Side Effects of Low-Dose Oral Minoxidil for Treating Alopecia

The document discusses a case series involving 51 patients with both scarring and nonscarring alopecias who were prescribed low-dose oral minoxidil (LDOM) for hair loss treatment. The patients, with a mean age of 42, were screened for cardiac, liver, and renal diseases, and treatment was deferred if they screened positive. The document emphasizes that prescribing dermatologists should be aware of contraindications to LDOM prescription, including drug hypersensitivity, pheochromocytoma, pulmonary hypertension with mitral stenosis, and severe hepatic impairment. Minoxidil acts as a systemic vasodilator, which can provoke myocardial ischemia and promote substantial fluid retention, thus it should be avoided in patients with heart failure, angina, recent myocardial infarction, or those at high risk for these conditions. When used for alopecia, the recommended dose is 1.25 mg, which can be increased to 2.5 mg if tolerated. Most adverse effects of minoxidil were reported in patients with longstanding uncontrolled hypertension or advanced kidney disease, and doses used were generally 10 mg/d or more. Lower rates of these adverse effects are expected with LDOM in healthy individuals.