According to the National Alopecia Areata Foundation, the estimation is that about 147 million people in the world currently have or will develop alopecia at some point in their lives.
With this sheer amount of people suffering from the disease, it is becoming more imperative to look for solutions that can help combat it. A particularly promising treatment is a medication called minoxidil.
While topical minoxidil is very common, it doesn't work for everyone.
Oral minoxidil has been gaining popularity because of that.
This article will explore the uses and effectiveness of oral minoxidil for the treatment of alopecia and other things you need to know about the medication.
Summary
Androgenic alopecia, commonly called pattern hair loss, usually manifests as baldness in the front of the head or as a receding hairline.
Affecting about 50% of males and females worldwide; this condition is a pretty common one.
Low-dose oral minoxidil is a fast-rising medication for hair loss for both genders. It is also the only FDA-approved treatment for female pattern hair loss.
However, there are many adverse reactions to the use of minoxidil for hair growth.
What is minoxidil?
Minoxidil (or Rogaine) is one of the only two FDA-approved drugs for treating alopecia and other balding in males and females.
It is a vasodilator (meaning it increases the size of blood vessels) and was initially used as a treatment for severe hypertension. However, it was discovered that the drug could stimulate hair growth.
Subsequently, it was approved by the FDA and marketed as a treatment option for female pattern hair loss and androgenetic alopecia.
What is oral minoxidil?
The oral dosage form, often used in prescribing oral minoxidil, is primarily for treating hypertension and is available only through a doctor's prescription.
This is because oral minoxidil is used only for severe cases and is often only considered after 2 other anti-hypertensive agents used simultaneously have proved ineffective.
How effective is oral minoxidil?
Oral minoxidil has shown promising results in small-scale studies for treating hair loss. About one-third of patients experience reduced hair shedding, and another third notice improved hair growth within 6 months or more, indicating that up to two-thirds of users may benefit from it.
A study by Ramos et al. in 2020 comparing oral and topical minoxidil in women with Female Pattern Hair Loss found that 1mg of oral minoxidil had comparable effects to 5% topical solution. After 24 weeks, women taking oral minoxidil saw a 12% increase in hair density, compared to a 7.2% increase with topical application.
Although the difference wasn't statistically significant, the oral minoxidil group also experienced less hair shedding. It's recommended to continue treatment for 6 to 12 months for optimal results.
What are the side effects of oral minoxidil?
Oral minoxidil is a powerful medication and is usually only prescribed for severe cases of hypertension. The primary reason is the numerous and sometimes critical side effects associated with the drug.
The standard or less severe side effects of oral minoxidil range from mild gastrointestinal disturbances like nausea, bloating, and vomiting. Extra or unwanted hair growth in different body parts may also be observed.
These symptoms will usually disappear within a couple of days or weeks; however, if they persist or become more severe, you must visit your medical advisor.
The more severe side effects include the following:
- Increase in heart rate or palpitations
- Difficulty in breathing
- Shortness of breath
- Lightheadedness
- Sudden weight gain
- Erectile dysfunction
- And skin disorders
Most of the symptoms mentioned above are indications of heart failure, and a doctor should immediately be contacted after they are noticed.
People who have allergies to minoxidil may also experience itching, rashes, or swelling on different body parts.
Other rare psychological side effects include depression and anxiety.
What should you take instead of oral minoxidil?
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What is topical minoxidil?
The topical dosage form of minoxidil is usually sold as an over-the-counter drug (OTC) for treating androgenic alopecia.
One of the primary reasons the topical minoxidil is famous for stimulating hair growth is its versatility; it can be used to treat androgenic alopecia in both males and females.
There are various brands of topical minoxidil now available in the market. The more popular ones include Regaine, Tugain, Minichek, and Mintop Forte.
How does topical minoxidil work for hair growth?
The exact mechanism by which minoxidil works for hair growth is not fully clear yet; however, some theories are still worth mentioning.
Minoxidil widens the blood vessels and opens potassium channels, thereby causing the hair follicles to have more access to blood and other nutrients needed to foster hair growth and thickness.
Additionally, Minoxodiil increases the production of prostaglandin compounds which can stimulate continuous hair growth.
Minoxidil is also believed to widen hair follicles that have reduced in size, helping to enhance the production of more hair.
Is oral minoxidil more effective than topical?
Studies show that oral minoxidil and topical minoxidil are both effective as a hair loss treatment, but you should always use topical minoxidil since it has the least side effects.
Topical minoxidil in the Rogaine brand has been the previously preferred Minoxidil treatment option for female pattern hair loss; however, some patients have claimed that the low-dose oral dosage form works better.
Why oral minoxidil might be more effective than topical minoxidil?
Presence of activating enzymes in the liver
It is believed that oral minoxidil may prove more effective than the topical form because a particular enzyme that activates the medication and causes it to work might be absent in the hair follicles of some patients, thus potentially rendering the topical medicines ineffective.
On the other hand, this enzyme is always present in the liver. Since all medications go through the liver, oral minoxidil is guaranteed to be activated, thus ensuring its effectiveness in treating alopecia.
Mild and treatable side effects
According to the American Academy of Dermatology Association, patients prefer oral minoxidil to topical medication because they claim it is more effective and has fewer side effects compared to topical minoxidil.
Low-dose oral minoxidil, used for hair loss treatment, has way less severe side effects than the dose used as an anti-hypertensive drug.
The most common side effect reported was mild hypertrichosis which could be easily managed by dose adjustment or hair removal.
Another common side effect reported was temporary shedding of the hair, which stopped after 3 weeks of using the medication. However, this side effect doesn't necessarily count as one because it is an essential step in hair growth; it lets the unhealthy hair follicles shed so the new healthy ones can grow.
Topical minoxidil, on the other hand, can cause rashes and irritations on the scalp, hair breakage, and dryness.
Less risk of contamination
Furthermore, oral minoxidil puts pets and other people who shouldn't come in contact with it at a lesser risk of contamination.
Does oral minoxidil stop hair loss?
The results of a study to show the efficacy and safety of low-dose oral minoxidil taken once a day confirmed that the medication proved effective for the male subjects, and there was a noticeable increase in hair growth.
Additionally, the medication was deemed safe as the most common side effect recorded was excessive hair growth.
Another study carried out to compare the efficacy of topical and oral minoxidil in treating alopecia confirmed that oral treatment proved more effective.
According to the study, "both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective."
How long does it take for oral minoxidil to grow hair?
Similar to topical minoxidil, it takes time to see results from oral minoxidil.
Minoxidil starts working immediately when it's used.
Within the first few weeks of usage, you'll see hair shedding instead.
Consistent usage of 3 to 12 months will yield hair growth results similar to pictures you've seen online.
What is the dosage of oral minoxidil?
The dosage form of oral minoxidil used for hair loss is usually less than 4 mg.
The maximum recommended dose is 2.5mg, with a starting dose of 0.625mg and 1.25mg daily for men and women. The dose can then be gradually increased.
Who should not use oral minoxidil?
It is generally advised that before you use any medication, you should consult your doctor or pharmacist to avoid any fatal contraindication.
Oral minoxidil should generally not be used by the following set of people.
People suffering from pheochromocytoma (pheo)
PHEO is a rare medical condition affecting the adrenal medulla. It is a tumor with chromaffin cells that can cause various symptoms, such as hypertension and an increased heartbeat rate (tachycardia). in addition, many side effects associated with minoxodiil can worsen the condition.
Pregnant women
Due to the lack of enough research, it is advised that pregnant women not use minoxidil unless the potential benefits outweigh the potential risks.
Additionally, a case study on the effects of topical minoxidil on fetuses confirms that the medication may cause severe fetal malformation and health issues in fetuses.
Cats and dogs
According to several studies, even the littlest amount of minoxidil can prove fatal to dogs and cats; it should therefore be kept away from them.
If you apply it to your hair or any piece of clothing, ensure that your pets do not come in contact with it.
People with other heart conditions
If you have any heart condition, it's recommended to notify your doctor before you start minoxidil.
Conclusion
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FAQs
Does oral minoxidil work for hair growth?
Yes, oral minoxidil (OM) can be a safe and effective treatment for hair loss from various causes. It is especially beneficial for patients who cannot tolerate topical minoxidil or have not had success with other treatments.
How long can you use oral minoxidil?
Oral minoxidil can be taken long-term at low dosages to maintain hair strengthening results. Patients should expect to be prescribed oral minoxidil for as long as they wish to see the effects of the treatment.
Does oral minoxidil cause more body hair?
Yes, oral minoxidil can cause thicker and darker hair growth all over the body, not just on the scalp, due to its systemic absorption.
Is minoxidil hair growth permanent?
There is no scientific evidence to confirm that minoxidil-induced hair growth, such as in the case of a minoxidil beard, is permanent for everyone. Minoxidil is a vasodilator that helps open blood vessels, enabling growth in stunted hair follicles, but its long-term permanence is not guaranteed.
Reference
- https://en.m.wikipedia.org/wiki/Minoxidil
- https://www.jaad.org/article/S0190-9622(19)32666-0/fulltext#relatedArticles
- https://www.aad.org/dw/dw-insights-and-inquiries/archive/2022/low-dose-oral-minoxidil-alopecia
- https://pubmed.ncbi.nlm.nih.gov/32622136/
- https://pubmed.ncbi.nlm.nih.gov/34370845/
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