Minoxidil

Aka: Minoxidil, Rogaine

1. Indications
   1. Androgenetic Alopecia
2. Preparations
   1. Regular Strength 2%
      1. Cost to pharmacist
         1. Brand Name: $25/month, $300/year
         2. Generic: $13/month, $156/year
   2. Extra Strength 5%
      1. Cost to pharmacist: $30/month, $360/year
      2. Not more effective than 2% in Androgenetic Alopecia
      3. Indicated as adjunct in Alopecia Areata
      4. Higher Incidence of facial Hypertrichosis
3. Mechanism
   1. Increases Hair Shaft epithelial cell growth
   2. Potentiated by Retin A
   3. Direct effect on Hair Follicle
      1. Activates Hair Follicles in Catagen
      2. Extends Anagen duration
      3. Expands Hair Follicles
   4. Decreases hair shedding
4. Dosing
   1. Apply bid to dry scalp
      1. Spray 6 times (1 ml) or
      2. Dropper bottle
   2. Wash hands carefully after applying
      1. Reduces risk of spread to face and Hypertrichosis
5. Advantages
   1. Appropriate for both men and women
   2. Modestly effective
   3. Most effective for vertex baldness
      1. Vertex baldness under 5 years
      2. Hair Loss under 10 cm (4 inch) diameter
6. Disadvantages
   1. Less effective for frontal Hair Loss
   2. New hair lost when treatment discontinued
7. Adverse effects
   1. Hypertrichosis (excessive facial hair)
      1. Resolves by one year even if Minoxidil continued
      2. Bleach more evident darker hairs
   2. Pruritus of scalp
   3. Allergic or Irritant Contact Dermatitis (usually to propylene glycol)
      1. Compounding pharmacist can use alternative base
8. References
   1. Price (1999) N Engl J Med 341:964-73 [PubMed]