Hair Loss medication: Minoxidil

Minoxidil

(Rogain/ Mintop/ Tugain/ Minokem)

for minoxidil, was the first FDA approved medication for the treatment of hair loss. Minoxidil is a topical solution that is applied directly to the scalp. It can now be purchased without a prescription and in generic formulations in concentrations of 5% (for men) and 2% (for women).

Minoxidil was developed from the oral blood pressure medication minoxidil (Loniten). Minoxidil taken orally has potential serious side effects on the heart and circulatory system and is used only when other blood pressure medications have been unsuccessful. It was observed that patients who were taking minoxidil began growing body hair and it was reasoned that applying minoxidil directly to a bald scalp might cause hair to grow in this area as well. Studies showed that this was indeed the case, although the growth was generally modest.

The original studies on Minoxidil were performed on the crown, so there is a misconception that it only works in this area. Although minoxidil usually works best in the crown, it also works to a lesser degree in other areas, such as the front of the scalp, as long as there is some fine (miniaturized) hair in the area. It does not work when the area is totally bald. The greatest benefit from the medication is seen from 5 months to 2 years, with a gradual decrease in effectiveness after that. Those using minoxidil long-term will continue to lose hair, but at a somewhat slower rate.

The exact mechanism by which minoxidil works is not known, but the drug is felt to increase the duration of the hair follicle growth cycle (called anagen). This improves the quality of the hair by increasing the diameter and length of fine (miniaturized) hair. The simultaneous use of minoxidil and Finasteride, which directly inhibits the formation of DHT, may have some synergistic benefit in the treatment of hair loss, although the latter medication is significantly more effective.

Using Minoxidil Minoxidil should be applied to the scalp twice a day. The medication only works if it is in direct contact with the scalp (not the hair) and only works in areas where it is applied. Therefore, it is important to use the medication in the front part of the scalp if this is an area of thinning.

The 5% formulation is twice as effective as the 2% solution, but contains propylene glycol, a compound that can irritate the scalp and can make the hair feel sticky and difficult to manage. If this is a problem, one should consider using the 5% solution at bedtime and the 2% solution (which is alcohol based and less sticky) in the morning. When using minoxidil, it may take 6-12 months before any results are seen. The majority of patients who see an effect from minoxidil experience a delay, or decrease, in the rate of hair loss. The drug also serves to thicken already existing hair, but most patients who do have results, grow only short, thin fuzz. It will not grow any new hair on a bald scalp.

Rogaine or Tugain Foam is a new form of 5% Minoxidil in a glycerin and alcohol base. The foam technology is a convenient way of delivering minoxidil to the scalp without the sticky and often irritating effects of propylene glycol, the delivery compound used in the original 5% solution. When released from the canister, the new product seems like a shaving foam, but it rapidly “melts” when it reaches skin temperature. Applying Rogaine as a foam allows convenient application to the scalp without dripping or running down the forehead or neck, and without leaving a sticky residue in the hair.

Once a day topical use of Rogaine (topical minoxidil 2% and 5%) seems to be almost as effective as using it twice a day. The reason is, that although minoxidil has a relatively short half-life of several hours when given orally, when topically applied, it has a half-life of 22 hours in the skin. This suggests that once a day dosing is a reasonable option. It is important to realize that Pfizer, the company that now makes Rogaine, specifically states that it will be less effective if used only once a day.

If minoxidil is discontinued, the effects of the drug wear off within three months and the previous pattern of hair loss resumes. When minoxidil is restarted, one generally does not regain the hair that was lost, so it is best not to stop and start the mediation, but to use it regularly.

Minoxidil has been prescribed (off-label) in conjunction with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications, however, can greatly increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and severe scalp irritation that has led to scarring.

Use in Women Only the 2% concentration of minoxidil is approved for use in women. Women are generally more sensitive to the side effects of minoxidil in decreasing blood pressure (hypotension) and may get light-headed from the medication. Women also have an increased risk of developing allergic skin reactions (contact dermatitis).

An annoying local reaction that women sometimes get from topical minoxidil is the development of facial hair. Although the facial hair slowly resolves when the medication is discontinued, at times the hair may need to be removed. Carefully trying to avoid the medication dripping down onto the temples and forehead seems to reduce, but not totally prevent, this problem. There is a significantly greater incidence of these side effects if the 5% solution is used.

Tips on Using Minoxidil (Rogaine / Mintop) – Men

Minoxidil solution comes in a generic formulation and can be purchased over the counter. The foam is available in brand only (Rogaine / Trigain Foam).

Minoxidil only works where you apply it. Apply it to all areas that are thinning.

• Minoxidil can work anywhere there is miniaturized hair (where the area is not totally bald)
• Minoxidil will work in the front part of the scalp and temples if these areas are just starting to thin – so it is important to apply it to the front part of your scalp and hairline if you are thinning in these areas.

Minoxidil must be applied to the scalp to work – it doesn’t work on the hair per se.

• Minoxidil 5% solution is the most effective if you have some hair, as the solution will be easier to apply to the scalp.
• If the 5% solution is irritating to your scalp, try the 5% Foam which does not contain propylene glycol, the most common irritant.
• If the 5% solution is too greasy and you find you are not using it, switch to the foam.

Although the Minoxidil works best when used twice a day, using it once a day will also be effective (and better than not using it at all).

• Many patients find applying the medication once a day at bedtime to be the most convenient way to use it.
• When using minoxidil once a day, use at least double the recommended dose, so that it will be applied to the entire area of thinning.

Minoxidil can be applied to damp scalp when you first get out of the shower and this can make grooming easier.

For minoxidil to be effective it must be used continually and regularly. Do not stop and start it. You may experience shedding during the first 3-6 months of treatment. This generally is an indication that the medication is working, so unless you are having side effects, do not stop the medication. If you do stop the medication, you will lose all of its benefits (although you will not be any worse off than if you had never used it).

Minoxidil works best when used with finasteride. Of the two medications, finasteride is more effective.

Tips for Women Using Minoxidil – Women

Minoxidil solution comes in a generic formulation and can be purchased over the counter. The foam is still available in brand only.

Minoxidil is generally prescribed as a 2% solution for women to be used twice a day. If twice a day is inconvenient, then use the 5% men’s formulation just once a day.

Minoxidil can cause increased facial hair. Although the 5% is more likely than the 2% to cause this, when the 5% is used one a day, the side effects seem to be about the same.

Minoxidil only works where you apply it. Apply it to all areas that are thinning.

• Minoxidil can work anywhere there is miniaturized hair (where the area is not totally bald).
• Minoxidil will work in the front part of the scalp and temples if these areas are just starting to thin.

Minoxidil must be applied to the scalp to work – it doesn’t work on the hair per se

• Minoxidil solution is the most effective if you have some hair, as the solution will be easier to apply to the scalp.
• If the solution is irritating to your scalp, try the Foam which does not contain propylene glycol, the most common irritant.
• If the solution is too greasy and you find you are not using it, switch to the foam.

Although the Minoxidil works best when used twice a day, using it once a day will also be effective (and better than not using it at all).

• Many patients find applying the medication once a day at bedtime to be the most convenient way to use it.
• When using minoxidil once a day, use double the recommended dose, so that it will be applied to the entire area of thinning.

Minoxidil can be applied to damp scalp when you first get out of the shower and this can make grooming easier.

For minoxidil to be effective it must be used continually and regularly. Do not stop and start it. You may experience shedding during the first 3-6 months of treatment. This generally is an indication that the medication is working, so unless you are having side effects, do not stop the medication. If you do stop the medication, you will lose all of its benefits (although you will not be any worse off than if you had never used it).