Hair Loss Medications: Bimatoprost

Bimatoprost

Latisse

Latisse is the first FDA approved (Dec. 2008) topical medication for eyelash growth. It is used to make eyelashes longer, thicker and darker. Applied once a day, it works in over 75% of those using it. Latisse takes about 16 weeks to work. The drug is available only through a doctor’s prescription.
Latisse is applied once a day to the base of the upper eyelashes. The bottom lashes receive the drug from the top lashes through blinking. A 30-day supply costs approximately $120 (About 6000 INR) . Once results are seen, it is possible to decrease the application to every other day, decreasing the cost and the inconvenience of applying the medication.But it has to continued for maintenance.
Background Latisse was first marketed under the name Lumigan to treat eye conditions associated with glaucoma. While being studied for the medical condition glaucoma, researchers noticed the drug had the side effect of stimulating eyelash growth and darkening of the eyelashes. It re-applied for FDA approval for the cosmetic purpose of eyelash growth under the new name. The active ingredient in both Lumigan and Latisse is Bimatoprost. Both products are made by the company, Allergan.
How it Works? Bimatoprost is a compound derived from fatty acids designed to bind to prostaglandin (PG) receptors. PG receptors are present in hair, particularly in the dermal papilla and outer root sheath of the hair follicle. Although the precise way that Bimatoprost works is unclear, it is believed to affect the growth of hair follicles by increasing the percent of hairs in the anagen (growth) phase of the hair cycle and increasing the duration of this phase. The long-term safety of Bimatoprost is based on clinical trials over 13 years.
Side Effects Side effects occur in about 4% of patients using Latisse and include itchy eyes, redness and skin pigmentation. The rare side effect of iris pigmentation that can occur when Bimatoprost has been used in much higher doses for glaucoma has not been reported when it is used to treat eyelashes, but this is still a potential risk. Any individual on antibiotics or other drugs, with heart medication, as well as those with neurological and certain other diseases, and those with severe allergies should discuss these conditions prior to beginning the treatment program. In addition, pregnant women as well as those with skin infections or other conditions on the upper eyelids are not good candidates.Latisse also has the potential to stimulate the growth of scalp hair although there may be some risk when applying it repeatedly to a large surface area.
Off-Label Use Although Latisse has been approved for use on eyelashes, its potential benefit in making eyebrows more full is currently being explored. This is, of course, an easy added advantage of using the medication, since there is usually enough medication left on the applicator stick to use on the eyebrows as well – for those who desire thicker brows.
At present, the cost alone would make this form of treatment prohibitive.

Hair Loss Medications: Spironolactone and Oral Contraceptives

Spironolactone:

Aldectone

Aldactone (spironolactone 25mg, 50mg, 100mg) is a medication that is primarily used to treat high blood pressure (hypertension). Therapy is usually started at a dose of 25mg twice a day. It works as a diuretic causing increased amounts of sodium and water to be excreted from the body, while potassium is retained.

Because of its ability to retain potassium, the medication can elevate the blood levels of potassium to dangerous levels (hyperkalemia). It should, therefore, only be used under a doctor’s supervision.

Spironolactone has anti-androgenic affects and has been used in the treatment of hair loss in women. It is a weak competitive inhibitor of the binding of androgens to their cellular receptors and decreases the synthesis of testosterone

Studies suggest that spironolactone requires at least 200mg/day for stopping loss and that it has little effect on regrowth of hair. Unfortunately, this dose is high enough to elevate potassium levels and place the patient at risk of hyperkalemia and other side effects, including cramps and diarrhea.

Since spironolactone is an anti-androgen (inhibits testosterone), it causes sexual dysfunction and breast enlargement in men. Because of these side effects, it is not used as a treatment for male pattern hair loss.

Oral Contraceptives:

How birth control pills work At the beginning of each menstrual cycle, estrogen levels begin to rise, and the lining of the uterus thickens in preparation of a fertilized egg (this period is called ovulation). After ovulation, progesterone, another reproductive hormone, rises preparing for a fertilized egg. Conception occurs when a fertilized egg implants in the uterine wall. If conception does not occur, both estrogen and progesterone levels drop, signaling the thickened uterine lining to shed and ushering in menstruation.

Oral contraceptives, also known as “birth control pills” (BCP) are a synthetic mixture of the hormones progesterone and estrogen. They prevent ovulation by maintaining constant levels of these hormones. As a result, the ovary does not release an egg and the estrogen level does not rise.

What are the risks involved with taking oral contraceptives? Oral contraceptives (OCA) can be associated with increased risks of several serious side effects. Women taking them are advised not to smoke due to an increased risk of blood clots, stroke and heart attack. Importantly, they do not protect against HIV infection or other sexually transmitted diseases.

Birth control pills causing hair loss BCP’s can cause hair loss through two different mechanisms, through drug induced shedding and by facilitating female pattern genetic hair loss. These are two very distinct processes.

Almost any drug can potentially cause hair loss but oral contraceptives are particularly implicated in a process called telogen effluvium, or hair shedding. Essentially what happens is that the drug causes hair in the growing phase (anagen) to be shifted to the resting phase (telogen). After the telogen phase (normally lasting about 2-3 months), hairs are spontaneously shed before they enter a new growth cycle (of 3 – 7 years). Normally only about 10-15% of hairs are in telogen at any one time, but this can increase to as much as 50% in telogen effluvium. As a result, large amounts of hair can be shed as they pass through this short telogen cycle. Interestingly, telogen effluvium can occur with starting birth control pills, switching birth control pills, or even discontinuing the BCP’s that a patient has been on for a long period of time. Fortunately, this process can be reversible once the implicating agent is stopped or the scalp has time to adjust to the new medication.

If a woman has a genetic predisposition for hair loss, then oral contraceptive medications containing progesterone can potentially increase that loss by adding a source of exogenous (outside) androgens. The birth control pills that are higher in progesterone compared to estrogen will more likely contribute to this process. In contrast to hair shedding, the thinning seen in genetic hair loss is characterized by a progressive decrease in hair shaft diameter rather than frank hair loss.

Birth control pills as a treatment for female pattern hair loss Just as progesterone dominant BCPs can facilitate female pattern hair loss, oral contraceptives higher in estrogen can stimulate hair growth by prolonging the anagen phase of the growth cycle. A problem is that estrogen dominant birth control pills have a greater incidence of certain side effects. Your gynecologist should advise you on which BPCs should be used in your particular situation.

The newer oral contraceptives such as Yasmin, Yaz, Desogen, Mircette, OrthoCyclen Ortho-TriCyclen and Ortho-TriCyclen Lo have lower androgenetic effects and are useful in patients concerned about hair loss. In particular, Yaz and Yasmin contain the progestin drospirenone, which has anti-androgen properties, and can therefore be particularly helpful in women experiencing female pattern hair loss.