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Any experience with oral minoxidil

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I could not find a really relevant thread covering this topic. I just had a HT this week in Thailand and agreed to start taking oral minoxidil. I picked up a 1 year supply (it's cheap here in Thailand). The doctor stated that in his experience he has noted excellent results from systemic use of the medication including good growth on the crown (far superior to topical use of minoxidil). He stated that the dosage prescribed is low that systemic side effects are negligible. The main problem was general growth of body hair. Unfortunately I could not find any good information on people's experiences with this drug, and it's therapeutic index or protective index for use with hair loss (pharmaceutical terms describing how efficacious the drugs are without causing serious side effects).

I would like to know if there is anybody out there using or prescribing oral minoxidil. Will I end up looking like Cousin It? And yes, I already know it was used historically for hypertension and hair growth was found as a serendipitous side effect. Any advice would be greatly appreciated! Thanks!

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NotUrAvg,

 

I wanted to direct you to a recent post on the hair loss Q & A blog discussing this very issue. I really recommend reading through it.

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I have hypertension that the mainstream medications haven't been able to touch. I talked my physician into the oral Minoxidil. I am currently on 10 mg. a day. I can't tell anything about hair growth yet as I've only been on it a week, but I tolerate it very well.

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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.

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Thank you Future_HT_Doc for the link to the blog. That discussion however was on Loniten which is the 10mg form of systemic minoxidil. I may have neglected to mention that the dosage prescribed to me was lower, maybe 1 or 2mg, thus mitigating the risks of more serious systemic side effects (Kind of like taking 1mg finasteride instead of 5mg). I don't know if there have been good head to head studies (excuse the pun) comparing it with topical minoxidil. I would love to hear your experience RCWest regarding hair growth and side effects.

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NotUrAvg,

 

Good to know that you're taking a lower concentration, but do you still think it outweighs simply using 2-5% topical minoxidil?

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Future_HT_Doc,

You are thinking exactly along the same lines I am. I would love to know if it outweighs topical minoxidil. In theory systemic medications have higher concentrations and better distribution due to circulation in the blood stream. But whether this translates to actual higher potency and efficacy I don't know. According to Dr. Path, he thinks the low dose of oral minoxidil has much better results than topical minoxidil, with a low side effect profile. I wish there was a good double blind prospective study, but I guess I have to rely on anecdotal experience. I wish there were other doctors on this forum who have had some experience with prescribing lose dose minoxidil. Maybe in your residency, Future, you can design this study and make some mullah (not that you won't be rich as a HT doctor as it is). Thanks for your input! =)

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Everybody I have spoken to on oral minoxidil thinks it is far better than the topical, studies have even proven it!

 

‘According to Dr. Path, he thinks the low dose of oral minoxidil has much better results than topical minoxidil, with a low side effect profile. He stated that the dosage prescribed is low that systemic side effects are negligible’.

 

I hope Dr Path (who is recommended on this forum) can tell us a bit more about it how he prescribes this drug. It sounds like he doesn’t recommend a diuretic with it.

 

‘I may have neglected to mention that the dosage prescribed to me was lower, maybe 1 or 2mg’

 

What dosage have you been prescribed 1mg or 2mg?

 

And are you taking it twice daily?

 

The study I saw found that best results were achieved when taken twice daily.

 

I have personally always wanted to take oral minoxidil and everybody I know on it has said it leaves the topical for dead. However I have been warned off it because of the serious side effects associated with it, my GP would not even prescribe the lower dosage when I asked him. I think Dr Path (who is a great surgeon) has an obligation to this community and especially NotUrAvg to respond to this post!

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Hey Julius thanks for your response and shared curiosity. I had a visit with Dr. Path in his clinic yesterday, and was fortunate to catch him at the end of his surgical day so I was able to have a 30 minute conversation with him about oral minoxidil. I'm a physician and reluctant to take off-label medications when they could be potentially dangerous. However, after talking with Dr. Path I was not only convinced but excited to take it.

He prescribes minoxidil 5mg PO once daily. It only has a 4 hour half life, so I don't know why he prescribes it once daily. He does not prescribe any accompanying diuretic or beta-blocker. He has twenty years of experience prescribing it to patients, and about fifteen years experience using it on himself. He states that the results of 5mg are definitely superior to 2.5mg. He has used the medication in a large number of patients, and has not seen any serious adverse reactions. He has written an entire chapter about it in "Hair Restoration Surgery in Asians" (not sure you can find that one in your local library) - Chapter 9 -Medical Treatment Including Herbs and the Unreported Use of Oral Minoxidil. He states that it potently promotes hair maturation, which could make miniaturized or vellus hairs mature to terminal hairs. This is very promising in MPB as many of the vellus hairs that are there are useless and probably doomed to fall out. Like topical rogaine, the results are reversed with cessation of the drug. Dr. Path states that stopping oral minoxidil is much more dramatic than stopping rogaine because the initial growth it caused is much greater. The main side effects he has seen are hirsutism and general growth of body hair (watch out unibrow). The fluid retention he has seen has come in the form of mild lower extremity edema and some puffiness in the face. In Thailand it's very cheap, but Dr. Path states that in the US it's something like $1000/month. I'm a little skeptical about that pricing, as epocrates suggests it maybe $20-30/month, but since i'm abroad I can't verify this. I ran into another of Dr. Path's patients from India who has been on the drug for 3 years (and swears by it), but states that he has to get it from Thailand.

 

My 2 cents. This is a very exciting prospect for me. I know that one HT session isn't going to be enough for me, but with this medication I'm adding a new weapon to the armamentarium against hair loss and towards regrowth. And a very powerful one at that. Like many others who have progressed to needing surgical treatment for MPB, I have been resigned to the limitations of medical treatments such as rogaine and propecia even though they are quite necessary to prevent further loss. No matter how effective they are, it is almost impossible to achieve adequate cosmetic results from medical therapy alone with advanced hair loss. However, Dr. Path made it sound like with oral minoxidil this was possible. He states he has patients he has turned down as surgical candidates because their hair loss was too advanced and donor area too small, and ended up prescribing them oral minoxidil. He states that when they return,. he has been shocked numerous times at the hair growth.

However, that being said, I think that using it has to be approached with caution. I have not seen good prospective studies looking at this dosage for hair loss. I don't know the therapeutic index which is extremely important for determining whether a medication is safe to take based on side effects. The side effects can be severe - tachycardia, arrthymia, and pericardial effusions. . However, there is no good data to suggest that these side effects are seen with 5mg doses. And even if they are, they may be in such small percentages it may not be worth worrying about. Even aspirin can theoretically cause aplastic anemia and Reye' syndrome (very lethal) which doesn't stop people from taking it. If it is so effetive, it makes you wonder why it is not approved by the FDA for hair loss. But asking yourself a question like that is useless because most reasons are financial or political and not related to safety. In medicine, when there are no good studies, the next best thing to look at is physicians' experiences. As far as credibility and experience, there are few who are up there in caliber with Dr. Path. So for me, it's an issue of trust, and if he recommends it for me, then yes, I trust him. I doubt you will be able to find a doctor in the US willing to prescribe the medication. Not because they have any knowledge about it's use or safety, but because they don't want to take on the unnecessary liability in giving a drug they have no experience in using, especially in a very litigious medical environment. In my opinion (I'm no cardiologist), I don't think it would be prudent to use this if anyone has any history of heart problems or arrythmias. If someone is on other antihypertensives, it's use should be monitored very closely, as to avoid orthostatic hypotension. But Dr. Path did not state that I should be monitored by a physician when I use it, so I don't know if he requires it's use to be monitored. I am young though without any other medical conditions, so I feel a little safer using it. Anyways, I'm very sorry for rambling on. I hope this discussion will be found useful to others. I would love to hear the opinion of any HT docs and any patients who have used oral minoxidil.

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Where can I get it from in Thailand? And how do you plan on getting it once you run out?

 

Will you take 2.5mg PO twice daily?

 

By the way if you are on oral minoxidil many hair restoration surgeons like H&W will require you to go off it two months before surgery like the topical, however the hair gained by using it will all have fallen out within a month because it doesn’t stay in the system as long as the topical which lasts three months.

 

I found this article on the net:

 

 

 

LONITEN (ORAL MINOXIDIL) FOR HAIR LOSS

 

 

 

Background: Loniten (pronounced Lon-ah-tin) is intended for patients with high blood pressure. Incidentally, it was also discovered that a very commonly reported side effects of Loniten is hair growth. Rogaine or topical minoxidil is a spinoff from Loniten and turned out to be a multi-million dollar success for Upjohn as a hair loss treatment. Recently, some have been experimenting with Loniten (oral minoxidil) to treat androgenetic alopecia.

Upjohn listed "undesirable hair growth" as one of the side effects associated with Loniten. Specifically, 8 out of every 10 patients reported that body hair grew longer and darker while on Loniten. The hair growth usually starts within 3 - 6 weeks after beginning treatment. It is commonly reported that the hair growth tends to start on the forehead, temples, cheeks, and between the eyebrows. Subsequently, hair growth may be noticed on arms, legs and scalp. Some of HairSite readers also reported denser eyebrows and hair on the back while on treatment. Upjohn further added that the hair growth is not permanent. It will stop within 1 - 6 months after discontinuing the treatment.

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. More info about spironolatcone.

 

 

These are some posts about oral spiro I found on another forum I thought may interest you:

 

I take all 10 mg in the morning. I'm not sure if it would be more effective to divide it into day and night.

 

I noticed thickening on 5 mg but 10 mg is a lot more effective.

 

I have not noticed fluid retention but I do take spironolactone. However, I've had to drop back dow to 50 mg as gyno is a huge problem.

 

I haven't had any chest pains or tachycardia. I attibute that to the beta blocker.

 

I have had an increase in body hair. On the arms, back, hands, forehead, eyebrows, eye lashes, sideburns and scalp.

 

Ive said it b4 and i will say it again ....Fin taken in conjunction with 5 mg of ORAL Minoxidil will turn your hair into CARPET..FISHING LINE ..whatever other metaphors you can come up with to describe how your hair shaft starts to look as thick as a tree trunk HOWEVER..the sides will positvely FLOOR YOU !!!!

 

 

 

5mg of oral minoxidil is not an especially high dose nor is it especially dangerous short term but i wouldn't take it over a long period, i.e. more than a year....people take 15mg orally for hairloss and these are the people i would say should reconsider...15mg orally is too dangerous...5mg every-other day for example certainly won't FLOOR you, but it's a little too risky over the long term...personally i used it and just shed a lot...a LOT...which freaked me out and i knocked it on the head...maybe i would've got some mega growth a couple of months later but i didnt want to find out...at that stage i still had a resonable NW2 and didnt want to keep going through big sheds at such an early stage in my treatment, so i persevered with topical minoxidil, hassle though it is

 

 

I once ingested a dose of 500mg minoxidil by mistake...and woke up the next day close to death, with a face swollen to twice its normal size, i was absurdly pale and had difficulty walking out the house....i somehow drove to work but was immediately sent home...in other words, the stuff IS very dangerous and anyone thinking more is better with it is simply asking for trouble...my advise would be if you're set on trying it, then start off on 5mg every other day.....if nothing happens on that then maybe try 5mg a day for a while....if nothing happens on that or if the gains are minimal then forget it - if you grow an absolute shitload of hair from it then i guess the risk is your own to weigh up as to whether you want to continue on it long term to keep a thick head of hair...being aware all the time of course that at some point its effectiveness would wear off and you'd have to continue taking it just to maintain, or even go to a higher dose to gain back your initial growth from the 5mg....and therein lies the danger

 

 

 

I found this on Dr Rassman’s (who is recommended here) balding blog:

 

Is oral minoxidil (loniten) good for treating hair loss?

No. Taken orally, minoxidil’s major impact will be a drop in blood pressure, not a treatment for hair loss. That is the reason it is placed on the scalp when used for hair loss.

Minoxidil Tablets

May 23 2006, 11:32 am PT | Posted in: Drugs

In Australia, there’s a hair clinic that’s been supplying Minoxidil tablets once a day in their offerings to young hair loss sufferers for a long time now. Reports indicate that maybe 50% of them have astounding scalp hair growth with a few side effects, but this medication when administered orally in tablet form, is not approved for this purpose by the FDA.

One reputable doctor does reports using the Minoxidil pill for severe psychological suffering in the young man and adding to it lotions containing finasteride and Rogaine. He warns of side effects and requires careful monitoring, which must be explained to the patient and the parents when minors are involved, and to use the medications only as a short term bridge for those young men with severe psychological dysfunction, until they can surround the dysfunctional state. There is caution suggested when side effects show up, because they can be life threatening. Of the ten or so young men reported by this doctor who received the pill in a 15 year period, one patient had excessive body hair and one developed occasional heart flutters. Stopping the medication stopped the heart flutters, but the excess body hair seemed to stay with the one patient that had it.

Minoxidil was originally developed as an antihypertensive agent to treat high blood pressure. If this medication is given to people without high blood pressure, it could drop the blood pressure enough to produce more than a heart flutter — like a heart attack or stroke — in some individuals who have other underlying conditions that lie dormant. Just remember, Minoxidil taken orally is NOT approved as a hair loss treatment. It may drop your blood pressure dangerously low and may cause strokes and even death.

 

 

 

I found this on Dr Bernstein’s (who is recommended here) blog:

 

Q: Is Loniten good for treating hair loss?

A: Loniten (oral minoxidil) is not useful for treating hair loss. The reason is that it stimulates hair growth all over the body (hypertrichosis) and has a number of serious side effects.

Even when used to treat blood pressure, for which it is FDA approved, it is a medication reserved only for severe hypertension, used after at least three other types of blood pressure medications have been tried and are unsuccessful.

In addition to increased body and facial hair growth, it can cause fluid retention and heart disease. When used topically (topical generic minoxidil or Rogaine) the medication generally does not cause any significant problems other than local skin irritation and occasionally increased facial hair (which can be real nuisance for women).

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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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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.

Edited by RCWest

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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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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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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.

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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.)

 

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!

 

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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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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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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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

Edited by Julius

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Just to update this topic, here is a little bit of info on doseage for hair loss.

 

http://dermatology.cdlib.org/rxderm-archives/minoxidil-alopecia

 

Arch Dermatol -- Abstract: Percutaneous Absorption of Minoxidil in Man, February 1985, Franz 121 (2): 203

 

From what I gather, applying topical 2% is roughly equal to 5 mg. daily of oral?

So if you want the equivalent of 5%, take 12.5 mg. of oral minoxidil daily.

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My general physician claims that oral minox has provided significant growth on his scalp, as well as his nephews. He gave me a prescription and I began to take 2.5 mg in the morning and 2.5 mg before bed. I stopped taking it because I thought it was making me feel tired and weak, and I couldn't find very much information on it through my research. After reading some of this I might give it another shot at a lower dose.

 

Would anyone recommend not taking oral minox along with topical minox?

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Hey Julius thanks for your response and shared curiosity. I had a visit with Dr. Path in his clinic yesterday, and was fortunate to catch him at the end of his surgical day so I was able to have a 30 minute conversation with him about oral minoxidil. I'm a physician and reluctant to take off-label medications when they could be potentially dangerous. However, after talking with Dr. Path I was not only convinced but excited to take it.

He prescribes minoxidil 5mg PO once daily. It only has a 4 hour half life, so I don't know why he prescribes it once daily. He does not prescribe any accompanying diuretic or beta-blocker. He has twenty years of experience prescribing it to patients, and about fifteen years experience using it on himself. He states that the results of 5mg are definitely superior to 2.5mg. He has used the medication in a large number of patients, and has not seen any serious adverse reactions. He has written an entire chapter about it in "Hair Restoration Surgery in Asians" (not sure you can find that one in your local library) - Chapter 9 -Medical Treatment Including Herbs and the Unreported Use of Oral Minoxidil. He states that it potently promotes hair maturation, which could make miniaturized or vellus hairs mature to terminal hairs. This is very promising in MPB as many of the vellus hairs that are there are useless and probably doomed to fall out. Like topical rogaine, the results are reversed with cessation of the drug. Dr. Path states that stopping oral minoxidil is much more dramatic than stopping rogaine because the initial growth it caused is much greater. The main side effects he has seen are hirsutism and general growth of body hair (watch out unibrow). The fluid retention he has seen has come in the form of mild lower extremity edema and some puffiness in the face. In Thailand it's very cheap, but Dr. Path states that in the US it's something like $1000/month. I'm a little skeptical about that pricing, as epocrates suggests it maybe $20-30/month, but since i'm abroad I can't verify this. I ran into another of Dr. Path's patients from India who has been on the drug for 3 years (and swears by it), but states that he has to get it from Thailand.

 

My 2 cents. This is a very exciting prospect for me. I know that one HT session isn't going to be enough for me, but with this medication I'm adding a new weapon to the armamentarium against hair loss and towards regrowth. And a very powerful one at that. Like many others who have progressed to needing surgical treatment for MPB, I have been resigned to the limitations of medical treatments such as rogaine and propecia even though they are quite necessary to prevent further loss. No matter how effective they are, it is almost impossible to achieve adequate cosmetic results from medical therapy alone with advanced hair loss. However, Dr. Path made it sound like with oral minoxidil this was possible. He states he has patients he has turned down as surgical candidates because their hair loss was too advanced and donor area too small, and ended up prescribing them oral minoxidil. He states that when they return,. he has been shocked numerous times at the hair growth.

However, that being said, I think that using it has to be approached with caution. I have not seen good prospective studies looking at this dosage for hair loss. I don't know the therapeutic index which is extremely important for determining whether a medication is safe to take based on side effects. The side effects can be severe - tachycardia, arrthymia, and pericardial effusions. . However, there is no good data to suggest that these side effects are seen with 5mg doses. And even if they are, they may be in such small percentages it may not be worth worrying about. Even aspirin can theoretically cause aplastic anemia and Reye' syndrome (very lethal) which doesn't stop people from taking it. If it is so effetive, it makes you wonder why it is not approved by the FDA for hair loss. But asking yourself a question like that is useless because most reasons are financial or political and not related to safety. In medicine, when there are no good studies, the next best thing to look at is physicians' experiences. As far as credibility and experience, there are few who are up there in caliber with Dr. Path. So for me, it's an issue of trust, and if he recommends it for me, then yes, I trust him. I doubt you will be able to find a doctor in the US willing to prescribe the medication. Not because they have any knowledge about it's use or safety, but because they don't want to take on the unnecessary liability in giving a drug they have no experience in using, especially in a very litigious medical environment. In my opinion (I'm no cardiologist), I don't think it would be prudent to use this if anyone has any history of heart problems or arrythmias. If someone is on other antihypertensives, it's use should be monitored very closely, as to avoid orthostatic hypotension. But Dr. Path did not state that I should be monitored by a physician when I use it, so I don't know if he requires it's use to be monitored. I am young though without any other medical conditions, so I feel a little safer using it. Anyways, I'm very sorry for rambling on. I hope this discussion will be found useful to others. I would love to hear the opinion of any HT docs and any patients who have used oral minoxidil.

Fin has like a 6-8 hour half life and it is once a day....and once your dht levels have dropped it takes like a week to pic back up....so 1/2 life doesn't mean everything depending on what it is doing to your system...but you know that...

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