A definitive guide to Oral Minoxidil for Hair Loss by a Dermatologist
Minoxidil is a successful hair treatment as an oral medication – even though most will be more familiar with it as a scalp foam or tonic. There are certain circumstances in which Minoxidil can be taken orally as a tablet, and increasingly this is being recognised by Dermatologists as an effective and convenient way of treating hair concerns.
Topical minoxidil is minoxidil which is applied on the skin.
Oral minoxidil is minoxidil in tablet form that is taken by mouth.
When is oral Minoxidil given for hair loss?Oral Minoxidil can be considered for hair loss if :Topical Minoxidil preparations cause a rash, irritation or allergyThere is a lack of any benefit from topical Minoxidil after 6 months of diligent useTopical Minoxidil causes poor hair texture – sometimes topical Minoxidil can cause dry, tangled hair prone to breakageThere are other difficulties using topical Minoxidil – and this causes compliance problems.Hair loss conditions that may improve with MinoxidilOral minoxidil is mainly used for male and female pattern hair loss. However, there can be benefits for other types of hair loss, too, including telogen effluvium, traction alopecia and loose anagen syndrome.Why would oral Minoxidil work when topical Minoxidil has not worked?Some people may not respond to topical Minoxidil as they lack the correct enzyme in their hair follicles to activate the medication from Minoxidil to Minoxidil Sulphate (the enzyme that activates Minoxidil is called sulfotransferase). This enzyme is present in the liver and will activate the oral medication even when it is.How effective is oral minoxidil?The studies are very small but indicate that about one-third of patients will notice a reduction in shedding, and a third will notice improved growth in 6 months or more. This means that up to 2 in 3 people may notice benefits from oral Minoxidil. It is best to take treatment for 6 to 12 months to give it enough time to work.The only head-to-head study comparing oral minoxidil to topical minoxidil in women with Female Pattern Hair Loss showed that 1mg of minoxidil gave comparable effects to 5% solution (1ml) once a day (Ramos et al. 2020). In this study, 26 women received oral minoxidil and 26 women received topical minoxidil. After 24 weeks of treatment, there was a 12% increase in hair density for women on oral minoxidil and 7.2% increase for women applying topical minoxidil. The difference was not statistically significant, but the oral minoxidil group also had less hair shedding.What are the side effects?Side effects are uncommon at the low doses used to treat hair loss. The largest study looking at side effects (Vañó-Galván et al. 2021) showed that in 943 women and 461 men, 2.5% of women and 0.5% of men had to stop treatment because of a side effect.Excessive hair (Hypertrichosis). The most common side effect is hypertrichosis for both men and women- excess hair growth elsewhere on the face and body. Excess growth is more likely to occur at higher doses. While this side effect is bothersome, it can usually be managed with hair removal methods and is not a common reason for someone to stop. Hypertrichosis may affect 10-25% of those on low doses (<4mg) and up to 50% of those on higher doses (>5mg). Vañó-Galván et al showed that 20% of women and 6% of men experienced hypertrichosis. Of those that experience this side effect, only 5% of women and 0% of men find it necessary to stop treatment.Temporary shedding. Temporary shedding is very common at the onset of starting oral or topical Minoxidil. This side effect occurs within the first 6 weeks and can be of significant concern. However, it is important to continue with the medication as this will stop after 4 weeks.Ankle swelling and fluid retention. Swelling of the lower legs can occur in up to 3% people. This is usually at higher doses. Fluid retention can also sometimes show up around the eyes as puffy eyes, which are worse in the morning. Vañó-Galván et al showed that 1.3% get ankle swelling (25% of these individuals stop treatment), and 0.3% experience swelling around the eyes (0% need to stop treatment for this).Low blood pressure and feeling lightheaded. Minoxidil is also used to control high blood pressure, usually at doses of 10-40mg per day – much higher than the doses used for hair loss. However, even lower doses can sometimes cause a reduction in blood pressure. 2% of people may get postural hypotension with low doses of Minoxidil. 8% may have general symptoms of lightheadedness. This leads to dizziness when getting up quickly. 1.7% of those on low-dose Minoxidil experience lightheadedness, and of these, only 11% need to stop treatment.Fast heart rate. Minoxidil can also cause a fast heart rate, but this is usually at higher doses. You should alert your doctor if you are taking other medications, such as asthma inhalers which can also increase the heart rate. 0.9% of those on low-dose oral minoxidil appear to experience this side effect, and 33% of these individuals need to stop treatment.Headaches. Headaches may occur in as many as 9% of people, but again, this seems to get better with time. 0.4% experience this side effect, and of these 44% need to stop treatment.Worsened hangovers. A 2024 report has suggested that that oral minoxidil may exacerbate alcohol hangover symptoms such as nausea, headaches, and light sensitivity in a small number of people taking oral minoxidil. The mechanism is unknown. The authors recommend that patients consider skipping their oral minoxidil dose on days they anticipate consuming excessive alcohol. There is a need for further research into this potential interaction.Uncommon side effects include – nightmares, insomnia, pericarditis, skin rashes, nausea, vomiting, and breast tenderness.It is important to report side effects to your doctor. However, if there is a rapid increase in pulse rate, palpitations, feeling dizzy, shortness of breath, chest pain and fainting, then you are advised to go to the A&E department or call the emergency services.Changes in lifestyle when taking oral MinoxidilIt is helpful to cut down on alcohol as alcohol can also reduce blood pressure. It is also helpful to cut down on caffeine as caffeine can cause the heart to race and cause palpitations.Doses of oral MinoxidilMinoxidil is available in 2.5mg, 5mg and 10mg tablets. We use the Loniten brand (Pfizer Ltd). A common starting dose is 0.625mg per day for women and 1.25mg per day for men. You should get a tablet cutter from your pharmacy and cut a 2.5mg tablet into quarters or halves to get this dose.The optimum dose for hair loss is not entirely clear. It may be in the region of 0.625mg to 2.5 mg daily. For men, a slightly higher dose may sometimes be required. You may be asked to take the medication daily or every other day.Doses of minoxidil for hair loss are considered ‘low dose’. This is because the doses used for hair loss are a lot lower than the doses which are used for conditions such as hypertension. The doses used for hypertension are 10-40mg per day.Brand of oral Minoxidil – LonitenWe prescribe Loniten branded Minoxidil tablets. These are manufactured by Pfizer.Please note that we do not dispense medications, and the provision of this medication is subject to local and national availability – which we do not have any control over.