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.
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, 2004-2014, 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.
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