What is minoxidil

History

• History, uses, doses, application, mechanism, side effects, advanced study

• Minoxidil was curated in the late 1950s by the Upjohn Company now constitutes a part in Pfizer to treat ulcers. In trials dogs were used in the compound which did not cure ulcers, but proved to be a powerful vasodilator.
• Minoxidil developed out of a lengthy research that started in 1960 to be precise by Upjohn chemists who were investigating the gastric acid effects of a compound they had ordered from a chemical catalogue element.
• Minoxidil structurally 2,4-pyrimidinediamine, 6-(1-piperidinyl)-, 3-oxide was first ever potent peripheral vasodilator agent for the treatment of severe refractory hypertension in the 1970s. 
• But due to its unignorable side effects, oral minoxidil was reserved for cases of severe hypertension that were reluctant to maximum doses of three antihypertensive agents. 
• Also, about decent portions of patients under oral minoxidil treatment developed hypertrichosis progressively. 
• In 1987, a topical form was developed to treat androgenic alopecia, initially for males and subsequently for females as well. 
• This activity strongly estimated about the contraindications, indications, and adverse effects of minoxidil and enlighten the inter-professional team’s role in managing patients with hair loss.
• When patients taking the antihypertensive agent minoxidil in clinical trials in the late 1960s they started getting a bit hairy.
• Although, executives at Upjohn the US pharmaceutical company who invented this drug proclaimed it as a harmless side effect.
• Founded in 1886 to make friable pills, Upjohn had an awesome reputation for serious pharmaceutical research, and did not want to get caught up in miracle baldness cures. 
• But once minoxidil was on the market for hypertension, it quickly became an open secret that the drug stimulated hair growth, and a letter in the New England Journal of Medicine1 put paid to any lingering hopes that Upjohn could keep the side effect under wraps. 
• “It was a wasteland, with predatory clinics offering spurious remedies to vulnerable men at considerable cost. In contrast, 40 % of men who use minoxidil get noticeable hair growth and, in another 40%, the drug stops them losing more hair. It was only about 20 % who do not get any benefit,” said by Professor Chu under his work.

Uses

• Used to treat Androgenic alopecia (the only FDA-approved indication for the usage)
• Alopecia areata – Minoxidil has shown to inculcate a positive clinical response, can be used in isolated form itself or in combination with other medications such like corticosteroids.
• Alopecia due to chemotherapy – Minoxidil has been proved to minimize hair loss and rejuvenation of hair regrowth.
• In Hair transplant effluvium of telogen is a keen observation. When administered before and after a hair transplant, minoxidil minimizes hair loss. However, treatment should be temporarily suspended some days before the transplant to avoid bleeding.
• Scarring alopecia – Minoxidil has  shown some  evidence to exhibit an  antifibrotic action. Hence, topical minoxidil medication can serve as a therapeutic choice in the early course of dermatoses causing scarring alopecia, especially from scalp burning.
• Monilethrix – Minoxidil can help in synchronization of the entry of hair follicles into the anagen phase.
• Hereditary alopecia/hypotrichosis – The use of minoxidil has proved to be beneficial by inducing a thickening in hair shafts and strengthening them.
• Minoxidil solution and foam are used to help hair growth in the treatment of male pattern baldness. It is not used for baldness at the front of the scalp or receding hairline in men. 
• The foam and 2% minoxidil solution is also used to help hair growth in women with thinning hair. Minoxidil belongs to a class of drugs known as vasodilators. 
• This medication is generally not used for sudden and patchy hair loss or unexplained hair loss or hair loss after giving birth.

Doses

Note – Don’t take any medicine without consulting to a Qualified Doctor.

General recommendation of initial dosage of minoxidil tablets is 5 mg of minoxidil tablets given as a single daily dose. Daily dosage can be increased to 10, 20 and then to 40 mg in single or divided doses gradually only if required for optimum blood pressure control.

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. 

The amount of medicine that you take depends on the strength of the medicine. 

The number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

A common and general starting dose is 0.625mg per day for women and 1.25mg per day for men.

However, you should get a tablet cutter to be able to cut a 2.5mg tablet into quarters or halves to get this dose. 

The optimum dose for hair loss is not universal and specific therefor is not entirely clear. It may be in the region of 0.625mg to 2.5 mg per day depending upon the need of consumption by the patient.

For hair growth

        For topical solution dosage form:

• Adults—Apply 1 milli litre (mL) to the scalp two times a day.
• Children—Use and dose must be determined by the doctor.

        For topical foam dosage form:

• Adults—Apply half a capful to the scalp two times a day.
• Children—Use and dose must be determined by your doctor.

Application

How to apply minoxidil topical solution:

• Make sure your hair and scalp are completely dry before applying this medicine.
• Apply the amount prescribed to the area of the scalp being treated, beginning in the centre of the area. Follow your doctor’s instructions on how to apply the solution, using the applicator provided.
• Do not shampoo your hair for 4 hours after applying minoxidil.
• Immediately after using this medicine, wash your hands to remove any medicine that may be on them.
• Do not use a hairdryer to dry the scalp after you apply minoxidil solution. Blowing with a hairdryer on the scalp may make the treatment less effective.
• Allow the minoxidil to completely dry for 2 to 4 hours after applying it, including before going to bed. Minoxidil can stain clothing, hats, or bed linen if your hair or scalp is not fully dry after using the medicine.
• Avoid transferring the medicine while wet to other parts of the body. This can occur if the medicine gets on your pillowcase or bed linens or if your hands are not washed after applying minoxidil.

Application of minoxidil in topical foam:

• Open the container by matching the arrow on can ring with the arrow on cap. Pull off the cap.
• Part the hair into one or more rows to expose the hair thinning area on the scalp.
• Hold the can upside down and press the nozzle to put foam on your fingers.
• Use your fingers to spread the foam over the hair loss area and gently massage into your scalp.
• Immediately after using this medicine, wash your hands to remove any medicine that may be on them.
• No scalp massage is necessary after use. Minoxidil uptake is about 50% after an hour and 75% after 4 hours. Some practitioners associate micro-needling with topical minoxidil to enhance efficiency, but more studies are needed to assess the value of this potential relationship.

If your scalp becomes abraded, irritated, or sunburned, check with your doctor before applying minoxidil.

Minoxidil topical foam or solution is for use on the scalp only. Keep this medicine away from the eyes, nose, and mouth. 

If you accidentally get it in your eyes, nose, or mouth, flush the area immediately with cool tap water and on using the pump spray, be careful not to breathe in the spray.

Do not use the foam near heat or open flame, or while smoking. Do not puncture, break, or burn the aerosol can use it with care.

Mechanism- How it works? 

• Researches shows that 5% minoxidil is more effective than 2% minoxidil in treating alopecia. Clinical response to minoxidil is more pronounced if the onset of alopecia is within five years in young adults chiefly and the hair follicles are not deeply miniaturized.
• Topical minoxidil empirical formula C9H15N5O is a hair growth stimulator. Its mechanism of action is not that well-established however is being studied upon since years now.
•  Scalp sulfotransferase changes minoxidil into minoxidil sulfate, the active form of the molecule. 
• Variations between individuals in sulfotransferase activity may be the cause of the discrepancy in minoxidil efficiency.  
• Minoxidil acts by shortening the telogen phase, causing the quiescent hair follicles to enter prematurely into the anagen phase. 
• The shortening of the telogen phase may induce telogen effluvium after the initiation of minoxidil therapy. Also, minoxidil increase the duration of the anagen phase. Lastly, increased hair length and diameter are the clinical effects of minoxidil.
• It is available as a foam and a solution formulation to use for men and women patients widely. 

Side effects-

Minoxidil is generally well tolerated. But some adverse effects have been observed in patients include – 

• Minoxidil induced telogen effluvium however Minoxidil causes the shortening of the telogen phase, subsequently leading to marked shedding
• Skin irritation: Erythema, discomfort, and a burning sensation
• Scaly changes of the scalp: Irritation or exacerbation of seborrheic dermatitis
• Isolated pruritus
• Allergic contact dermatitis: Erythema, eczematous skin reaction, and pruritus. Minoxidil and propylene glycol are the two major allergens in allergic contact dermatitis. 
• Patch testing may help reveal the causative agent. In the case of allergic contact dermatitis to propylene glycol, minoxidil foam (lacks propylene glycol) is an option.
• Localized or generalized hypertrichosis: This effect can occur with both oral and topical minoxidil. However, it is more commonly seen with the oral form and 5% versus 2% minoxidil. Research suggests that hypertrichosis is related to minoxidil’s prolongation of the anagen phase.
• Systemic cyclosporine may enhance side effects like hypertrichosis when used with topical minoxidil. The hypertrichosis symptoms improved drastically after stopping topical minoxidil for two months.
• Coadministration of baby aspirin may also reduce the topical minoxidil efficacy. This reduction in efficacy is believed to be associated with the negative inhibition of sulfotransferase enzymes by baby aspirin in the human hair.
• Percutaneous toxicity is uncommon after the conventional use of minoxidil. There is no known antidote for minoxidil toxicity after massive oral ingestion. Accidental oral ingestion of minoxidil can result in vomiting and does rarely require hospitalization.

But side effects can be very well regulated if you seek the medication on the professional recommendation of hair transplant specialist.

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Conclusion

While the pharmaceutical industry produces several medications to manage male pattern baldness, and the effectiveness between individuals varies. 

Minoxidil has been proved to be working since three decades and is almost universally prescribed by hair specialists and physician, and dermatologists. 

Pharmacists have verified that there are no alarming drug to drug interactions and Minoxidil is considered a first-line treatment to aid hair growth, but it shows inconsistent efficacy. 

Some patients see improvement, while some notice minimal changes. Healthcare workers should educate patients that each individual may react to minoxidil differently, and hair growth occurs best with consistent medication adherence. 

All inter-professional healthcare team members need to spread awareness when a patient is seeking minoxidil and factor that into the overall healthcare delivery strategy for that individual to achieve optimal patient outcomes. 

Do not use this medication more often without need or apply it to an irritated or sunburned scalp. Doing so can cause the drug to be absorbed into your body and result in serious side effects. 

This product might have alcohol and can irritate and dry the scalp. So it is advisable to always ask your doctor or pharmacist how to use this product safely. It is always better to seek the prescription from a skilled hair doctor.