minoxidil

(mi nox' i dill)

Oral:
Loniten, Minox (CAN)
Topical:
Minoxigaine (CAN), Rogaine, Rogaine Extra Strength

Pregnancy Category C

Drug classes
Antihypertensive
Vasodilator

Therapeutic actions
Acts directly on vascular smooth muscle to cause vasodilation, reducing elevated systolic
and diastolic BP; does not interfere with CV reflexes; does not usually cause orthostatic
hypotension but does cause reflex tachycardia and renin release, leading to sodium and
water retention; mechanism in stimulating hair growth is not known, possibly related to
arterial dilation.

Indications
• Severe hypertension that is symptomatic or associated with target organ damage
and is not manageable with maximum therapeutic doses of a diuretic plus two
other antihypertensive drugs; use in milder hypertension not recommended
• Topical use (when compounded as a 1%–5% lotion or 1% ointment): Alopecia
areata and male pattern alopecia

Contraindications and cautions

• Contraindicated with hypersensitivity to minoxidil or any component of the
topical preparation (topical); pheochromocytoma (may stimulate release of
catecholamines from tumor); acute MI; dissecting aortic aneurysm; lactation.
• Use cautiously with malignant hypertension; CHF (use diuretic); angina pectoris
(use a beta-blocker); pregnancy.

Available forms
Tablets—2.5, 10 mg; topical 2%, 5%

Dosages
ADULTS AND PATIENTS > 12 YR
Oral
• Monotherapy: Initial dosage is 2.5–5 mg/day PO as a single dose. Daily dosage
can be increased to 10, 20, then 40 mg in single or divided doses. Effective range
is usually 10–40 mg/day PO. Maximum dosage is 100 mg/day. If supine diastolic
BP has been reduced less than 30 mm Hg, administer the drug only once a day. If
reduced more than 30 mm Hg, divide the daily dosage into two equal parts.
Dosage adjustment should normally be at least at 3-day intervals; in emergencies,
q 6 hr with careful monitoring if possible.
 • Concomitant therapy with diuretics: Use minoxidil with a diuretic in patients
relying on renal function for maintaining salt and water balance; the following
diuretic dosages have been used when starting minoxidil therapy:
hydrochlorothiazide, 50 mg bid; chlorthalidone, 50–100 mg daily; furosemide,
40 mg bid. If excessive salt and water retention result in weight gain > 5 lb,
change diuretic therapy to furosemide; if patient already takes furosemide,
increase dosage.
• Concomitant therapy with beta-adrenergic blockers or other sympatholytics: The
following dosages are recommended when starting minoxidil therapy:
propranolol, 80–160 mg/day; other beta-blockers, dosage equivalent to the above;
methyldopa 250–750 mg bid (start methyldopa at least 24 hr before minoxidil);
clonidine, 0.1–0.2 mg bid.
Topical
Apply 1 mL to the total affected areas of the scalp twice daily. The total daily dosage
should not exceed 2 mL. Twice daily application for > 4 mo may be required before
evidence of hair regrowth is observed. Once hair growth is realized, twice daily
application is necessary for continued and additional hair regrowth. Balding process
reported to return to untreated state 3–4 mo after cessation of the drug.
PEDIATRIC PATIENTS < 12 YR
Experience is limited, particularly in infants; use recommendations as a guide; careful
adjustment is necessary. Initial dosage is 0.2 mg/kg/day PO as a single dose. May
increase by 50%–100% increments until optimum BP control is achieved. Effective range
is usually 0.25–1 mg/kg/day; maximum dosage is 50 mg daily. Experience in children is
limited; monitor carefully.
GERIATRIC PATIENTS OR PATIENTS WITH IMPAIRED RENAL FUNCTION
Smaller doses may be required; closely supervise to prevent cardiac failure or
exacerbation of renal failure.

Pharmacokinetics
Route Onset Peak Duration
Oral 30 min 2–3 hr 75 hr
Topical Generally no systemic
absorption

Metabolism: Hepatic; T1/2: 4.2 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Fatigue, headache
• CV: Tachycardia (unless given with beta-adrenergic blocker or other
sympatholytic drug), pericardial effusion and tamponade; changes in direction
and magnitude of T-waves; cardiac necrotic lesions (reported in patients with
known ischemic heart disease, but risk of minoxidil-associated cardiac damage
cannot be excluded)
• Dermatologic: Temporary edema, hypertrichosis (elongation, thickening, and
enhanced pigmentation of fine body hair occurring within 3–6 wk of starting
 therapy; usually first noticed on temples, between eyebrows and extending to
other parts of face, back, arms, legs, scalp); rashes including bullous eruptions;
Stevens-Johnson syndrome; darkening of the skin
• GI: Nausea, vomiting
• Hematologic: Initial decrease in Hct, Hgb, RBC count
• Local: Irritant dermatitis, allergic contact dermatitis, eczema, pruritus, dry
skin/scalp, flaking, alopecia (topical use)
• Respiratory: Bronchitis, upper respiratory infection, sinusitis (topical use)

Interactions
Drug-drug
• Risk of profound orthostatic hypotension if given with guanethidine. Stop
guanethidine; if not possible, hospitalize patient

Nursing considerations
Assessment
• History: Hypersensitivity to minoxidil or any component of the topical
preparation; pheochromocytoma; acute MI, dissecting aortic aneurysm; malignant
hypertension; CHF; angina pectoris; lactation, pregnancy
• Physical: Skin color, lesions, hair, scalp; P, BP, orthostatic BP, supine BP,
perfusion, edema, auscultation; bowel sounds, normal output; CBC with
differential, kidney function tests, urinalysis, ECG

Interventions
• Apply topical preparation to affected area; if fingers are used to facilitate drug
application, wash hands thoroughly afterward.
• Do not apply other topical agents, including topical corticosteroids, retinoids, and
petrolatum or agents known to enhance cutaneous drug absorption.
• Do not apply topical preparation to open lesions or breaks in the skin, which
could increase risk of systemic absorption.
• Arrange to withdraw oral drug gradually, especially from children; rapid
withdrawal may cause a sudden increase in BP (rebound hypertension has been
reported in children, even with gradual withdrawal; use caution and monitor BP
closely when withdrawing from children).
• Arrange for echocardiographic evaluation of possible pericardial effusion; more
vigorous diuretic therapy, dialysis, other treatment (including minoxidil
withdrawal) may be required.

Teaching points
Oral
• Take this drug exactly as prescribed. Take all other medications that have been
prescribed. Do not discontinue any drug or reduce the dosage without consulting
your health care provider.
 • These side effects may occur: Enhanced growth and darkening of fine body and
face hair (do not discontinue medication without consulting health care provider);
GI upset (eat frequent small meals).
• Report increased heart rate of > 20 beats per minute over normal (your normal
heart rate is ___ beats per minute); rapid weight gain of more than 5 lb; unusual
swelling of the extremities, face, or abdomen; difficulty breathing, especially
when lying down; new or aggravated symptoms of angina (chest, arm, or shoulder
pain); severe indigestion; dizziness, light-headedness, or fainting.
Topical
• Apply the prescribed amount to affected area twice a day. If using the fingers to
facilitate application, wash hands thoroughly after application. It may take 4 mo
or longer for any noticeable hair regrowth to appear. Response to this drug is very
individual. If no response is seen within 4 mo, consult with your health care
provider about efficacy of continued use.
• Do not apply more frequent or larger applications. This will not speed up or
increase hair growth but may increase side effects.
• If one or two daily applications are missed, restart twice-daily applications, and
return to usual schedule. Do not attempt to make up missed applications.
• Do not apply any other topical medication to the area while you are using this
drug.
• Do not apply to any sunburned, broken skin or open lesions; this increases the risk
of systemic effects. Do not apply to any part of the body other than the scalp.
• Twice daily use of the drug will be necessary to retain or continue the hair
regrowth.

Adverse effects in Italic are most common; those in Bold are life-threatening.