How much oral minoxidil should you take daily?

Table of Content:
What is minoxidil? | How to get a prescription? | How long does it take to work? | Recommended dose | Can you take oral and topical minoxidil? | Minoxidil for female hair loss | Minoxidil and finasteride for men | Types of hair loss it treats | Benefits | Side-effects | Drug interactions

What is oral minoxidil?

Minoxidil was developed as medication to treat high blood pressure, but its unintended side effect of causing hypertrichosis (excessive hair growth) led to its off-label use for hair growth.

The low dose of oral minoxidil for hair loss has become more popular in recent years.  Although this medication is not FDA-approved for the treatment of hair loss in men and women, clinical studies show promising results in the treatment of different types of hair loss including male and female pattern loss (androgenetic alopecia), alopecia areata, telogen effluvium, traction alopecia and chemotherapy-induced hair loss.

In this article we cover the basics on the doses typically prescribed for hair loss in men and women, what happens if you skip a dose, as well as the benefits and side effects of taking this medication.

This information will help you and your online dermatologist make an informed decision whether minoxidil is adequate for you. 

So, how to get a prescription for minoxidil?

To get oral minoxidil for hair loss We can put in touch with an independent online dermatologist. If oral minoxidil is suitable and safe for you, your assigned online dermatologist can write you a prescription after a short photo-based virtual consultation.

How long does it take for oral minoxidil to work for hair loss?

Oral minoxidil typically takes about 3 to 6 months to show noticeable effects for hair loss. During the first few months, you may not see immediate results, and some people even experience initial shedding, which is a sign that the medication is starting to work by promoting the growth of new, healthier hair. Consistent use is key, and optimal results are usually seen after 6 to 12 months of regular treatment. assigned online dermatologist can write you a prescription after a short photo-based virtual consultation.

What is the oral minoxidil dose for hair loss?

Studies show promising results as hair loss treatment with the use of minoxidil at a low dose which can vary from 0.25 mg – 5 mg day with minimal side-effects^{1 2}.

What is the starting dose of oral minoxidil for hair loss?

A common starting dose of oral minoxidil for hair loss for women is typically 0.625 mg per day. The starting dose for men is usually higher, around 2.5 mg per day. However, according to Dr. Patrick Mahar, expert dermatologist,  there are no hard rules about which to start, and patients may be reasonably prescribed anywhere from 0.25 mg – 2.5 mg orally per day depending on patient factors³.

Since minoxidil is available in tablets of 2.5 mg, 5 mg and 10mg, you should get a pill cutter to obtain the desired dose or consider a compounding pharmacy, such as Skin Medicinals, to make up capsules of the intended dose.

What is the highest dose of minoxidil for hair loss?

The highest dose of minoxidil usually prescribed for hair loss in men is 5 mg per day and 1.25 mg per day for women⁴.

What is the lowest dose of minoxidil for hair loss?

The lowest reported doses of oral minoxidil prescribed for hair loss in women is 0.25 mg per day and for men it is 2.5 mg.  In clinical practice, however, Dr. Mahar says that there isn’t a ‘lowest dose’ for men and women since the dose may be influenced by patient factors such as age, blood pressure, other medications or the severity of a patient’s condition⁵.

Is oral minoxidil 2 mg used for hair loss?

Yes, minoxidil 2.5 mg in oral form is used for hair loss as an off-label treatment for androgenetic alopecia (male or female pattern hair loss). It can be an alternative for individuals who do not respond well to or prefer not to use topical minoxidil.

What happens if I miss a dose of minoxidil for hair loss?

If you miss a dose of oral minoxidil, you should take it as soon as possible. However, if it is very close to your next dose, skip the missed dose and follow your regular dosing schedule. You should not take double doses.

What happens if I take a double dose of minoxidil?

Dr. Mahar says that if you take a double dose of minoxidil by accident once, you will probably be fine, but make sure this does not happen on a regular basis and pay attention to any side effects that may arise as a consequence of the double dose. If you notice serious side effects, notify your doctor. 

Can you take oral and topical minoxidil together?

Dr. Mahar says it is possible to take oral and topical minoxidil together for hair loss, but this should only be done under the guidance of a dermatologist. Combining oral and topical minoxidil may provide a more robust treatment approach, as oral minoxidil works systemically, and topical minoxidil works locally on the scalp. However, using both formulations may increase the risk of potential side effects.

Is oral minoxidil used for women?

A study revealed promising results with the use of low-dose oral minoxidil for female pattern hair loss. Patients were treated with daily doses of minoxidil ranging from 0.25 to 2 mg for a duration of 9 months. The study revealed that 80% of the patients showed clinical improvement, especially those in more advanced stages of alopecia. 

Adverse effects were noted in 19% of patients, with hypertrichosis being the most common, but only 2% of patients withdrew from treatment due to adverse effects. 

The study concluded that there wasn’t a difference in the effectiveness or safety of minoxidil based on dosage or age of the patients, indicating that it can be a viable treatment for women across different age groups⁶.

Can oral minoxidil be combined with oral spironolactone for women’s hair loss?

Yes, studies show that oral spironolactone and oral minoxidil taken together are effective for the treatment of female hair loss in women and adolescents^{7 8 9}. 

Combining these two medications may provide a synergistic effect and enhance the treatment outcome for some patients. Here’s how they work:

On one hand, oral minoxidil acts as a vasodilator to increase blood flow to hair follicles, promoting hair growth¹⁰. On the other hand, oral spironolactone serves as an antiandrogen, reducing the effects of androgens on hair follicles, which can contribute to hair loss in women¹¹.

What is best for hair loss in men: oral minoxidil or finasteride?

Both oral minoxidil and finasteride are effective in the treatment of hair loss in men, specifically androgenetic alopecia (male pattern baldness), but they work in very different ways.

Finasteride works by inhibiting the enzyme 5-alpha-reductase, which converts testosterone to dihydrotestosterone (DHT). DHT is a hormone that can contribute to hair follicle shrinkage and hair loss in men¹². 

Minoxidil is a vasodilator, and its exact mechanism of action in promoting hair growth is not fully understood. It is thought to increase blood flow to the hair follicles and prolong the anagen (growth) phase of the hair cycle¹³. 

It is important to have a discussion with your online dermatologist to determine what treatment is most appropriate based on your individual medical history.

Read Dr. Carolina Fernandez Quiroga’s insights in our article on the effectiveness and differences of oral minoxidil and finasteride to learn more about these treatments.

Can minoxidil and finasteride be used together for male pattern hair loss?

Yes, minoxidil and finasteride can be used together for the treatment of male pattern hair loss (androgenetic alopecia). Research suggests that a combination of finasteride and minoxidil can improve hair growth in up to 94% of men compared to using either medication alone¹⁴. 

However, since both medications can lower your blood pressure, hypotensive patients should be advised caution while using these two medications together.

More about using oral minoxidil for hair loss

Can you use oral minoxidil for all types of hair loss?

Yes, you can use oral minoxidil to treat non-scarring hair loss^{15 16} . However, it is mainly used in the treatment of androgenetic alopecia, a hormonal-related type of hair loss that is caused by an excessive response to androgen hormones¹⁷. This type of hair loss is progressive, can occur anytime after puberty, and affects up to 50% of men and women.

Types of hair loss treated with oral minoxidil

• Androgenetic alopecia
• Telogen effluvium
• Alopecia areata
• Chemotherapy-induced alopecia
• Traction alopecia
• Monilethrix
• Loose anagen syndrome

Androgenetic alopecia (also known as male or female pattern baldness)

Many studies reveal that oral minoxidil at a low dose stimulates hair growth in patients with androgenetic alopecia¹⁸.

Stress-or-illness related hair loss

Studies show that patients with stress-related hair loss or hair loss due to serious illnesses (telogen effluvium) have also shown reduced hair shedding  and experienced new hair growth with the use of oral minoxidil¹⁹.

Alopecia areata

Clinical studies suggest that some people with this autoimmune disorder that causes hair loss, have used minoxidil to regrow hair successfully²⁰.

Hair loss due to chemotherapy

In some cases, minoxidil might be effective to help regrow hair after chemotherapy²¹.

Traction alopecia

Oral minoxidil can also be used to treat traction alopecia, a type of hair loss that occurs due to hairstyles that pull on the hair roots²², although stopping the practices that lead to the traction is the primary treatment.

Monilethrix

In some cases oral minoxidil has been successful in helping individuals with monilethrix, a rare hereditary hair disorder characterized by having sparse, brittle hair that often breaks before becoming long. The hair is usually dry and shows signs of patchy hair loss areas²³.

Although minoxidil works by helping extend the growth phase of the hair follicles, which can in turn promote hair growth, it usually takes several months of consistent use to see results, and it may not work for everyone²⁴.

Loose anagen hair syndrome 

Loose anagen hair syndrome (LAHS) is a hair problem mainly seen in young girls between 2 to 6 years old. This condition causes hair to fall out easily, makes the hair look dull, and prevents it from growing long. The issue comes from weak hair roots and problems with the inner part of the hair. A study revealed that a very low dose of oral minoxidil has been used successfully to improve this condition in young girls²⁵.

Benefits of using oral minoxidil for hair loss

There are some advantages of using oral minoxidil for hair growth. 

• Effective: Studies suggest that oral minoxidil is at least as effective as topical minoxidil in promoting hair growth and can be used when topical minoxidil is not well-tolerated²⁶.
• Uniform hair growth: Since it is systemically absorbed, oral minoxidil promotes a more even hair growth.
• Suitable for men and women: Oral minoxidil is suitable for both genders. Some other hair loss medications such as spironolactone or finasteride are mainly suitable for either men or women. 
• Convenient: Taking a tablet is often more convenient and less time-consuming than applying a topical solution throughout the entire head.
• Affordable: Minoxidil tablets are priced between $25 to $40 per 30 tablets, which is less expensive than topical formulations.
• Combination therapy: Minoxidil tablets can be used in combination with other treatments, such as spironolactone, finasteride, topical minoxidil, Redensyl™, Procapil™, Capixyl™, or Anagain™ potentially improving the effectiveness of the treatment.

Side effects of using oral minoxidil for hair loss

A research conducted with almost total of 1,500 patients revealed that in most cases, patients did not experience any severe side effects. However, the most common side effects experienced were:

• Hypertrichosis (generalized excessive hair growth)
• Dizziness
• Postural hypotension and hypotension
• Chest palpitations and chest pains
• Headaches
• Fluid retention
• Eye puffiness
• Insomnia²⁷

Common minoxidil drug interactions

Minoxidil can interact with other medications, leading to increased risks or decreased effectiveness. Here are some possible drug interactions with minoxidil:

• Blood pressure medications: Minoxidil can lower blood pressure, so taking it with other antihypertensive agents can lead to excessively low blood pressure (hypotension).
• Nonsteroidal anti-Inflammatory drugs (NSAIDs)  such as ibuprofen, naproxen, aspirin, diclofenac, celecoxib, indomethacin, meloxicam are widely used to reduce inflammation, relieve pain, and decrease fever. However, it is believed that NSAIDs inhibit hair growth and may reduce the vasodilatory effects of minoxidil by inhibiting prostaglandin synthesis²⁸. 
• Sympathomimetics: Minoxidil may enhance the effects of drugs that increase heart rate and blood pressure, such as sympathomimetics (epinephrine and noradrenaline)²⁹. 
• Corticosteroids: There may be an increased risk of fluid retention and edema when corticosteroids are used concurrently with minoxidil, especially in high doses³⁰. 
• Alcohol: Consuming excessive alcohol while on treatment with oral minoxidil can increase your risk of hypotension and developing headaches.

Can you use minoxidil after its expiration date?

In view of toxicity and unforeseen adverse events from an expired drug and its excipients, oral minoxidil should not be consumed after its expiry date.

If you are interested in why you shouldn’t use expired minoxidil, Dr. Anna Chacon explains the reasons why it should not be done and the difference between the expiry date and a medication’s shelf life.

Lee éste artículo en Espanol ¿Qué es y para que sirve el minoxidil?

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