REVIEWS

Oral minoxidil treatment for hair loss: A

review of efficacy and safety
Michael Randolph, BS, and Antonella Tosti, MD
Miami, Florida

Background: Although topical minoxidil is an effective treatment option for hair loss, many patients are
poorly compliant because of the necessity to apply the medication twice a day, undesirable hair texture,
and scalp irritation.

Objective: In recent years, oral minoxidil at low dose has been proposed as a safe alternative. This study
reviewed articles in which oral minoxidil was used to treat hair loss to determine its efficacy and safety as
an alternative to topical minoxidil.

Methods: PubMed searches were performed to identify articles discussing oral minoxidil as the primary
form of treatment for hair loss published up to April 2020.

Results: A total of 17 studies with 634 patients were found discussing the use of oral minoxidil as the
primary treatment modality for hair loss. Androgenetic alopecia was the most studied condition, but other
conditions included telogen effluvium, lichen planopilaris, loose anagen hair syndrome, monilethrix,
alopecia areata, and permanent chemotherapy-induced alopecia.

Limitations: Larger randomized studies comparing the efficacy/safety of different doses with standardized
objective measurements will be needed to clarify the best treatment protocol.

Conclusion: Oral minoxidil was found to be an effective and well-tolerated treatment alternative
for healthy patients having difficulty with topical formulations. ( J Am Acad Dermatol
2021;84:737-46.)

Key words: alopecia; alopecia treatment; androgenetic alopecia; efficacy; hair loss; minoxidil; oral
minoxidil; safety; systemic minoxidil.

M inoxidil was first introduced in the 1970s as conditions in both men and women, although it
a treatment for severe refractory hyperten- was approved only for androgenetic alopecia (AGA).
sion because of its potent vasodilatory The exact mechanism of action remains unknown,
qualities. Minoxidil has a relaxant effect on vascular although the conversion of minoxidil to its active
smooth muscle through the opening of adenosine derivative, minoxidil sulphate, by follicular sulfo-
triphosphateesensitive potassium channels.1 During transferase activity is a key step in the medication’s
this time, hypertrichosis and regrowth of hair was effectiveness.8,9 Minoxidil causes a shortening of the
found to be a common adverse effect among users, telogen phase and lengthening of the anagen phase
and a topical preparation was first marketed in with a progressive growth in hair follicle diameter
1986.2-7 For several decades, minoxidil has been and length.10,11 The topical formulation must
used as 2% and 5% topical solutions and, later, 5% continue to be applied, or beneficial effects will
foam for the treatment of a variety of alopecia regress.12 The adverse effects are largely cutaneous,

From the Dr Phillip Frost Department of Dermatology and Reprint requests: Antonella Tosti, MD, Department of
Cutaneous Surgery, University of Miami School of Medicine. Dermatology and Cutaneous Surgery, University of Miami
Funding sources: None. Hospital, 1475 NW 12th 14 Ave, Suite 2175, Miami, FL 33136.
Disclosure: Dr Tosti has served as a consultant or advisor for DS E-mail: [email protected].
Laboratories, Monat Global, Almirall, Thirty Madison, Lilly, Leo Published online July 2, 2020.
Pharmaceuticals, Bristol Myers Squibb, and Procter & Gamble. 0190-9622/$36.00
Author Randolph has no conflicts of interest to delcare. Ó 2020 by the American Academy of Dermatology, Inc.
IRB approval status: Not applicable. https://doi.org/10.1016/j.jaad.2020.06.1009
Accepted for publication June 29, 2020.

737
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738 Randolph and Tosti J AM ACAD DERMATOL
MARCH 2021

with the most common complaints being scalp minoxidil,’’ ‘‘hair loss,’’ ‘‘systemic minoxidil,’’ and
pruritus, scalp scaling, and hypertrichosis. Contact ‘‘alopecia.’’ No language or time restrictions were
dermatitis can also develop over time.13-15 used. Articles found were read and reviewed; they
Although topical minoxidil is an effective were judged appropriate for inclusion if they
treatment option for hair loss, many patients are described treatment of hair loss primarily with OM.
poorly compliant because of the necessity to apply The references of these articles were reviewed to
the medication twice a day, identify additional
undesirable hair texture, resources.
and scalp irritation. CAPSULE SUMMARY
Patients must also be made RESULTS
aware of a temporary shed- This review discusses the limitations of
d
Efficacy
ding period that occurs after topical minoxidil for hair loss treatment A total of 17 studies
the initiation of topical and assesses oral minoxidil as an with 634 patients were
application. If unaware of emerging treatment alternative. found discussing the use
this adverse effect, patients Low-dose oral minoxidil is an effective
d of OM as the primary treat-
may discontinue use and safe treatment alternative for a ment modality for hair loss
prematurely. variety of hair loss disorders in healthy (Table I). AGA was the
Until recently, oral patients having difficulties with topical most studied condition.
minoxidil (OM) has not minoxidil preparations. In general, OM was found
been used for treatment of to be an effective treat-
hair loss because of the ment for AGA. In the
potential adverse effects of largest study, Rodrigues-
the medication when used at doses between 10 and Barata et al20 determined a mean dose of 1 mg of
40 mg daily. Sodium and fluid retention have been OM in 148 women to be an effective form of
shown to be a significant adverse effect, especially in treatment for female pattern hair loss (FPHL).
patients with renal conditions. This adverse effect Response to therapy was more significant in patients
will commonly present as edema or weight gain, with more advanced stages of FPHL. Although a
although it may infrequently cause pulmonary large portion of patients in this study were taking
congestion. Coadministration with beta blockers concomitant treatments, little difference in effective-
was common to reduce sodium/fluid retention and ness was reported between patients receiving OM
control heart rate.16 Acute pulmonary edema and monotherapy and patients receiving OM plus addi-
pulmonary hypertension have also been reported as tional treatment. Sinclair21 used 0.25 mg minoxidil
possible adverse effects, although a direct causal daily in women with FPHL and showed improve-
relationship has yet to be proven.17 Cardiac conditions ment in the Sinclair hair loss severity score and hair
associated with the medication include, most shedding score through 1 year of treatment. OM was
commonly, reflex tachycardia and, less commonly, associated with spironolactone 25 mg daily to reduce
electrocardiogram (ECG) changes, pericardial the risk of fluid retention. Additionally, 50 mg of
effusion, and congestive heart failure in patients sodium chloride was added to the capsule for
with advanced renal disease.18 The dose-related women with low blood pressure.
adverse effects were studied for the use of At a dosage of 1.25 mg daily, Beach et al22 studied
minoxidil as an antihypertensive agent, with a OM for treatment of AGA and traction alopecia in 18
typical maintenance dose between 10 and 40 mg patients, 17 of whom were female, for an average
daily.19 duration of 6 months. At follow-up, 33% of patients
Use of low-dose OM overcomes many of these reported decreased hair shedding, and 28% reported
therapeutic limitations and has recently become increased scalp hair. Similar improvements were
more popular, with several studies and reports noted by Jha et al23 in men taking 1.25 mg; however,
published on its efficacy and safety.This review will a higher dosage may be necessary if no response is
analyze the available studies to determine the noticed within 6 months. Ramos et al24 compared the
effectiveness and safety of OM as a treatment option efficacy of 1 mg daily OM to topical 5% solution daily
for hair loss. and found OM to be as effective as the topical
solution. Parietal hair density measured through a
METHODS blinded analysis of trichoscopic images was the
Key word searches of PubMed were performed to primary endpoint in this study. Ramos et al25 also
identify all articles discussing OM treatment of hair indicated that a lower follicular sulfotransferase
loss until April 2020. Search terms included ‘‘oral activity threshold is needed for bioactivation of OM

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J AM ACAD DERMATOL Randolph and Tosti 739
VOLUME 84, NUMBER 3

the review found case reports of OM therapy proving

Abbreviations used:
to be useful in the treatment of loose anagen hair
AGA: androgenetic alopecia syndrome, monilethrix, alopecia areata, and perma-
ECG: electrocardiography
FPHL: female pattern hair loss nent chemotherapy-induced alopecia.32-36
OM: oral minoxidil
Safety
This review found OM to be well tolerated with
only minor adverse effects described in the literature
compared to topical minoxidil. Additionally, in this (Table II). The most reported adverse effect was
study, OM produced better improvement of hair hypertrichosis, which was reported in approximately
shedding score, indicating favorable results for one fifth of patients. Interestingly, hypertrichosis was
treatment of telogen effluvium.24 The improved almost never a cause for discontinuation of the
hair shedding score supported findings by Sinclair medication, because many patients considered it
and Perera26 in which OM effectively treated chronic only a mild adverse effect and easily manageable.
telogen effluvium in women. In this study, most Overall, hypertrichosis was more common among
women (29 of 36) were taking 1 mg or less daily. patients who used 5 mg daily and was seen in slightly
In male AGA, Lueangarun et al27 studied the use of more than half of these patients.27,28,32 A dose of
a 5-mg daily dose. Measured over 24 weeks, photo- 0.25 mg had the lowest incidence of hypertrichosis
graphs showed 100% improvement, with 43% of (less than 10% of patients).21,29 Although hyper-
men having remarkable improvement. With a longer trichosis seems to be dose related, larger studies
duration of treatment, more patients showed are needed to accurately determine the true inci-
remarkable improvement. Additionally, they found dence. Areas of hypertrichosis described in the
OM to be effective both in the vertex and frontal area, studies included the face and body. Therianou
although the vertex showed greater progress.27 et al33 showed 0.25 mg twice daily OM to be a
Similarly, Jimenez-Cuahe et al28 studied male AGA satisfactory and safe alternative to topical solutions in
treated with a 5-mg or 2.5-mg daily dose. In a women who develop acute contact dermatitis to
subgroup of patients treated with OM monotherapy, propylene glycol in topical minoxidil solutions. As
mostly at 5 mg, all showed clinical improvement, with topical minoxidil, OM is associated with a
with 37.5% showing marked improvement. When temporary period of increased hair shedding that
using a lower dose of 0.25 mg, which was found to can last 3 to 6 weeks. Patients should be warned of
be effective in FPHL, Pirmez and Salas-Callo29 found this possible adverse effect to avoid premature
improvement or stabilization in 40% to 60% of male discontinuation of treatment. Most studies did not
patients treated for AGA. However, it was not report this adverse effect, but Sinclair21 reported that
considered statistically significant when hair thick- 22 out of 100 women found this increase in shedding
ness and density were evaluated. Current data to be of significant concern. No women discontinued
indicate that 2.5- to 5-mg daily doses are more treatment due to this adverse effect, and shedding
effective in treating males with AGA. However, larger ceased for most of these women within 4 weeks.
prospective studies with standardized objective Cardiovascular adverse effects were overall
measurements are needed to truly elucidate the rare and relatively minor. Blood pressure was
optimum dosing protocol for both male and female monitored in some of the studies, with only minor
patients. Interestingly, Sinclair et al30 examined the changes.21,22,26,30 Ramos et al24 found no difference
use of sublingual administration of minoxidil in mean blood pressure when comparing groups
because it bypasses hepatic metabolism for greater who used topical minoxidil as opposed to oral
bioavailability. At a dosage of 0.45 mg daily, both administration; however, OM did increase heart
male and female patients had improvements in rate by 6.5%. Postural hypotension/dizziness was
multiple measurements including Sinclair stage, reported in approximately 2% of patients. Sinclair21
Sinclair hair shedding score, and International described the use of 50 mg of sodium chloride daily
Global Assessment. for treatment of patients reporting postural hypoten-
A recent retrospective analysis by Vano-Galvan sion. Lower limb edema was seen in only approxi-
et al31 showed that OM (0.5 mg daily for women and mately 3% of patients, the majority of which were
2.5 mg daily for men) improved or maintained hair taking the 5-mg dose. Of these patients, only 1
thickness in a majority of patients with classical discontinued due to the edema.28 ECG changes
lichen planopilaris and was especially beneficial for were reported in approximately 1% of cases; how-
patients with diffuse lichen planopilaris. In addition ever, it is unclear if patients were regularly examined
to AGA, telogen effluvium, and lichen planopilaris, with ECG because this was reported in only 1 study.

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 Table I. Summary of studies

740 Randolph and Tosti

Authors Number of
and year Disease Dosage/regimen participants Results Adverse effects
Vano- LPP Median daily dose: 0.5 mg daily for N = 51 20 patients (39%) had improved hair 27% (n = 14) hypertrichosis
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Galvan women and 2.5 mg daily for men (36 F, 15 M) thickness 6% (n = 3) postural hypotension
exclusivamente. No se permiten otros usos sin autorización. Copyright ©2023. Elsevier Inc. Todos los derechos reservados.

et al,31 Average duration: 21 months Mean age: 55 y 27 patients (53%) remained stable 4% (n = 2) tachycardia
2020 There were no changes to 4 patients (8%) had worsening hair 2% (n = 1) weight gain
concomitant therapies within the thickness
last 6 months. Improvement was more likely with
higher doses in male patients.
Diffuse LPP was associated with a
better response than patchy LPP
Therianou FPHL with 0.25 mg twice per day N=9 All patients were satisfied with 22% (n = 2)
et al,33 contact Average duration: 17 months (9 F, 0 M) treatment. facial hypertrichosis
2020 dermatitis to
propylene
glycol in 2%
and 5%
solutions
of TM.
Beach AGA 1.25 mg nightly N = 18 33% had decreased hair shedding 6% (n = 1)
et al,22 Traction Average duration of prescription: (17 F, 1 M) 28% had increased scalp hair hypotension and urticaria
2018 alopecia 6 months AGA: n = 14 39% (n = 7)
All patients previously using TM (13 F, 1 M) hypertrichosis of face
Traction alopecia: In all but 1 patient, blood pressure
n = 4 (4 F, 0 M) remained normal or improved in
Average age: 41 y those with hypertension.
No heart rate changes were found.
Cranwell Loose 0.5 mg daily N = 1 (1 F) Shedding and hair density improved Hair color change from reddish-brown
and anagen hair Previously using 5% topical solution Age: 11 y in first 3 months. to light brown
Sinclair,34 syndrome for 5 years Discontinued after 12 months with no
2018 recurrence
Sinclair Chronic Varied between 0.25 mg and 2.5 mg N = 36 (36 F, 0 M) Baseline HSS: 5.64 n = 2 with transient postural
and telogen daily (29 patients used 1 mg or less Average age: 46.9 y 6-month HSS: 3.9 hypotension that resolved
Perera,26 effluvium daily) 12-month HSS: 3.05 n = 1 with ankle edema

J AM ACAD DERMATOL
2017 n = 5 at 0.25 mg n = 14 with hypertrichosis
n = 4 at 0.5 mg Average blood pressure change:
n = 19 at 1 mg S: -0.5 mm Hg

MARCH 2021
n = 8 at 2.5 mg D: 12.1 mm Hg
 VOLUME 84, NUMBER 3
J AM ACAD DERMATOL
Jimenez- AGA 5 mg daily (10 patients received N = 41 (41 M, 0 F) n = 37 (90.2%) had clinical n = 10 (24.3%)
Cauhe 2.5 mg daily, 31 patients received OM monotherapy: improvement. hypertrichosis
et al,28 5 mg daily) n = 16 n = 11 (26.8%) had marked n = 2 (4.8%) lower limb edema; 1
2019 Average age: 33.3 y improvement. patient discontinued
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n = 4 (9.8%) showed stabilization.

Of OM monotherapy subgroup: All
exclusivamente. No se permiten otros usos sin autorización. Copyright ©2023. Elsevier Inc. Todos los derechos reservados.

had clinical improvement, with 6

(37.5%) showing marked
improvement.
OM at a dose of 5 mg daily was
effective and presented an
acceptable safety profile
Pirmez AGA 0.25 mg daily N = 25 (25 M, 0 F), Improvement or stabilization was n = 5 (20%) body hypertrichosis
and Measured all receiving seen in a percentage of patients n = 4 (16%) hair shedding
Salas- d total hair density monotherapy but was not found to be statistically n = 1 (4%) pedal edema
Callo,29 d density of terminal hair Average age: 36.7 y significant. n = 13 (52%) increased beard density
2019 d new hairs n = 10 mild AGA Higher doses such as 2.5 mg or 5 mg
d new terminal hairs n = 15 severe AGA might be necessary for significant
effects in men
Lueangarun AGA 5 mg daily for 24 weeks N = 30 (30 M,0 F) Vertex area showed 100% 93% with hypertrichosis
et al,27 Average age: 38 y improvement. Remarkable 10% with pedal edema
2015 improvement was seen in 43% of 10% with ECG changes
patients.
Significantly increased total hair count
at the vertex.
Significant response at the frontal
area but less than at the vertex
area.
Ramos FPHL 1 mg daily for 24 weeks vs 5% topical N = 52 (52 F, 0 M) Total hair density increased by 12% in Hypertrichosis:
et al,24 solution daily TM 5%: n = 26 OM and 7.2% in TM d OM: 27%
2019 Average age: 47.3 y No significant difference between d TM: 4%

OM: n = 26 them (P = .10)

Average age: 40.6 y OM provides improvement of FPHL Edema:

Randolph and Tosti 741

d OM: 4%
that does not differ from TM, with a
d TM: 0%
safe profile and well-tolerated
adverse effects. Scalp pruritus:
d OM: 0%

d TM: 19%

Mean heart rate:

d OM: increase by 6.5%

d TM: no change

No difference in mean blood pressure

between groups
Continued
 Table I. Cont’d

742 Randolph and Tosti

Authors Number of
and year Disease Dosage/regimen participants Results Adverse effects
35
Sinclair, Monilethrix 0.25 mg to 0.5 mg N = 2 (2 F, 0 M) Patient 1: Hair growth with reduced No reported adverse effects
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2016 n = 1 at 0.25 mg 35 y and 40 y breakage and increased hair

exclusivamente. No se permiten otros usos sin autorización. Copyright ©2023. Elsevier Inc. Todos los derechos reservados.

volume/length; maintained
through 2 years of follow-up.
Patient 2: Decreased shedding with
0.25 mg; improved hair density
when dosage increased to 0.5 mg
Maintained through 18 months of
follow-up
Sinclair,21 FPHL Once-daily capsule containing N = 100 (100 F, 0 M) Baseline Sinclair hair loss severity n = 4 facial hypertrichosis
2017 0.25 mg minoxidil and 25 mg Average age: 48.44 y score: 2.79 n = 2 postural hypotension
spironolactone Baseline HSS: 4.82 n = 2 urticaria (likely due to
Reduction in hair loss severity score: spironolactone)
0.1 at 3 months Average decrease of 4.52 mm Hg in
0.85 at 6 months systolic and 6.48 mm Hg in diastolic
1.1 at 9 months blood pressure
1.3 at 12 months
Reduction in HSS:
1.1 at 3 months
2.3 at 6 months
2.7 at 9 months
2.6 at 12 months
Low-dose OM is well tolerated and a
reasonable alternative to TM.
Wambier Alopecia Tofacitinib 5 mg 2 times daily or N = 12 (7 F, 5 M) n = 8 (67%) achieved [75% scalp n = 6 (50%) hypertrichosis
et al,32 areata 10 mg 2 times daily regrowth. n = 2 (17%) acne
2019 OM: 2.5 mg daily for women n = 4 (33%) achieved 11% to 75% No reported blood pressure changes,
OM: 2.5 mg twice daily for men scalp regrowth. peripheral edema, or symptoms of
Median baseline SALT score: 99.5% hypotension
Median final SALT score: 6.5%
Combination tofacitinib and OM may
be more efficacious than tofacitinib

J AM ACAD DERMATOL
monotherapy.
Yang and Permanent OM 1 mg daily N=1F Subjective increase in hair growth was None
Thai,36 chemotherapy- Age: 39 y seen at 6 weeks. After 1 year, the

MARCH 2021
2015 induced patient regrew significant amounts
alopecia of hair.
Significant decreases in telogen
follicles and a reversal of follicle
miniaturization were seen.
 VOLUME 84, NUMBER 3
J AM ACAD DERMATOL
Rodrigues- FPHL 0.25 to 2 mg daily N = 148 (148 30 patients (20.3%) had stabilization n = 25 hypertrichosis
Barata F, 0 M) of hair loss. n = 2 tachycardia
et al,20 125 patients 118 patients (79.7%) had clinical n = 1 peripheral edema
2020 received improvement (95 had slight
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concomitant improvement, 23 had marked

therapies, improvement)
exclusivamente. No se permiten otros usos sin autorización. Copyright ©2023. Elsevier Inc. Todos los derechos reservados.

including OM may be an effective and safe

d Dutasteride therapy for FPHL
d Mesotherapy

dutasteride
d TM 5%

d PRP

d Finasteride

d Flutamide

d Bicalutamide

d Cyproterone

acetate
d LLLT

d Latanoprost

Jha et al,23 AGA 1.25 mg N = 32 14/32 patients experienced marked n = 1 peripheral edema
2020 (0 F, 32 M) improvement. 13/32 experienced n = 1 hypertrichosis
Age range: mild improvement on global
18-45 y assessment.
25/32 patients experienced
statistically significant
improvement in average total hair
density per unit area and hair shaft
diameter.
1.25 mg/d can be used in male AGA,
although
2.5-5 mg/d may be necessary if
response is suboptimal after
6 months of treatment.

Randolph and Tosti 743

Sinclair AGA 0.45 mg daily (sublingual) N = 64 Male and female patients had mean n = 8 hypertrichosis
et al,30 (31 F, 33 M) reduction of Sinclair stage and n = 5 postural dizziness
2020 Mean age: 50.92 y Sinclair HSS. n = 2 peripheral edema
Male patients had mean Average blood pressure at start of
improvement of Investigator Global study: 126.27/76.69 mm Hg
Assessment. Average blood pressure after
Sublingual minoxidil at a dose of 12 months of OM use: 121.85/
0.45 mg daily was effective and had 77.46 mm Hg
an acceptable
safety profile.
Continued
744 Randolph and Tosti J AM ACAD DERMATOL
MARCH 2021

AGA, Androgenetic alopecia; D, diastolic; F, female; FPHL, female pattern hair loss; HSS, hair shedding score; LLLT, low-level light therapy; LPP, lichen planopilaris; M, male, OM, oral minoxidil; PRP,
The ECG changes were mild and consisted of
tachycardia, premature ventricular contractions,
and T-wave changes in lead 1.20,27 No severe car-
diopulmonary events were reported in any study.
Adverse effects

DISCUSSION
Introduced in the 1970s, OM was originally in-
Not discussed

tended for the treatment of severe refractory hyper-

tension. Hypertrichosis was quickly noted as a
frequent side effect, and a topical option was created
to provide the hair growth benefits of minoxidil while
circumventing the unwanted, and occasionally se-
follicular accumulation of minoxidil.

vere, adverse effects of OM. However, the topical

activity on OM, as well as greater
Bio-activation of OM related to TM
requires a lower sulfotransferase

explained by the impact of liver

activity threshold. This may be

preparation is not without limitations, because patient

and platelet sulfotransferase

compliance is frequently low.

This review found that OM has promising results
as an effective and safe option for a variety of hair
Results

loss conditions, including AGA, chronic telogen

effluvium, traction alopecia, loose anagen syndrome,
alopecia areata, monilethrix, chemotherapy-induced
hair loss, and even scarring alopecia. AGA in females
was the most studied condition, with doses between
0.25 mg and 1.25 mg proving to be effective and safe.
The combination of 0.25 mg minoxidil and 25 mg
spironolactone may prove to be the best option
because the low dose of OM limits adverse effects,
N = 13 (13F, 0M)
participants
Number of

and spironolactone aids in reducing the fluid/sodium

retention properties of minoxidil. In male AGA,
low doses of OM (0.25 mg) were found to be less
effective. Effective treatment in men was seen with
platelet-rich plasma; S, systolic; SALT, Severity of Alopecia Tool; TM, topical minoxidil.

2.5 mg or 5 mg minoxidil daily. Larger studies

comparing the efficacy of different doses with
standardized objective measurements will be needed
to clarify the best treatment protocol.
As an antihypertensive agent, minoxidil was
Dosage/regimen

typically used at 10- to 40-mg daily maintenance

1 mg daily for 24 weeks

doses. At this amount, minoxidil was associated

with several severe cardiopulmonary adverse ef-
fects. However, this review has found OM at lower
doses (\5 mg) to be tolerable, with few and mild
adverse effects. By far, the most common adverse
effect was hypertrichosis, which was reported as
mild and easily manageable. Other less common
adverse effects include postural hypotension/
dizziness, lower limb edema, mild blood pressure
changes, and ECG changes. No severe cardiopul-
Disease

monary adverse effects were noted. However,

providers must remain cautious and continue to
FPHL

monitor patient blood pressure, heart rate, and

Table I. Cont’d

signs of fluid retention such as weight gain and

pedal edema. Additionally, physicians should
et al,25

recognize OM as an option for healthy young

and year

2020
Authors

Ramos

patients who are having difficulty with the topical

formulation.

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J AM ACAD DERMATOL Randolph and Tosti 745
VOLUME 84, NUMBER 3

Table II. Summary of adverse effects with varying oral minoxidil doses
Minoxidil dosage, mg/d Men, n Women, n Hypertrichosis, n (%) Lower limb edema, n (%) Hypotension, n (%) ECG changes, n (%)
0.25 25 106 9 (6.8) 1 (0.7) 3 (2.3) 0
0.45* 33 31 8 (12) 2 (3.1) 5 (7.8) 0
0.5 0 15 4 (27) 0 0 0
1y 0 220 46 (21) 3 (1.4) 1 (1.4) 2 (0.9)
1.25 33 17 8 (16) 1 (2) 1 (5.5) 0
2.5 10 15 13 (52) 1 (4) 0 0
5 66 0 36 (55) 5 (7.6) 0 3 (4.5)
Total 167 404 117 (20.5) 13 (2.2) 10 (1.8) 5 (0.9)

ECG, Electrocardiography.
*Sublingual administration.
y
Includes data from Rodrigues-Barata et al.20 Patients took a range of doses; however, the mean dose was 1 mg, and multivariate analysis
showed no significant statistical differences among dosages.

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