Class: Direct Vasodilators
VA Class: CV490
CAS Number: 38304-91-5
Risk of developing potentially serious cardiac effects.110 b (See Cardiovascular Effects under Cautions.) Pericardial effusion, progressing to tamponade may occur and angina pectoris may be exacerbated.110 b Reserve for hypertensive patients who do not respond to maximum therapeutic doses of a diuretic and 2 other antihypertensive agents.110 b
Uses for Minoxidil
Management of severe symptomatic hypertension or hypertension associated with end-organ damage in patients with uncontrolled hypertension not manageable with maximal therapeutic dosages of a diuretic and 2 other antihypertensive agents.110 158 b
Often effective in management of hypertension resistant to other drugs.b
May be used in combination with other antihypertensive therapies (e.g., a diuretic and a β-adrenergic blocking agent, an ACE inhibitor, a calcium-channel blocking agent, and/or an angiotensin II receptor antagonist).110 158 b
Used topically to stimulate regrowth of hair in patients with androgenetic alopecia106 107 108 109 116 117 118 119 122 123 124 128 129 130 131 132 133 134 135 137 b (male pattern alopecia, hereditary alopecia, common male baldness) or alopecia areata†.102 103 104 105 106 107 116 117 118 125 126 127 b Safety and efficacy of extemporaneously prepared formulations of topical minoxidil in promoting hair growth not fully evaluated and such preparations may vary in strength and efficacy.110 b FDA requests that physicians and pharmacists refrain from preparing extemporaneous topical formulations using the commercially available tablets.113
Minoxidil Dosage and Administration
A β-adrenergic blocking agent (equivalent to 80–160 mg of propranolol daily) must be given before initiation of minoxidil therapy and continued for duration of therapy, to minimize minoxidil-induced tachycardia and increased myocardial workload.110 b If a β-adrenergic blocking agent is contraindicated, methyldopa (250–750 mg twice daily) should be initiated at least 24 hours prior to minoxidil therapy; clonidine (0.1–0.2 mg twice daily) may be used as an alternative.110 b
Dosages may be increased at intervals of at least 3 days in increments of 50–100% until optimum BP response is achieved.110 b If rapid control needed, adjust dosage every 6 hours; monitor BP closely.110 b
Children >12 years of age: Initially, 2.5–5 mg once daily.b Dosages may be increased at intervals of least 3 days to 10 mg, 20 mg, and then 40 mg daily in 1 or 2 divided doses until optimum BP response is achieved.110 b If rapid control needed, adjust dosage every 6 hours; monitor BP closely.110 b
Some experts (JNC 7) recommend a usual dosage of 2.5–80 mg daily given in 1 or 2 divided doses daily.158
Initially, 2.5–5 mg once daily.b Dosages may be increased at intervals of least 3 daysb to 10 mg, 20 mg, and then 40 mg daily in 1 or 2 divided doses until optimum BP response is achieved.110 b If rapid control needed, adjust dosage every 6 hours; monitor BP closely.110 b
Removed during dialysis.b Some clinicians recommend administering minoxidil immediately after dialysis (if dialysis is at 9 a.m.); if dialysis is after 3 p.m., the daily dose is given at 7 a.m. (i.e., 8 hours before dialysis). b
Cautions for Minoxidil
Sodium and water retention occur frequently; may result in edema, weight gain, CHF, pulmonary edema, and refractoriness to the antihypertensive effects of minoxidil.110 b Concomitant administration of a diuretic (usually a loop diuretic) generally required.110 b (See General under Dosage and Administration.) Ascites also reported.110 b
Tachycardia occurs commonly and angina pectoris may worsen or occur without previous angina; these effects may be minimized by concomitant administration of a β-adrenergic blocking agent.110 b (See General under Dosage and Administration.)
Pericarditis and pericardial effusion (occasionally with tamponade) reported mainly in patients with connective tissue disease, uremic syndrome, CHF, or marked fluid retention; idiopathic cases also reported.110 b Observe patients closely.110 b (See Boxed Warning.)
Rapid or excessive BP reductions in patients with severe BP elevation may precipitate syncope, cerebrovascular accidents, MI, and ischemia of special sense organs resulting in decrease or loss of vision or hearing;110 b hospitalize patients with malignant hypertension and those already receiving guanethidine (see Specific Drugs under Interactions) during initial minoxidil therapy and monitor closely to assure that BP is decreasing but not too rapidly.110 b
Monitor fluid and electrolyte balance and body weight.110 b Closely supervise patients with renal failure or those undergoing dialysis to prevent exacerbation of renal failure or precipitation of cardiac failure.110 b Observe patients for signs and symptoms of pericardial effusion.110 b
Repeat any abnormal laboratory test (e.g., urinalysis, renal function, ECG, chest radiograph, echocardiogram) occurring at initiation of therapy, initially at 1- to 3-month intervals and as stabilization occurs, at 6- to 12-month intervals.110
Select dosage with caution; because of greater frequency of hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy in the elderly.110 b (See Geriatric Patients under Dosage and Administration.)
Common Adverse Effects
Interactions for Minoxidil
Readily distributed into body tissues.b
Plasma Protein Binding
Clearance is directly affected by GFR.110
Reduces BP in both supine and standing patients; does not produce orthostatic hypotension.b
Advice to Patients
Importance of informing patients about continuance of all antihypertensive drugs and taking only as prescribed.110
Do not discontinue minoxidil unless instructed by a clinician.110
Importance of providing patient a copy of manufacturer's patient information.110
Inform patients of the likelihood of hair growth, which may develop within 3 to 6 weeks after starting therapy and may be especially disturbing to children and women.110 Inform patients about this effect before initiating therapy.110
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as concomitant illnesses.110
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.110
Importance of informing patients of other important precautionary information. (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Mutual, Par, Watson
Mutual, Par, Watson
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Minoxidil 10MG Tablets (PAR): 90/$53.99 or 180/$85.96
Minoxidil 2.5MG Tablets (PAR): 60/$19.99 or 180/$50.99
AHFS DI Essentials. © Copyright, 2004-2016, Selected Revisions July 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
Only references cited for selected revisions after 1984 are available electronically.
100. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1984; 144:1045-57. [IDIS 184763] [PubMed 6143542]
101. Valdivieso A, Valdés G, Spiro TE et al. Minoxidil in breast milk. Ann Intern Med. 1985; 102:135. [IDIS 194820] [PubMed 3966734]
102. Weiss VC, West DP, Mueller CE. Topical minoxidil in alopecia areata. J Am Acad Dermatol. 1981; 5:224-6. [PubMed 7263970]
103. Fenton DA, Wilkinson JD. Topical minoxidil in the treatment of alopecia areata. BMJ. 1983; 287:1015-7. [IDIS 177632] [PubMed 6412929]
104. King CM, Harrop B, Dave VK. Topical minoxidil in the treatment of alopecia areata. BMJ. 1983; 287:1380. [IDIS 178404] [PubMed 6416428]
105. Weiss VC, West DP, Fu TS et al. Alopecia areata treated with topical minoxidil. Arch Dermatol. 1984; 120:457-63. [IDIS 185288] [PubMed 6703751]
106. Vanderveen EE, Ellis CN, Kang S et al. Topical minoxidil for hair regrowth. J Am Acad Dermatol. 1984; 11:416-21. [PubMed 6384289]
107. Novak E, Franz TJ, Headington JT et al. Topically applied minoxidil in baldness. Int J Dermatol. 1985; 24:82-7. [PubMed 3886571]
108. Vermorken AJM. Reversal of androgenic alopecia by minoxidil: lack of effect of simultaneously administered intermediate doses of cyproterone acetate. Acta Derm Venereol. 1983; 63:268-9. [PubMed 6192653]
109. De Villez RL. Topical minoxidil therapy in hereditary androgenetic alopecia. Arch Dermatol. 1985; 121:197-202. [IDIS 196318] [PubMed 3883902]
110. Par Pharmaceutical, Inc. Minoxidil tablets prescribing information. Spring Valley, NY; 2003 Apr.
111. Weiss VC, West DP. Topical minoxidil therapy and hair regrowth. Arch Dermatol. 1985; 121:191-2. [IDIS 196316] [PubMed 3977331]
112. Franz TJ. Percutaneous absorption of minoxidil in man. Arch Dermatol. 1985; 121:203-6. [IDIS 196319] [PubMed 3977334]
113. Anon. Unapproved use of minoxidil. FDA Drug Bull. 1985; 15(4):38.
114. Kaler SG, Patrinos ME, Lambert GH et al. Hypertrichosis and congenital anomalies associated with maternal use of minoxidil. Pediatrics. 1987; 79:434-6. [IDIS 227024] [PubMed 3547299]
115. Rosa FW, Idanpaan-Heikkila J, Asanti R. Fetal minoxidil exposure. Pediatrics. 1987; 80:120. [IDIS 231951] [PubMed 3601507]
116. Anon. Topical minoxidil for baldness. Med Lett Drugs Ther. 1987; 29:87-8. [PubMed 3306300]
117. Rumsfield JA, West DP, Fiedler-Weiss VC. Topical minoxidil therapy for hair regrowth. Clin Pharm. 1987; 6:386-92. [IDIS 229037] [PubMed 3311578]
118. Clissold SP, Heel RC. Topical minoxidil: a preliminary review of its pharmacodynamic properties and therapeutic efficacy in alopecia areata and alopecia androgenetica. Drugs. 1987; 33:107-22. [IDIS 228948] [PubMed 3552591]
119. de Groot AC, Nater JP, Herxheimer A. Minoxidil: hope for the bald? Lancet. 1987; 1:1019-21.
120. Mitchell AD, De Villez R. Minoxidil for male-pattern baldness. Lancet. 1987; 1:1436. [PubMed 2884528]
121. de Groot AC, Nater JP, Herxheimer A. Minoxidil for male-pattern baldness. Lancet. 1987; 2:563. [PubMed 2887848]
122. Koperski JA, Orenberg EK, Wilkinson DI. Topical minoxidil therapy for androgenetic alopecia: a 30-month study. Arch Dermatol. 1987; 123:1483-7. [IDIS 235936] [PubMed 3314717]
123. Olsen EA, Weiner MS. Topical minoxidil in male pattern baldness: effects of discontinuation of treatment. J Am Acad Dermatol. 1987; 17:97-101. [PubMed 3301926]
124. Roenigk HH Jr, Pepper E, Kuruvilla S. Topical minoxidil therapy for hereditary male pattern alopecia. Cutis. 1987; 39:337-42. [PubMed 3556042]
125. Fiedler-Weiss VC. Topical minoxidil solution (1% and 5%) in the treatment of alopecia areata. J Am Acad Dermatol. 1987; 16(3 Part 2):745-8. [PubMed 3549811]
126. Price VH. Topical minoxidil (3%) in extensive alopecia areata, including long-term efficacy. J Am Acad Dermatol. 1987; 16(3 Part 2):737-44. [PubMed 3549810]
127. Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil. J Am Acad Dermatol. 1987; 16(3 Part 2):730-6. [PubMed 3549809]
128. Kreindler TG. Topical minoxidil in early androgenetic alopecia. J Am Acad Dermatol. 1987; 16(3 Part 2):718-24. [PubMed 3549807]
129. Katz HI, Hien NT, Prawer SE et al. Long-term efficacy of topical minoxidil in male pattern baldness. J Am Acad Dermatol. 1987; 16(3 Part 2):711-8. [PubMed 3549806]
130. Roberts JL. Androgenetic alopecia: results with topical minoxidil. J Am Acad Dermatol. 1987; 16(3 Part 2):705-10. [PubMed 3549805]
131. Savin RC. Use of topical minoxidil in the treatment of male-pattern baldness. J Am Acad Dermatol. 1987; 16(3 Part 2):696-704. [PubMed 3549804]
132. Olsen EA, DeLong ER, Weiner MS. Long-term follow-up of men with male pattern baldness treated with topical minoxidil. J Am Acad Dermatol. 1987; 16(3 Part 2):688-85. [PubMed 3549803]
133. Rietschel RL, Duncan SH. Safety and efficacy of topical minoxidil in the management of androgenetic alopecia. J Am Acad Dermatol. 1987; 16(3 Part 2):677-85. [PubMed 3549802]
134. Shupack JL, Kassimir JJ, Thirumoorthy T et al. Dose-response study of topical minoxidil in male pattern alopecia. J Am Acad Dermatol. 1987; 16(3 Part 2):673-6. [PubMed 3549801]
135. De Villez RL. Androgenetic alopecia treated with topical minoxidil. J Am Acad Dermatol. 1987; 16(3 Part 2):669-72. [PubMed 3549800]
136. Stern RS. Topical minoxidil: a survey of use and complications. Arch Dermatol. 1987; 123:62-5. [IDIS 224038] [PubMed 3800424]
137. Olsen EA, Weiner MS, Delong ER et al. Topical minoxidil in early male pattern baldness. J Am Acad Dermatol. 1985; 13(2 Part 1):185-92. [PubMed 3900155]
138. Franz TJ. Percutaneous absorption of minoxidil. Arch Dermatol. 1986; 122:15-6. [IDIS 209656] [PubMed 3942404]
139. Lustig S, Pitlik SD, Garty M et al. Pericarditis after minoxidil reinstitution. Drug Intell Clin Pharm. 1985; 19:763. [IDIS 205310] [PubMed 4053985]
140. Krehlik JM, Hindson DA, Crowley JJ Jr et al. Minoxidil-associated pericarditis and fatal cardiac tamponade. West J Med. 1985; 143:527-9. [IDIS 206109] [PubMed 4090485]
141. Evans CW, Tucker SC. Pericarditis: a complication of minoxidil therapy. South Med J. 1983; 76:815-6. [IDIS 171817] [PubMed 6857316]
142. 1988 Joint National Committee. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1988; 148:1023-38. [IDIS 242588] [PubMed 3365073]
143. Anon. Drugs for hypertension. Med Lett Drugs Ther. 1989; 31:25-30. [PubMed 2927361]
144. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med. 1993; 153:154-83. [IDIS 309043] [PubMed 8422206]
145. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health; 1997 Nov. (NIH publication No. 98-4080.)
146. Kaplan NM. Choice of initial therapy for hypertension. JAMA. 1996; 275:1577-80. [IDIS 365188] [PubMed 8622249]
147. Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. 2000; 35:1021-4. [PubMed 10818056]
148. Frohlich ED. Recognition of systolic hypertension for hypertension. Hypertension. 2000; 35:1019-20. [PubMed 10818055]
149. Bakris GL, Williams M, Dworkin L et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis. 2000; 36:646-61. [IDIS 452007] [PubMed 10977801]
150. Hansson L, Zanchetti A, Carruthers SG et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998; 351:1755-62. [IDIS 409003] [PubMed 9635947]
151. American Diabetes Association. Clinical Practice Recommendations 2001. Position Statement. Diabetic nephropathy. Diabetes Care. 2001; 24(Suppl 1):S69-72.
152. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2001; 24(Suppl 1):S33-43.
153. Pharmacia & Upjohn. Rogaine (minoxidil) topical solution prescribing information. In: Physicians’ desk reference. 50th ed. Montvale, NJ: Medical Economics Company. 1996; 2637- 41.
154. Appel LJ. The verdict from ALLHAT—thiazide diuretics are the preferred initial therapy for hypertension. JAMA. 2002; 288:3039-60. [IDIS 490723] [PubMed 12479770]
155. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288:2981-97. [IDIS 490721] [PubMed 12479763]
157. Whelton PK, Appel LJ, Espeland MA et al. for the TONE Collaborative Research Group. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). JAMA. 1998; 279:839-46. [PubMed 9515998]
158. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) Express. Bethesda, MD: May 14 2003. From NIH website. (). (Also published in JAMA. 2003; 289.
159. Psaty BM, Smith NL, Siscovick DS et al. Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA. 1997; 277:739-45. [IDIS 380501] [PubMed 9042847]
160. American Diabetes Association. Treatment of hypertension in adults with diabetes. Diabetes Care. 2003; 26(Suppl 1):S80-2.
161. Guidelines Committee. 2003 European Society of Hypertension–European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertension. 2003; 21:1011-53.
162. The Guidelines Subcommittee of the WHO/ISH Mild Hypertension Liaison Committee. 1999 guidelines for the management of hypertension. J Hypertension. 1999; 17:392-403.
163. National high blood pressure education program working group on hypertension control in children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(Suppl 2):555-76.
b. AHFS drug information 2007. McEvoy GK, ed. Minoxidil. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1740-3.].
More about minoxidil
- Other brands: Loniten