Does oral minoxidil cause facial hair growth

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 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 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 studies are very 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. This means that 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.

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 5% solution (1ml) once a day (Ramos et al. 2020). In this study, 26 women received oral minoxidil and 26 women received topical minoxidil. After 24 weeks of treatment, there was a 12% increase in hair density for women on oral minoxidil and 7.2% increase for women applying topical minoxidil. The difference was not statistically significant, 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 largest 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 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.
• Ankle swelling and fluid retention. 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 feeling lightheaded. 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 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 cut down on 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 common starting dose is 0.625mg per day for women and 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.

Brand of oral Minoxidil – Loniten

We prescribe Loniten branded Minoxidil tablets. These are manufactured by Pfizer.

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:

• drug allergy – NB it appears that oral minoxidil is safe if you have reacted to topical minoxidil even if your patch tests shows 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 there are a number of medical reports to 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 is lacking. Controlled clinical studies on oral Minoxidil are also lacking. Low-quality evidence, no matter how significant it is, means that such medications are not included in national guidelines. Oral Minoxidil is such a medication.

Until larger, more statistically sophisticated studies are carried out, oral Minoxidil for hair loss will remain unlicensed in the UK. This means that you can only receive a prescription from a doctor who has experience in using this medication and who 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 not suggest this treatment to you if they do not 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 under no obligation to continue prescribing or monitoring unlicensed medications. This 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 with caution if you are on other medications that reduce blood pressure.

We recommend 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 which you should bring with you to your appointments.

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 has adequate knowledge of your health and condition. A particular medication is only prescribed if it is suitable for a person in their 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 also do not necessarily continue prescriptions for medications you may have been prescribed elsewhere, including from overseas or from 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 initially 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.

References

• Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J American Acad Dermatol 2020. https://doi.org/10.1016/j.jaad.2020.06.1009
• Beach R, McDonald K, Barrett B. Tolerated, Effective, Successful: Low Dose Oral Minoxidil for Treating Alopecia, A 3-Year North American Retrospective Case Series. J Am Acad Dermatol 2020 doi: 10.1016/j.jaad.2020.10.032.
• Baltazar Sanabria, Tamara de Nardo Vanzela, Hélio Amante Miot, Paulo Müller Ramos. Adverse Effects of Low-dose Oral Minoxidil for Androgenetic Alopecia in 435 patients. Journal of the American Academy of Dermatology,
  2020. https://doi.org/10.1016/j.jaad.2020.11.035.
• Ramos, P. M., Sinclair, R. D., Kasprzak, M. & Miot, H. A. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad Dermatol 2020; 82: 252–253
• Vañó-Galván, S. et al. Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients. J Am Acad Dermatol 2021; 84: 1644–1651.
• Therianou A, Vincenzi C, Tosti A, How safe is prescribing oral minoxidil inpatients allergic to topical minoxidil?, Journal of the American Academy of Dermatology (2020), doi:https://doi.org/10.1016/j.jaad.2020.04.027

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