Characterization and Management of Adverse Events of Low-Dose Oral Minoxidil Treatment for Alopecia: A Narrative Review

Low-dose oral minoxidil (LDOM) is an effective treatment for alopecia with a generally favorable safety profile, though it can cause adverse events (AEs) such as hypertrichosis, fluid retention, and cardiovascular effects. Hypertrichosis affects about 15% of patients, more commonly in women and those on higher doses. Fluid retention occurs in 1.3–10% of patients, primarily women, and cardiovascular AEs like tachycardia are rare, affecting fewer than 5% of cases. Severe AEs, such as pericardial effusion, are extremely rare and often linked to dosing errors. Management includes dose reduction, pharmacological interventions, and lifestyle changes. Despite these AEs, LDOM remains a valuable option for alopecia, with careful patient selection and monitoring essential to minimize risks. Studies involving large cohorts, such as one with 1,404 patients, support the manageability of these side effects.