What is the Perfect Dose of Oral Minoxidil for Hair Loss?

Oral Minoxidil is currently being prescribed for the management of androgenic alopecia in men, but just how effective is oral Minoxidil for the management of hair loss in men and is there such thing as the perfect dose?

Numerous replicable studies show oral Minoxidil is effective for the management of hair loss in men and its effectiveness is dose dependant. In fact, visible improvements in hair count can be seen in as little as three months when 5mg Minoxidil is taken once daily. The dosing range for oral minoxidil varies from 0.25mg once daily to 5mg once daily. 

Studies show women showed a positive response to a lower dose of oral minoxidil compared to men (usually 0.25mg to 2.5mg). Women are also more sensitive to postural hypotension and this should be considered when prescribing.

In men, the dosages that appear to produce the most pronounced result is 2.5mg-5mg once daily, with a success rate >65%.

Across 14 studies with a total of 442 patients, hypertrichosis (excessive body hair) was observed in 24% of patients and pedal edema occurred in 2%. Postural hypotension (dizziness when standing up) and changes to heart rate were also reported. The studies concluded low dose oral minoxidil was an effective and well-tolerated treatment alternative for healthy patients who have difficulties with topical formulations (notably for scalp pruritus, scaling, hypertrichosis, and contact dermatitis). 

Most patients starting on oral minoxidil reported increased hair shedding in the first 2 months of starting oral minoxidil and this impact is reduced by the third month. It is thought that this increased in transient hair shedding in the first couple of months could be due to the drug kick starting a new hair cycle. 

Low dose oral minoxidil is no doubt an effective alternative to topical minoxidil for the management of androgenic alopecia, although this is still currently prescribed as off-label use.  The perfect dose will vary for each individual and this can explored with your doctor to ensure minimal adverse effects. 

Author: Helen Huynh B Pharm. MPS

References:

1. Rajab, F (2022). Low-Dose Minoxidil for Hair Loss. Dermatology Times. November 2022 (Vol. 43. No. 11)
2. Heymann, W (2022). "Coming Full-Circle (almost). Low dose Minoxidil for Alopecia. American Academy of Dermatology. January 5, 2022. (Vol.4 No. 1)
3. Panchaprateep, R et al. (2020). Efficacy and Safety of Oral Minoxidil 5mg once daily in the treatment of Male Patients with Androgenic Alopecia. An Open Label and Global Photographic Assessment. Journal of Dermatol Therapy. Dec; 10(6): 1345–1357.