Low-Dose Oral Minoxidil (Loniten)
Oral minoxidil has been used for the treatment of androgenic alopecia for many years by hair loss specialists. However, in December 2020, Dr. Sergio Vañó Galván presented groundbreaking research at the Global Hair Loss Summit that sparked renewed interest in this 50-year-old medication’s potential to treat various forms of hair loss, including androgenic alopecia.
Dr. Galván’s presentation, titled “Emerging Treatments in Hair Loss,” showcased his use of oral minoxidil in cases that were resistant to other treatments, with impressive results. Since then, hair loss specialists and dermatologists have been prescribing low-dose oral minoxidil and seeing what is being described as remarkable outcomes in their patients.
Recent studies have shown that low-dose oral minoxidil can be a safe and effective treatment for hair disorders, such as male-patterned hair loss and female-patterned hair loss. Oral minoxidil offers practical advantages over its topical formulation, such as improved cosmesis, cost savings, and the potential for co-therapy with other topicals as well as the ease of use of camouflage products since topical application will not interfere with application.
Low-dose oral minoxidil may be especially helpful for patients who cannot tolerate topical minoxidil or other systemic treatments. The usual dose for female-patterned hair loss is 0.25 to 1.25 mg daily, while the dose for male-patterned hair loss is 2.5 to 5 mg/day. The low side-effect profile of low-dose oral minoxidil allows for long-term adherence to the medication and favorable clinical response, resulting in stabilization and improvement of hair loss.
Minoxidil works by shortening the telogen phase and prolonging the anagen phase of hair growth, resulting in an increase in hair diameter and length. The active derivative of minoxidil, minoxidil sulfate, is converted by follicular sulfotransferase activity, and its pharmacologic action comes from its sulfated metabolite. Recent studies suggest that oral minoxidil, when given orally instead of topically, may reach a higher follicular accumulation due to conversion by platelet sulfotransferase.
Minoxidil works as a vasodilator, an inducer of the Wnt/β-catenin signaling pathway, and has anti-androgenic and anti-inflammatory properties. It relaxes blood vessels, leading to an increased supply of nutrients and oxygen to the hair follicles, and reduces perifollicular microinflammation, suppressing T-lymphocytes. Minoxidil’s anti-inflammatory effect is enhanced by inhibiting the effects of prostacyclin and interleukin-1α.
Minoxidil may also stimulate the release of vascular endothelial growth factors and activate the β-catenin signaling pathway, which plays a role in hair follicle regeneration. Finally, oral minoxidil’s use in scarring alopecias is justified by its anti-fibrotic properties, inhibiting lysyl hydroxylase, an enzyme necessary for collagen cross-linking. Further studies are needed to test the efficacy of oral minoxidil in other types of alopecia and compare it to other commonly used medications.
While low-dose oral minoxidil is generally safe and well-tolerated, there are potential adverse effects that should be considered. Some common side effects include fluid retention, which may manifest as edema, weight gain, or increased blood pressure. Patients with pre-existing cardiovascular or renal disease may be more susceptible to these side effects, so caution should be exercised in these populations. Additionally, some patients may experience hypertrichosis, or excessive hair growth, which can be a cosmetic concern. Other potential adverse effects include headache, dizziness, and gastrointestinal disturbances such as nausea and vomiting.
It is important to note that oral minoxidil is a prescription medication and should only be used under the supervision of a qualified healthcare provider. Patients with a history of heart disease, kidney disease, or high blood pressure should inform their healthcare provider before starting oral minoxidil. Pregnant women should not use oral minoxidil due to potential risks to the fetus. Patients should also inform their healthcare provider of all medications they are taking, including over-the-counter and herbal supplements, to avoid potential drug interactions. Regular monitoring of blood pressure and kidney function may be necessary during treatment with oral minoxidil. Patients should not exceed the recommended dosage and should report any adverse effects to their healthcare provider immediately.
Used for: Male Pattern Baldness, Female Pattern Baldness