People with hair loss may soon have an easier time treating this condition with pills instead of applying medicated foams and oils like Rogaine directly to their scalp thanks to a new international consensus statement for using oral minoxidil.
The consensus statement provides guidance on the best oral minoxidil starting doses for different patients with hair loss, as well as the potential benefits and risks of this treatment option. This information should help more doctors feel comfortable prescribing oral minoxidil for hair loss, says Brittany Craiglow, MD, a coauthor of the new guidelines and an associate adjunct professor of dermatology at Yale University School of Medicine in New Haven, Connecticut.
“Given that the use of oral minoxidil in dermatology is still quite new, many doctors do not yet feel comfortable prescribing it,” Dr. Craiglow says. “This consensus statement provides a lot of useful information regarding indications, dosing, and adverse effects that will hopefully give dermatologists more confidence in its use.”
Why Are Minoxidil Pills Better for Some People Than Topical Minoxidil Treatments Like Rogaine?
Thinning hair is extremely common as people age. It affects more than 80 percent of men and almost 50 percent of women, according to NYU Langone Health. Many people turn to topical treatments like creams, shampoos, oils, and gels that promise to regrow hair or stop the problem from getting worse.
These treatments typically contain topical minoxidil, a form of the medicine that’s been approved by the U.S. Food and Drug Administration (FDA) as a hair loss remedy. The trouble with topical minoxidil is that it’s often too expensive, ineffective, or disliked by patients due to how it feels or looks, according to the new consensus statement, which is published in JAMA Dermatology.
Oral minoxidil isn’t approved by the FDA for hair loss — only topical minoxidil is. However, doctors are free to prescribe oral minoxidil (which is FDA-approved for high blood pressure) for this “off-label” use, and the new consensus statement endorses this option for people who don’t get what they want with topical minoxidil.
“The consensus suggests that low-dose oral minoxidil may be considered if topical minoxidil application is logistically challenging, or results in undesirable hair styling issues or scalp irritation, or has not been effective, or is more affordable,” says Paradi Mirmirani, MD, a coauthor of the statement and a dermatologist practicing in Northern California.
Do I Need a Prescription for Minoxidil Pills?
The statement recommends a maximum daily oral minoxidil dose of 5 milligrams (mg) for adults and adolescent males, and a top daily dose of 2.5 mg for adolescent females. It also recommends optimal starting doses for patients based on age and sex:
Patients should consult with their primary care physician or a cardiologist before starting minoxidil pills to make sure they won't interact with other medications and to determine whether any precautions might be needed due to certain underlying medical conditions that can increase the risk of side effects, per the statement.
Side effects of oral minoxidil can include:
A sharp drop in blood pressure
Accumulation of fluid around the heart
Rapid and irregular heartbeat
Headaches
Dizziness
Who Shouldn’t Take Oral Minoxidil?
People who are pregnant or have certain heart conditions like congestive heart failure or pericarditis (fluid around the heart) should not take minoxidil pills, according to the statement. People with a history of low blood pressure, irregular heartbeat, or kidney disease should see a specialist in those conditions before taking oral minoxidil because they may need closer monitoring for side effects, the statement recommends.
“Certainly I will be a bit more cautious in patients with known heart disease and will often reach out to their primary care provider or cardiologist to confirm that low dose minoxidil will be okay, which it usually is,” says Adam Friedman, MD, a professor and chair of dermatology at George Washington School of Medicine and Health Sciences in Washington, DC, who wasn’t involved in the consensus statement.
Some patients at risk for cardiac side effects might need lab tests or an electrocardiogram before starting oral minoxidil, but these evaluations don’t need to be routinely done for every person taking the drug, according to the statement.
Tom Gavin joined Everyday Health as copy chief in 2022 after a lengthy stint as a freelance copy editor. He has a bachelor's degree in psychology from College of the Holy Cross.
Prior to working for Everyday Health, he wrote, edited, copyedited, and fact-checked for books, magazines, and digital content covering a range of topics, including women's health, lifestyle, recipes, restaurant reviews, travel, and more. His clients have included Frommer's, Time-Life, and Google, among others.
He lives in Brooklyn, New York, where he likes to spend his time making music, fixing too-old electronics, and having fun with his family and the dog who has taken up residence in their home.
Lisa Rapaport is a journalist with more than 20 years of experience on the health beat as a writer and editor. She holds a master’s degree from the UC Berkeley Graduate School of Journalism and spent a year as a Knight-Wallace journalism fellow at the University of Michigan. Her work has appeared in dozens of local and national media outlets, including Reuters, Bloomberg, WNYC, The Washington Post,Los Angeles Times, Scientific American, San Jose Mercury News, Oakland Tribune, Huffington Post, Yahoo! News, The Sacramento Bee, and The Buffalo News.
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Resources
Akiska Y et al. Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement. JAMA Dermatology. November 20, 2024.
Most Men Experience Hair Loss — But It Isn't Inevitable. NYU Langone Health. 2024.
