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oral minoxidil

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Oral minoxidil
Why use oral minoxidil?

Oral minoxidil is a medication that plays a significant role in the treatment of hair loss. It is commonly used to help treat androgenetic alopecia, a condition characterized by patterned hair loss that affects both men and women. Minoxidil is a medication that was initially used to treat high blood pressure, but its ability to stimulate hair growth was discovered as a side effect.

When taken orally, minoxidil works by widening the blood vessels, thereby improving blood flow to the hair follicles. This enhanced circulation delivers essential nutrients and oxygen to the hair follicles, promoting hair growth and helping to prevent further hair loss. It also has a direct impact on the hair growth cycle by prolonging the anagen (growth) phase and shortening the telogen (resting) phase, potentially leading to increased hair density and thickness.

Oral minoxidil is often considered in cases where topical minoxidil solutions have been ineffective or if a patient is unable to tolerate the topical formulation. It requires a prescription and should be taken under medical supervision due to its potential side effects, such as low blood pressure, fluid retention, and increased heart rate.

It is important to note that the use of low dose oral minoxidil for hair loss should be approached with caution and strictly following the prescribed dosage and instructions. The information gathered in this form allows Dr. Ball to determine the appropriateness of this treatment option based on your individual circumstances and to monitor any potential side effects.

The branded form of oral minoxidil is Loniten (manufactured by Pfizer). This is Dr Ball’s recommend formulation of low dose oral minoxidil. 

Many commercially available forms of oral minoxidil are sold as generic, unbranded minoxidil (or Lonitab). Many experienced hair transplant surgeons have commented that their patients report better results when taking high quality branded medication, rather than generic copies. This is possibly due to higher quality active product ingredients (the active drug) and also higher quality exipients (the inactive ingredients) in certain branded medication compared to their generic equivalents. Also, pharmacies will often vary the supplier of their generic products depending on who is selling at the best price. 

Dr Ball recommends the use of branded Loniten (made by Pfizer), however, in the event of a national supply shortage of Loniten, the pharmacy will issue you a high quality and consistent generic minoxidil from Roma Pharmaceuticals. 

Please read section 4 of the Patient Information Leaflet for information regarding potential side effects of oral minoxidil. 

Like all medicines, oral minoxidil can cause side effects although not everybody gets them.

The following events have been reported in patients with high blood pressure being treated with oral minoxidil (Loniten) tablets:

Contact your doctor immediately if any of the following occur
• You may feel faint or dizzy, especially when you stand up.
• Your body could hold on to more water than normal: you may notice that your
ankles get puffy, or your rings get tight, or you put on weight.
• You may find that you get more wheezy, breathless and tired, especially if you
already have a weak heart.
• You may notice angina (usually pains in your chest) for the first time, or if you have
angina already it could get worse.

Other side effects LONITEN may cause are:

Very common (may affect more than 1 in 10 people):
Increased heart rate, inflammation of the lining that surrounds the heart, abnormal
electrocardiogram (ECG), increased hair growth, hair colour changes.

Common (may affect up to 1 in 10 people):
Accumulation of fluid around the heart, compression of the heart due to a build up of fluid, fluid retention.

Rare (may affect up to 1 in 1,000 people):
Decrease in white blood cells, reduction in blood platelets, which increases risk of bleeding or bruising, serious illness with blistering of the skin, mouth, eyes and genitals (StevensJohnson syndrome), inflammation and blistering of the skin, rash.

Not known (frequency cannot be estimated from the available data):
Accumulation of fluid between the layers of tissue that line the lungs and chest cavity, chest pains (angina), gastrointestinal disorders, swelling of the ankles, feet or fingers associated with or independent of weight gain, breast tenderness, reduced kidney function resulting in increased creatinine and urea levels in your blood.

The initial dose of oral minoxidil is 1.25 mg daily (half a tablet), taken just before bed. After 3 weeks of treatment, if it is well tolerated and has not had a significant effect on your blood pressure, Dr Ball recommends increasing the dose to 2.5 mg daily (a whole tablet).

The price for 60 tablets of oral minoxidil 2.5 mg tablets (2-month supply) is £47.50, including tracked 48 Royal Mail postage.

Dr. Ball will advise you on the precise dose he would like you to take. The recommended dose of oral minoxidil usually ranges from 1.25 mg to 2.5 mg daily. A standard 2.5 mg tablet can be broken in half to achieve 1.25 mg. You can purchase a pill cutter to assist in cutting the tablets in half or simply break the tablet along the scored line. Only take the dose that has been prescribed for you by Dr Ball.

How to order your medication?

Complete the online order form below.

Dr Ball will review your responses and, if clinically appropriate, will issue your prescription.

Your prescription will be sent directly to the pharmacy and they will prepare your medication.

Your order will be dispatched with Royal Mail 48 Tracked service and you will receive your tracking number.

We will check in with you periodically to ensure that you are responding well to treatment. You are welcome to contact The Maitland Clinic at any time for information or support during your treatment.

FREQUENTLY ASKED QUESTIONS

Our hair loss medication services provide a personalised, “concierge” experience for every patient. Through a comprehensive medical assessment via our order forms, we ensure that the prescribed medication meets your specific needs, health, and requirements. All hair loss medication requests are reviewed and approved by Dr Edward Ball.

Due to the increased risks when taking oral medication, we offer ongoing support and review of your treatment (including blood pressure, pulse and weight review to monitor your response to the medication).

Minoxidil is well known as a topical solution or foam for treating hair loss. However, it was originally licensed in the 1970s as an oral medication (tablet/pill) for treating high blood pressure. One of the side effects that was noticed in patients using the tablet for high blood pressure was an increased amount of hair on the body and scalp. This prompted further study and ultimately the development of topical minoxidil.

Both oral and topical minoxidil are available today. Topical minoxidil can be bought without a prescription under the brand name Regaine and is also available as a generic (unbranded) product.

Oral minoxidil requires a prescription and more follow up monitoring. The licensed indication for oral minoxidil is to treat severe hypertension (high blood pressure) that does not respond to standard treatments. Patients taking minoxidil for blood pressure control use 10-40 mg daily, with a maximum dose of 100 mg. The dose used for hair loss is only 1.25 mg to 2.5 mg (considerably less than the dose used for treating blood pressure).

Oral minoxidil has been less well studied compared to topical minoxidil. However, there is evidence for benefit in androgenetic alopecia (male pattern hair loss), hair fragility disorders, alopecia areata and chemotherapy related hair loss.

 

Despite years of use, the precise mechanism by which minoxidil helps hair growth is not fully known. It is believed that it helps increase blood flow in the scalp. Minoxidil use also leads to hair follicle potassium channel activation, prolonging the anagen growth phase of the hair cycle and shortening the telogen resting phase.

Applied on the scalp, topical minoxidil is converted to its active form, minoxidil sulfate, by sulfotransferase enzymes located in the outer root sheath of the hair follicle. Variations between individuals in sulfotransferase activity might explain why some patients respond better than others to topical minoxidil. In fact, studies have shown that as few as 30-40% of patients will achieve hair growth with topical 5% minoxidil. Oral minoxidil is thought to be activated by liver and platelet sulfotransferase, therefore achieving a higher accumulation in the hair follicle than topical minoxidil. 

No. Oral minoxidil is not licensed for the treatment of hair loss but has been used very successfully in recent years as an “off-license” treatment for androgenetic alopecia (male and female pattern hair loss).

Oral minoxidil is licensed for the treatment of hypertension (high blood pressure). It was used in the 1980s in high doses as a blood pressure treatment but found to cause hypertrichosis (excessive hair growth on the head and also the face and body).

It is possible for a doctor to prescribe low dose oral minoxidil “off license” when clinically indicated and when the risks and benefits have been discussed with the patient. To understand more about unlicensed medication, please read our information blog about unlicensed and “off-label” medication.

The General Medical Council (GMC) states that unlicensed medication can be prescribed where, on the basis of an assessment of an individual patient, a prescriber concludes, for medical reasons, that it is necessary to do so to meet the specific needs of the patient. This may be in the event that a patient needs a medicine in a formulation that is not specified in an applicable licence. 

Some patients suffering from androgenetic alopecia (male pattern hair loss) may not experience a satisfactory response from 5% minoxidil and so it may be appropriate to consider prescribing higher strengths or oral minoxidil (which are unlicensed).