Efficacy and safety of low-dose oral minoxidil in the management of androgenetic alopecia

ABSTRACT

Introduction

Treating alopecia can be challenging. The available treatments are topical minoxidil, low-dose oral minoxidil (LDOM), and 5-α reductase inhibitors like finasteride and dutasteride. Only topical minoxidil and finasteride 1 mg daily are FDA-approved, while the rest are used off-label. Recent research has suggested that oral minoxidil may be a safe and effective treatment for both female androgenetic alopecia (female AGA) and male androgenetic alopecia (male AGA).

Areas covered

In this review, we explore the pharmacokinetics, mechanism of action, safety, and efficacy of oral minoxidil. Additionally, we discuss its effectiveness compared to other treatments available for female AGA and male AGA.

Expert opinion

LDOM has demonstrated a favorable efficacy and safety profile in several trials. Subsequently, its use for the treatment of male AGA and female AGA is increasing. However, its use remains off-label, and through increased usage, we will get a better idea of the best dosage and monitoring guidelines. LDOM has also been used with some effectiveness in other forms of hair loss.

KEYWORDS:

• Androgenetic alopecia
• alopecia
• minoxidil
• male pattern hair loss
• female pattern hair loss

Article highlights

• Oral minoxidil can be used off-label in the treatment of female AGA and male AGA.

• Only topical minoxidil (2% and 5%) and oral finasteride 1mg/day are FDA-approved treatments for female AGA and male AGA.

• Minoxidil may enhance hair growth through various mechanisms, such as vasodilation, anti-inflammatory action, induction of the Wnt/β-catenin signaling pathway, and anti-androgen effect (?).

• The serum half-life of oral minoxidil is approximately 4 hours, but its pharmacologic effect persists for about 72 hours.

• For male AGA, patients may start minoxidil at 1.25 mg/day, with the option to raise the dosage to 2.5 mg/day within 2–3 months. Subsequently, after an additional 2–3 months, a further increase to 5 mg/day, the maximum daily dose, may be considered. For female AGA, patients may start minoxidil at 1.25 mg/day, with the option to increase the dosage to 2.5 mg/day (the maximum daily dose) after 2–3 months. The starting dosage regimen used to titrate upwards and the monitoring frequency during therapy may vary by physician and clinic.

• Oral minoxidil’s common side effects include hypertrichosis, and systemic side effects (lightheadedness, hypotension, edema, premature ventricular contractions, and tachycardia).

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Authors’ contribution

Conception of the manuscript by A K Gupta. The work was drafted by M Talukder, and substantively edited and revised by A K Gupta, M Talukder and A Shemer.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2024.2314087

Additional information

Funding

This paper was not funded.