oral Minoxidil with Finasteride

Your doctor may direct you to combine Minoxidil with Finasteride. You can read more about finasteride here.

Hair consultation and prescription of Minoxidil

Oral Minoxidil is prescribed after a face-to-face assessment by a specialist dermatologist at an initial hair loss consultation.

You can make an enquire for a hair consultation appointment here.

Medications are only prescribed during a consultation once your doctor knows your health and condition well. A particular medication is only prescribed if it suits a person’s current situation.

We ask that you do not assume that a particular medication will be prescribed at a consultation, as this will be down to the medical assessment made by your doctor. Further, we do not necessarily continue prescriptions for medications you may have been prescribed elsewhere, including from overseas or online providers, as the same criteria for prescribing are applied.

Follow up consultations

You will be asked to attend for follow-up every 3 months and then every 6 months once you have been established on a stable dose. Individual recommendations may vary, and you may be asked to attend for follow-up consultation sooner.

Common mistakes in prescribing oral Minoxidil for women’s hair loss 

For potentially better treatment, some dermatologists are prescribing minoxidil orally to address hair loss. Although the U.S. Food and Drug Administration (FDA) has not approved these pills for hair loss, doctors are free to prescribe oral minoxidil for this off-label use.

How do you start oral minoxidil?

A standard starting dose is 0.625mg daily for women and 1.25mg 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 partially transparent.

Is it safe to take minoxidil orally?

Less well-known but now growing in reputation is off-label, low-dose oral minoxidil, which is inexpensive and proven safe and relatively effective on its own or in combination with topical treatments, says Cleveland Clinic dermatologist Wilma Bergfeld, MD.

How much oral minoxidil a day?

Adults and children over 12: 5 to 40 milligrams taken as a single dose or in divided doses. Children up to 12 years of age: 200 micrograms to 1 milligram per kilogram of body weight a day to be taken as a single dose or in divided doses.

Common mistakes in prescribing oral Minoxidil for women’s hair loss 

Last update on 2024-04-19 / Affiliate links / Images from Amazon Product Advertising API

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