MINOXIDIL, ALSO KNOWN AS ROGAINE
An FDA-approved treatment for hair loss.
Oral minoxidil was initially developed as a treatment for high blood pressure, but during clinical trials, patients were growing excessive hair. This desirable side effect, known as hypertrichosis, led to the development of a topical form of minoxidil, which was eventually approved by the FDA for the treatment of androgenic alopecia, commonly known as male pattern baldness. Later, the FDA also approved it for the treatment of female pattern hair loss.
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THE MAGIC OF MINOXIDIL
Despite being globally accepted and used commercially for more than 30 years, the exact way that minoxidil works is still not fully understood. However, in simplistic terms, minoxidil is thought to stimulate hair follicles by prolonging the anagen (growth) phase and shortening the telogen (resting) phase. According to the National Library of Medicine, an enzyme in the human scalp, called sulfotransferase, helps turn minoxidil into its active form, minoxidil sulfate. Minoxidil seems to work by affecting the potassium channels in the blood vessel walls and hair follicles, which can influence blood flow and hair growth.
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Clinical effectiveness of minoxidil.
Minoxidil has demonstrated amazing results across numerous clinical trials conducted with topical minoxidil at multiple concentrations. In men with androgenic alopecia, 5% minoxidil solution demonstrated a significant increase in the mean difference of hair density, between the baseline and end of the study, compared with a 2% minoxidil solution and placebo treatments. The patients that used the 5% solution saw faster results and had 45% more hair regrowth after 48 weeks of treatment than the group that used the 2% solution.
Studies have also demonstrated that minoxidil treatment produces more noticeable results if the patient started losing their hair within five years of initiating treatment, and if the hair follicles are not already significantly miniaturized.
Beyond male and female pattern hair loss, minoxidil has been used off-label to treat alopecia areata, scarring alopecia, and hair shaft disorders, as well as to enhance hair growth in areas like eyebrows and beards. Before you begin any minoxidil regimen, schedule a consultation with one of our doctors to evaluate your situation.
The history of minoxidil.
- Late 1950s: The Upjohn Company develops 200 variations of the compound that would one day become minoxidil in an attempt to treat ulcers.
- 1963: Upjohn synthesizes a version of oral minoxidil that’s discovered to be a strong vasodilator (a drug that widens blood vessels) instead of an ulcer treatment.
- 1967-1968: The Upjohn Company brings in Dr. Charles A. Chidsey, the chief of clinical pharmacology at the University of Colorado School of Medicine, who conducts two studies on minoxidil for hypertension treatment.
- 1970: Dr. Chidsey noticed unexpected hair growth on some of his subjects during the second study and consulted Dr. Guinter Kahn who, while a dermatology resident at the University of Miami, had been the first to observe and report on unexpected hair growth on patients using minoxidil.
- 1970-1971: Dr. Guinter Kahn and Dr. Paul J. Grant conducted experiments with 1% solutions of topical minoxidil without approval or knowledge of Upjohn or the University.
- 1971: The Upjohn Corporation files a patent for 2% Minoxidil solution as used for baldness with Dr. Chidsey as the inventor
- 1972: Drs. Kahn and Grant file their own patent for topical minoxidil solution for hair loss.
- 1979: The FDA approves oral minoxidil (brand name Loniten) in oral tablet form for treating high blood pressure.
- Early 1980s: Physicians begin prescribing Loniten (oral minoxidil) off-label for balding patients.
- 1986: Dr. Kahn and Upjohn end a long-standing patent conflict by agreeing to a consolidated patent that includes credit and royalties for both Dr. Kahn and Dr. Grant, plus ownership to Upjohn.
- 1988: The FDA approves 2% minoxidil solution (brand name ‘Rogaine’) for treating baldness in men.
- 1991: Rogaine’s license is extended to women with hair loss.
- 1996: The FDA approves both over-the-counter sales of 2% minoxidil as well as production of generic formulations. Upjohn cuts the price of the prescription formula.
- 1997: Upjohn releases a prescription 5% formula of Rogaine solution.
- 1998: The FDA approves an over the counter 5% minoxidil formulation.
- 2006: Men’s Rogaine goes off-patent and generics become widely available.
- 2006: The FDA approves the 5% aerosol foam formula for medical use in the United States.
- 2014: Women’s Rogaine goes off-patent and generics become widely available.
- 2017: The FDA approves generic versions of the 5% aerosol foam formula.
Will minoxidil work for my hair loss?
Minoxidil is one of only two FDA-approved medication for treating hair loss men and the only approved treatment for women. It has been shown to be effective in promoting hair growth for many individuals experiencing pattern baldness, but everyone is different. Your personal results will vary depending on the cause and severity of your hair loss. To be sure you have an objective view of the changes in your hair over time, at the Anderson Center for Hair we’ll capture serial photographs for your medical record each time you visit.
How long will it take before I see results after I start using minoxidil?
In clinical trials, results were visible for some patients as soon as 3 to 6 months after starting consistent use and improvement continued as late as 48 months later. Most patients saw their maximum results around 12 months after beginning treatment. Hair grows slowly, so patience and consistency are key. Be sure to continue using the medication as directed, even if you don’t see immediate results.
Will minoxidil keep working forever or will I build a tolerance to it?
Minoxidil can be effective as long as it’s used consistently. If you stop applying it as scheduled, any hair growth that occurred while using minoxidil may be lost, even as quickly as just a few months.
While there is no evidence that you will build a “tolerance” to minoxidil, it may appear that this scenario is happening because hair loss is not linear, and minoxidil alone may not always be able to keep up. There may be periods of time when you appear to lose more hair, even while consistently using minoxidil. Think of a similar situation with your teeth. Even if you consistently brush your teeth twice a day, you might still develop a cavity. You wouldn’t throw out your toothbrush if that happened. Instead, you might floss more or add a new mouthwash. Hair loss prevention works the same way. If minoxidil alone doesn’t work, adding a finasteride (for men) and/or a low-level laser therapy (LLLT) device should be the next step.
Does this sound like your situation? Schedule a consultation with your doctor to check in and create the right plan for you.
Will topical minoxidil work on a beard, eyebrows, and/or leg hair?
Minoxidil is primarily intended for use on the scalp to treat pattern baldness. The FDA has only approved minoxidil for use on the scalp. While some users have reported success using minoxidil to promote hair growth in other areas, such as the beard or eyebrows, its effectiveness for these purposes is not well-established and requires more research before it can be prescribed widely. It is not recommended for use on leg hair.
Are there minoxidil pills? Are they the same as Propecia (finasteride)?
Minoxidil is available as an oral medication, but it is typically prescribed for high blood pressure and not for hair loss. Propecia (finasteride) is a different medication that’s also used to treat hair loss in men, but it works by different mechanisms and has different side effects. Click here to learn more about finasteride.
Are minoxidil and Nioxin the same?
No, minoxidil and Nioxin are not the same. Minoxidil is a medication used to treat hair loss, while Nioxin is a brand of hair care products designed to “promote a healthy scalp.” Nioxin products do not contain minoxidil.
Which is better, minoxidil foam or solution? And 2% or 5% strength?
The choice between minoxidil foam and solution is mostly personal preference. Some users find the foam easier to apply, while others prefer the consistency of minoxidil solution and the ability to apply drops with precision.
In clinical trials the 5% strength was found to be more effective than the 2% strength, but it may also cause more side effects. If you have sensitive skin or are concerned you may have a reaction, test a small patch at the nape of the neck and observe the side effects before applying it to your entire scalp.
Does generic minoxidil work just as well as the name brand product, Rogaine, if it’s the same formulation and strength?
Generic minoxidil products that contain the same formula and strength as the brand name Rogaine should provide similar results. The active ingredient, minoxidil, is the same in both products. However, some patients may notice differences in consistency or scent between brands.
Is it safe to use minoxidil if I have a cat?
Minoxidil can be toxic to cats if they ingest it, so it’s important to take the necessary precautions when using this product around cats:
- Store minoxidil products securely, away from your cat’s reach.
- Wash your hands thoroughly after use, especially before petting your cat.
- Clean spills and surfaces and objects that you touch after using minoxidil to minimize the risk of your cat coming into contact with the medication.
- Allow the medication to dry completely before coming into contact with your cat or allowing your cat to come into contact with the treated area.
- Keep towels and bedding that come into contact with minoxidil away from your cat.
Contraindications and side effects.
Minoxidil is well-tolerated by most people, but you should not use minoxidil if you:
- are allergic or hypersensitive to minoxidil or any of the ingredients in the product,
- have cuts, abrasions, infections, or sunburn on your scalp,
- are pregnant or breastfeeding as the effects of minoxidil on the fetus or infant are not well-studied, or
- are under the age of 18.
Topical minoxidil is generally considered safe; however, some patients may experience side effects after applying minoxidil drops or foam. The most common side effect is irritant contact dermatitis which presents as itching and scaling. This side effect is less common with minoxidil foam, which does not contain propylene glycol, a known irritant in some patients. Clinical studies have shown that side effects such as dermatitis and headaches were more common when using a 5% solution versus a 2% solution. If you do experience any side effects, call our office to speak with your doctor. In most cases, side effects will resolve spontaneously after discontinuing minoxidil use, transitioning to an alternative formula, or trying a different strength solution. Your doctor will create a plan depending on your specific needs.
Although rare, systemic side effects such as hypotension, abnormal heart rate, and weight gain have been reported. These side effects are not generally a concern when minoxidil is used topically and as directed.
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