If oral Finasteride is the anchor, oral Minoxidil is the boost.
They work differently.
In this 50 Facts Video I will tell you only the pertinent points separating the grain from the chaff.
And in the end, my protocol for using Oral Minoxidil.
Minoxidil is a potent anti-hypertensive medication developed in 1964.
Minoxidil relaxes blood vessels so blood can flow more easily. Minoxidil was first used to treat high blood pressure, for hypertension increases chances of strokes, heart attacks, and kidney problems.
Though one of the most obscure treatments for hair loss and heretofore controversial as well for hair loss, there is at this moment an ever increasing interest in oral Minoxidil.
In this Video I will touch only upon the important facts about this drug for hairloss, facts that matter.
For more details watch my previous video with link in the description below.
1. It is an OTC medication when prescribed orally.
2. Are its side effects similar to topical form? As compared to topical version, oral Minoxidil stimulates hair everywhere and the most disquieting side effect occurs in women who grow facial hairs on using oral form of Minoxidil.
3. Not everyone who can apply Topical Minoxidil can take the medication orally.
4. Minoxidil Is a stimulator- It increases the anagen phase of the hair cycle and increases the length as well as thickness of hair.
5. Since it is not a DHT blocker, it does not address the underlying issue and hence baldness progresses unhindered when Minoxidil is used in isolation as the primary hair loss treatment.
6. Does Minoxidil work better when taken orally? Yes it does but in doses more than 1 mg a day. Otherwise it is only as effective as the 5% Minoxidil formulation.
7. Any growth that you get with Minoxidil has to be maintained with its continued use.
8. People who use both oral Finasteride and oral Minoxidil do grow a lion’s mane!
9. So who would like to get Oral Minoxidil when Topical works in a majority: (a)
There is a lack of any benefit from topical Minoxidil used continuously for 6-8 months.
(b) When topical Minoxidil causes poor hair texture- hair that is coarse, tangled, dry and prone to breakage. (c) Those who have sensitive skin & those with pre existing skin conditions like eczematous dermatitis, psoriasis. Since Minoxidil in topical form can cause rash, irritation, or allergy (d) Those who hate the greasiness of topical Finasteride (e) Poor compliance to topical form for various reasons.
10. The cardiovascular status needs to be evaluated before prescribing Minoxidil. So when prescribing the doctor has to counsel the patient and weigh pros and cons keeping in mind the benefits and likely side effects.
11. Oral Minoxidil can cause fluid retention.
12. When fluid retention is a problem and if otherwise alright to administer, the potassium channel blocker Spironolactone may be added.
13. When used together they grow and maintain hair differently. Finasteride blocks DHT while Minoxidil opens potassium channels.
14. Both Finasteride and oral Minoxidil complement one another. If oral Finasteride is the anchor, oral Minoxidil is the boost.
15. Will hair shed when I switch from topical to oral Minoxidil? Yes there will be a shedding phase due to telogen effluvium though not too severe.
16. How long does the shedding of Oral Minoxidil last when it is started without
previous exposure to topical Minoxidil? Shedding starts 2-8 weeks after starting the drug and soon subsides.
17. There are 4 types of non-responders: (a) Minoxidil works when it is converted by an enzyme sulfotransferase to Minoxidil sulphate. Those who lack this enzyme are non responders. (b) Also thick dermis does not respond well. (c) If you have a verymlarge area of thinning, the concentration may not be good enough to cause results.
(d) Topical Minoxidil also can cause excessive dandruff and scaling in those prone.
In others it can cause increased sensitivity. Hence cannot be used in those with inflammatory or immune skin diseases.
18. In what indications is it given for women for treating their hair loss? (a) female
pattern alopecia (b) Chronic telogen effluvium (c) isolated cases of post- chemotherapy alopecia (d) monilethrix (e) traction alopecia (f) loose anagen syndrome.
19. Best time to take Oral Minoxidil? Since it lowers blood pressure, it can cause fainting. Most commonly seen in women who have low BP and in those who are sensitive to BP fluctuations in the erect posture. So, women particulalrly should take this medication at night.
20. Does Minoxidil cause facial aging? Some people develop dark circles around eyes and eye bags and may feel it causes facial aging. It has also been noted that it increases skin laxity in the scalp and face. Minoxidil does affect collagen synthesis and this may be the reason, However, there is no evidence in medical literature to
support the myth that it causes facial aging.
21. Do the hair due to Minoxidil on face go away after stopping Minoxidil? They may not.
22. Can laser treatment be done for excessive facial hair in those who get this side
effect? Yes laser is helpful for the hypertrichosis that develops. Laser delivers energy that heats up stem cells around hair follicles, causing arrest of growth.
23. Is Oral Minoxidil FDA approved? It is not FDA approved for hair loss treatment.
24. What is the dose of Oral Minoxidil? Sadly, there is no standardised dosage for treating hair loss. Dosage has been worked out by trial and error. One has to try out the dose that is free of side effects and beneficial at the same time. The recommended dose for hair loss is 2.5 mg and 5 mg in my practice and is relatively safe for most. However some consider this high. 1.25-1.5 mg a day is universally considered safe. But then the effect is lesser. Women on the other hand benefit by a much lesser dose- as low as 0.25 mg a day. Needless to say that Minoxidil in higher doses like 5 mg a day must be closely supervised by a doctor.
25. What is the tablet size? Oral Minoxidil comes in 2.5, 5 & 10 mg tablets under various trade labels.The 2.5 and 10 mg tablets need to be cut with a pill-splitter when taking lower doses.
26. What are its common side effects? It can cause changes in color, length, or thickness of body or facial hair, nausea, vomiting, rash, and breast pain or tenderness.
27. What are its serious side effects? New or worsening chest pain, fast or pounding heartbeats, swelling in your legs, ankles, or feet, rapid weight gain, especially in your face and midsection, shortness of breath, lightheadedness, pain when you breathe, wheezing, gasping for breath, cough with foamy mucus, swelling in your face or tongue, skin pain, followed by red or purple skin rash that spreads and causes blistering and peeling.
28. How are side effects different from those of Oral Finasteride? When we speak of side effects of Oral Minoxidil, these are well documented unlike Finasteride where they may be anecdotal. They mostly pertain to your cardiovascular health & mind you cardiovascular diseases are the biggest killer in the world. So the side effects are not to be taken lightly.
29. Can pregnant women take Oral Minoxidil? No. Even those breast feeding should not.
30. Is Minoxidil safe for kidneys? Not if kidney function is deranged.
31. Can you use both oral and topical Minoxidil together? Oral form is used for those who for some reason can either not tolerate topical form or are refractory to its effects. And there is no additional benefit.
32. Can you take oral Minoxidil and Finasteride together? Yes and this is a routine in my practice in a given set of patients.
33. Does Minoxidil negatively effect collagen? Minoxidil inhibits collagen deposition and we shall discuss this in detail in the next video.
34. Will it benefit hair loss due to low thyroid hormones? Yes it most certainly will.
35. Can you consume alcohol when on oral Minoxidil? You should consume alcohol only socially and occasionally when on this drug.
36. Is it safe in patients with hypertension? Yes. But you need to get this cleared from your treating physician so he can modulate the other drugs you are taking for hypertension.
37. Can you compare results of Finasteride with oral Minoxidil? Though oral Minoxidil causes equally good results, it does not in the long term. As I said if Finasteride be the anchor, Minoxidil is the boost.
38. What is the ‘front-loading protocol’ for Oral Minoxidil? Used to expedite the growth process especially in those who are young and have aggravated hair loss like telogen effluvium.Also frontloading protocol can be used alone in selected patients. I use 2.5-5 mg a day for 3 months and then switch to topical form which has a more safe profile.
39. How long does it take to get full benefit from this medication? It takes between 6-12 months.
40. How do you compare benefit from oral Minoxidil with that of topical Minoxidil?
One study stated that 1 mg oral Minoxidil gives comparable results to when you use 1 ml 5% Minoxidil. And since in women we neither give 5% Minoxidil nor 1 mg oral Minoxidil is the preferred dose, oral Minoxidil and topical Minoxidil may work similarly.
However, since higher doses are given for men, in men surely the oral form is more efficacious.
41. How do you grade Oral Minoxidil for efficacy in hair loss treatment? It is an effective treatment though the margin of error is low. If continued under medical supervision, I grade it as the second most potent hair loss treatment today.
42. What is my protocol? In men
43. Does Minoxidil cause change in hair colour? Yes it makes hair darker. A blonde person may notice his hair turn auburn or brown.
44. How long does Oral Minoxidil stay in the body? Maximum plasma concentration is reached within the first hour and declines rapidly thereafter. The plasma half life is 4.2 hours.
45. Does Minoxidil work only for the crown? Minoxidil grows hair in all places. It is a myth that it is effective in the crown.
46. Why do some people who do not respond to topical form will respond to oral Minoxidil? This is because these people lack the enzyme sulfotransferase in hair follicles. However this enzyme will activate oral Minoxidil since it is present in the liver.
47. What is your protocol for Oral Minoxidil administration? In both males and females who are cardiovascularly assessed to be fit for this drug, I initiate with 0.625 mg a day for women and 1.25 mg day for men. I then slowly build up over 3-6 months.
48. Is this low dose what you give for hair loss? Doses for hair loss are considered low dose since we rarely exceed 5 mg a day when the recommended dose for the drug for use in hypertension is 10-40 mg a day. However since cosmetic use is a zero error use, it is very diligently and sparingly dispensed for hair loss.
49. What are the contraindications for use of Oral Minoxidil? (a)
pheochromocytoma (b) pulmonary hypertension with mitral stenosis (c)severe hepatic impairment (d) angina or recent myocardial infarction (heart attack) (e) left ventricular hypertrophy (f) heart failure
At what age should it be used? It should not be used in hair loss sufferers less than 18 years of age.