Oral minoxidil for hair loss: A dermatologist’s guide for patients

Table of Content:
What is minoxidil? | Types of hair loss it can treat | Benefits | Side-effects | Recommended dose | Common drug interactions | Can you use minoxidil after it expires? | Oral and topical minoxidil | Using oral minoxidil for female hair loss | Oral minoxidil and spironolactone for women | Oral minoxidil and finasteride for men | How to get a prescription

What is oral minoxidil?

Oral minoxidil is a prescription medication used off-label for the treatment of hair loss at a low dose, especially in cases where topical minoxidil has not been effective.

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.

Why is oral minoxidil used for hair loss?

Minoxidil dilates small arteries causing muscle cells to relax, which in turn, leads to increased blood flow to the area stimulating hair growth¹.

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

Yes, you can use oral minoxidil to treat non-scarring hair loss^2 3 . 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 hormones⁴. 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 alopecia⁵.

Telogen effluvium (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 minoxidil⁶.

Alopecia areata

Clinical studies suggest that some people with this autoimmune disorder that causes hair loss, have used minoxidil to regrow hair successfully⁷.

Hair loss due to chemotherapy

In some cases, minoxidil might be effective to help regrow hair after chemotherapy⁸.

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 roots⁹, 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 areas¹⁰.

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 everyone¹¹.

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 girls¹².

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-tolerated¹³.

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 other hair loss treatments.

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 effects¹⁴. 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
• Insomnia¹⁵ 

What is the recommended minoxidil dose for hair loss?

The recommended dose of minoxidil for hair loss ranges from 0.25 mg – 5 mg per day¹⁶. Since it may cause hypertrichosis, the dose tends to be lower in women than it is in men.

For more details on starting doses of oral minoxidil, skipping a dose, or taking a double dose, read Dr. Patrick Mahar’s advice on low dose minoxidil use for hair growth.

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 synthesis¹⁷. 

Sympathomimetics: Minoxidil may enhance the effects of drugs that increase heart rate and blood pressure, such as sympathomimetics (epinephrine and noradrenaline)¹⁸.

Corticosteroids: There may be an increased risk of fluid retention and edema when corticosteroids are used concurrently with minoxidil, especially in high doses¹⁹.

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.

Is oral minoxidil better than topical minoxidil for hair loss?

The efficacy of oral versus topical minoxidil for hair loss depends on the individual response, the type and extent of hair loss, and tolerance to the treatments. In some cases oral minoxidil may be more effective for certain individuals or types of hair loss, given its systemic absorption. 

To understand the differences between oral and topical minoxidil, read Dr. Anna Chacon’s explanations in our article on “Oral vs topical minoxidil application and absorption mechanisms”.

Using oral minoxidil for female hair loss

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 groups²⁰.

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

Yes, studies show that oral spironolactone and oral minoxidil taken together are effective for the treatment of female hair loss in women and adolescents^{21 22 23} .  

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 growth²⁴. 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 women²⁵.

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 men²⁶.

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 cycle²⁷.

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 alone²⁸.

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

So, how to get a prescription for minoxidil?

We can help you make a virtual appointment with the independent dermatologist to get oral minoxidil for hair loss.

After a quick, $59 photo-based virtual consultation, your assigned online dermatologist will provide you a prescription for oral minoxidil if it’s safe and appropriate for you.

Article References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9650732/
https://www.sciencedirect.com/science/article/abs/pii/S0190962221004187
https://www.ncbi.nlm.nih.gov/books/NBK430924/
https://pubmed.ncbi.nlm.nih.gov/35244759/
https://pubmed.ncbi.nlm.nih.gov/3674909/
https://www.medscape.com/viewarticle/986017
https://www.jaad.org/article/S0190-9622(23)00278-5/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887583/#
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/
https://academic.oup.com/bjd/article-abstract/184/5/977/6702293
https://www.jaad.org/article/S0190-9622(19)32666-0/fulltext
https://www.sciencedirect.com/science/article/abs/pii/S0190962221004187
https://pubmed.ncbi.nlm.nih.gov/9008235/
https://www.sciencedirect.com/topics/neuroscience/sympathomimetic-amines
https://www.drugs.com/drug-interactions/cortisone-with-minoxidil-748-0-1638-0.html#
https://karger.com/sad/article/6/3/175/304677/Low-Dose-Oral-Minoxidil-for-Female-Pattern-Hair
https://pubmed.ncbi.nlm.nih.gov/29231239/
https://pubmed.ncbi.nlm.nih.gov/17222303/
https://www.ncbi.nlm.nih.gov/books/NBK554421
https://www.ncbi.nlm.nih.gov/books/NBK513329/
https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.12246