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Hair Loss Drugs Share your opinions and experiences regarding drugs like Propecia (finasteride), Minoxidil and others.

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  #11   Top  
Old 07-12-2010, 05:52 AM
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Julius,

Thank you for sharing this information. Although NotUrAvg did state that he would be taking a much lower dose than that found in Loniten (1 % versus 10% minoxidil I believe) it does not seem like many hair restoration physicians recommend systemic minoxidil in general. Hopefully, NotUrAvg will take this into consideration and possibly consult with another physician or even a recommended surgeon before beginning a full regimen?
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  #12   Top  
Old 07-12-2010, 06:58 PM
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Quote:
Originally Posted by Future_HT_Doc View Post
RCWest,

I apologize for the intrusion (and if it's too personal, feel completely free not to answer), but did your doctor prescribe a diuretic to take with the oral minoxidil? From my personal research, it seemed like one of the biggest downfalls with taking oral minoxidil for hair loss was not taking it with the prescribed diuretic to prevent water retention, swelling, and weight gain.

Yes he did. He prescribed me a diuretic, and I was already on a beta blocker (Atenolol). He said that at that low dose that I probably wouldn't notice side effects. He says in extreme hypertension cases that Loniten can be given at up to 100 mg./day!

NotUrAvg-I've only been on it for 5 days. So far it's well tolerated. My insurance pays for it, but off insurance 30 10mg. tabs is well under $20.
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Finasteride 1.25 mg. daily
Avodart 0.5 mg. daily
Spironolactone 50 mg twice daily
5 mg. oral Minoxidil twice daily
Biotin 1000 mcg daily
Multi Vitamin daily

Damn, with all the stuff you put in your hair are you like a negative NW1?

Last edited by RCWest; 07-18-2010 at 07:57 AM.
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Old 07-13-2010, 12:12 AM
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Loniten Tablets come in 2.5 mg, 5 mg and 10mg.

Check this out:
http://www.medicines.org.uk/emc/document.aspx?documentid=1532


It would sure be nice if a Dr. could contribute here as there are serious safety concerns!
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Old 07-13-2010, 07:49 AM
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It's true that Loniten is among the most powerful blood pressure drugs out there. BUT, such a low dose is almost unnoticeable unless you have hypotension.
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Finasteride 1.25 mg. daily
Avodart 0.5 mg. daily
Spironolactone 50 mg twice daily
5 mg. oral Minoxidil twice daily
Biotin 1000 mcg daily
Multi Vitamin daily

Damn, with all the stuff you put in your hair are you like a negative NW1?
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Old 07-13-2010, 03:14 PM
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I just thought I'd let you guys know that I contacted Dr. Pathomvanich, informed him of this discussion, and asked if he would give his input on prescribing oral minoxidil. Hopefully, he will clear up some issues. I look forward to his reply. Thanks.
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Old 07-14-2010, 12:28 PM
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Julius, your research into the topic is impressive and extremely helpful. I will be looking forward to sharing our experiences starting the medication together (I started it 2 days after you). Future_HT_Doc, thanks for trying to get Dr. Path involved in the discussion. He has literally written the book (or at least the chapter) on the subject, and until I find another HT doc with 20 years of experience prescribing this medication, I will assume he is one of the foremost authorities on it's use. His contribution to the discussion will be of extreme value. And to answer your concerns " Hopefully, NotUrAvg will take this into consideration and possibly consult with another physician or even a recommended surgeon before beginning a full regimen? " I have discussed it with other physicians, and I'm a physician myself, so I guess you can say I've discussed it with myself =) And as far as talking with a recommended surgeon, it was Dr. Path who recommended it's use, so I feel, like I said, I've gotten advice from one of the world's experts on the appropriateness of the medication for my specific situation. In my opinion, unless another HT doctor has personal history using the medication in their patients, their advice will be based more on conjecture than experience (I hope that doesn't sound offensive). This is a great discussion about, what I think, may be a good weapon against hair loss.[IMG]file:///C:/DOCUME%7E1/CHRISC%7E1/LOCALS%7E1/Temp/moz-screenshot-4.png[/IMG]
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Old 07-14-2010, 07:16 PM
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Quote:
Originally Posted by NotUrAvg View Post
Future_HT_Doc, thanks for trying to get Dr. Path involved in the discussion. He has literally written the book (or at least the chapter) on the subject, and until I find another HT doc with 20 years of experience prescribing this medication, I will assume he is one of the foremost authorities on it's use.
I agree that Dr. Path is definitely an expert and I have complete confidence in his skills. However, my concern is simply that most physicians seemed to recommend against this treatment, so his specific input would be extremely helpful (you don't happen to have a PDF of that chapter, do you?? I'd love to review it.)

Quote:
Originally Posted by NotUrAvg View Post
I have discussed it with other physicians, and I'm a physician myself, so I guess you can say I've discussed it with myself =)
I definitely remember, and think this gives you a very unique point of view. Like your forum name suggests, you definitely aren't the "average" transplant patient : ). Additionally, I wanted to let you know that I have nothing but respect for your expert knowledge and training!

Quote:
Originally Posted by NotUrAvg View Post
And as far as talking with a recommended surgeon, it was Dr. Path who recommended it's use, so I feel, like I said, I've gotten advice from one of the world's experts on the appropriateness of the medication for my specific situation. In my opinion, unless another HT doctor has personal history using the medication in their patients, their advice will be based more on conjecture than experience (I hope that doesn't sound offensive).
You are definitely not being offensive at all! I really appreciate your contribution to this discussion, and I hope you understand that my only concern is the safety and efficacy of the restorative treatments used on this site. Like you said, Dr. Path is an expert, and I have nothing but respect for his opinion. I would just like to hear his explanation for this case and for future questions regarding oral minoxidil. Additionally, I'm pleased to say that I received an email from Dr. Path this morning, and he is in the process of creating a reply for this thread. I think this should help with a lot of the concerns and questions regarding this matter. Furthermore, I'm hoping a few other expert physicians will give their input on the use of oral minoxidil.

Thank you for being so responsive and helpful thus far NotUrAvg. I hope my input has been helpful and I think we'll both benefit from Dr. Path's impending reply.
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  #18   Top  
Old 07-15-2010, 10:43 AM
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Default Minoxidil Tablet for hairloss treatment

Thanks for allowing me to share my experience for the use of Oral Minoxidil in the treatment of Androgenic Alopecia.

Minoxidil is a peripheral vasodilator used officially as an antihypertensive. It occurs as a white crystalline powder and is soluble in alcohol, propylene glycol and slightly soluble in water.

The chemical name is 2, 4, - pyrimidine-diamine, 6-(1- piperidinyl), 3-oxide with molecular wt. 209.25.

More than 90% of drug is absorbed from gastrointestinal tract, reaching the maximum plasma level within first hour and declining rapidly thereafter. The average half-life in humans is 4.2 hours. Approximately 90% is metabolized predominantly in Liver by conjugation with glucuronic acid, with some by conversion to more polar products. All metabolites are excreted in urine.

Minoxidil is a direct acting peripheral vasodilator capable of reducing both elevated systolic and diastolic blood pressure. It does not interfere with the vasomotor reflux and is therefore unlikely to produce orthostatic hypotension. The primary use is for the treatment of hypertension.

Dosage is usually 2.5 to 100 mg per day as a single dose for adults.

The side effect is salt and water retention, with swelling of hands and feet, face, lower legs; rapid weight gain can occur.

Cardiovascular effects including chest pain, hypotension, and fast and irregular heart beat are possible effects. Hypertrichiosis without virilism as elongation, thickening and increased pigmentation of fine body hair are seen in about 80% of users, developing within 3-6 weeks after starting the therapy. Hypertrichosis is usually first noticed on the temples, glabella, forehead or along the sideburns. Later it may extend to a back, arms, legs, and scalp. Upon discontinuation of minoxidil the growth of new hair is arrested, but 1- 6 months may be required to resume pretreatment appearance. No endocrine abnormalities have been found to explain to this abnormal hair growth.

Other effects like thrombocytopenia, nausea, vomiting are uncommon. Breast tenderness occurs in less than 1%. Allergic rashes, blurred vision; flushing of the skin; headache; decreased sexual desire or impotence; numbness or tingling in the hands, feet or face have all been reported.

Contraindication
Minoxidil should not be used in Pheochromocytoma or those who are sensitive to the components of the preparations. It may produce pericardial effusion and occasional tamponade. Angina pectoris may be exacerbated. Full details of the drug usage and side effects may be found in the PDR.

Minoxidil may pass from mother to the child through breast milk. Therefore, women who are pregnant and breast feeding should not use minoxidil.

When I started my private practice 20 years ago, I have seen a large number of patients who were taking oral minoxidil other than minoxidil lotion from other physicians and some patients even took on their own. I was entirely against taking oral minoxidil since it is not approved by the FDA and encouraged those patients to change to minoxidil lotion only, in fear of the side effects from oral minoxidil. After many years of practice, I have realized the remarkable effect on hair growth from oral minoxidil compared with the lotion. In many patients the result has changed from minimal hair over the scalp i.e. miniaturized hair to the cosmetic fullness of hair i.e. more terminal hair growth over both the front and the crown areas. Some have responded only at the crown but not at the front; also, there were patients who did not respond other than hypertrichosis. I have a few patients, whom I turned them down for hair transplantation surgery since they were poor candidates’ i.e. poor donor and severe degree of hair loss. One of them took oral minoxidil on his own and I was amazed when he returned to see me in four months, his temples hair was full with moderate hair growth at the crown but not at the front and made him a candidate for hair transplantation. Please see the attached photograph below. I did two sessions of hair transplant surgery on him and he was happy with the final results.

I prescribed oral minoxidil for hair loss treatment in less than 1% of patients in my practice over past 20 years. These are those hopeless patients who have the hair loss problem with no response from finasteride, dutasteride and minoxidil lotion but the patient wants to have some treatment option to treat the hair loss. I use it with caution, since there is no study regarding the dosage and safety in treating androgenic alopecia.
I do not prescribe this medicine to patients who are known to have cardiovascular disease, history of deranged blood pressure, liver and kidney dysfunction.


What is the optimal dose of oral minoxidil for the hair growth with minimal side effects?

I have learned from other physicians, who have prescribed minoxidil extensively to treat androgenic alopecia and was informed that 5 mg daily was enough to stimulate the hair growth without any effect on blood pressure and heart rate. One of my patients, who took oral minoxidil tablet and lives close by the clinic, came to the clinic twice a day for blood pressure monitoring for one month and all the reading were within the normal limits of his baseline; therefore, I am no longer monitoring the blood pressure as often as I did in the past. I have been using 5 mg daily for years and in some patient taken a low dose such as 2.5 mg tab per day or 5mg every other day still reported significant hair growth and stopped the hair loss to his satisfaction.

The most common side effect in my practice was puffy eyelids, leg swelling. Similar to any other forms of hair growth product, the gain hair will shed in 3-4 months on stopping the pill. This oral form should not be used in women due to hypertrichosis, it may persist in cases even on discontinuing the drug.

All of my patients were informed that the US FDA did not approve the use of oral minoxidil for hair growth and they have to take at their own risk, after understanding the risk and complications of the drug. I believe all the drug have side effects whether they are finasteride, dutasteride, spironolactone or dianee (for female hair loss). The long term treatment with oral minoxidil has more benefit than the chances of over said side effects at the low dose 2.5 - 5 mg once daily needs to be further studied. I advise the patient once the hair loss has stopped and experienced hair gained to stop oral minoxidil and switch back to minoxidil lotion for the long term maintenance usage. However, most of the patients did not want to switch to minoxidil lotion since there was no side effect noted. In some patient who switched to minoxidil lotion reported progressive hair loss.


I did not prescribe the diuretic as a routine since most of patients who experience water retention, refused to continue with this drug. Publications from Upjohn explicitly stated that a diuretic "must be" taken in conjunction with Loniten in most cases. The rationale is that while Loniten lowers blood pressure, your body's defense mechanism will automatically return your blood pressure to the original elevated level. Your body accomplishes that by retaining water and salt so that there will be more fluid to pump throughout the body. So in order for Loniten to be safe to consume, it is necessary to use a diuretic medication to remove excess water and salt from your body. Spironolactone is a natural choice for most hair loss sufferers since not only is Spironolactone a diuretic, it is also a potent anti-androgen.

In conclusion, only few percentage of the bald population in the world approaches the hair restoration clinics for the solution for hair loss. Of these there are many people who have marked social and emotional impact of hair loss in their lives thus, affecting their psychology. Most of these patients are very well benefited by the treatments like topical minoxidil, oral finasteride and the currently available artistic hair transplant surgeries offered by the clinics.

However there are number of patients, who are poor candidates for the hair transplant as they have poor donor area i.e. small donor area, thinning over donor area or have poor quality (more miniaturization at donor site) with large area of baldness NW-Class VII and searching for any possible hope that might improve their hair loss. These patients need to be emphasize regarding the side effects of oral minoxidil and with no FDA approval for hair loss indication. If patient consent's for this treatment, we propose to these terminal hair loss but high hoping patient that they might get benefit from opting to the oral minoxidil as the last sort of therapy till further new drug is available.

Best regards,
D. Pathomvanich MD FACS
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  #19   Top  
Old 07-15-2010, 12:08 PM
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Very well said Dr Path. I think at least, there is some light at the end of the tunnel for those high NW with bad donor density!

Blake, thanks for looking into this issue, who knows, maybe u will start an oral minoxidil evolution when u are ready to be a HT doc
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Old 07-16-2010, 11:54 PM
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Thank you Future HT Doc for all your work on behalf of this community.

Dr Pathomvanich thank you very much for your reply it is very much appreciated and deserves to be applauded.

Do you think the efficacy wears off overtime as with the topical?

NotUrAvg said you use it yourself (even though you appear to be a lower Norwood), is that true?


Cheers

Last edited by Julius; 07-17-2010 at 04:08 AM.
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