Low-dose oral minoxidil for hair loss well-tolerated
Q: What can you tell me about minoxidil pills for hair loss? Some people say that low-dose minoxidil really does increase hair volume. Having thin, “postmenopausal” hair myself, I’m planning to ask my doctor about it sometime soon. First, though, I’d like your opinion.
A:
Researchers initially developed minoxidil as an oral blood pressure medication. It was granted Food and Drug Administration approval in 1979 under the brand name Loniten. When people reported hair growth as a side effect, a topical formulation was created with the name Rogaine.
Topical minoxidil was less likely to cause worrisome side effects, such as fluid retention (edema), rapid heart rate, headache and weight gain. More serious reactions associated with oral minoxidil include inflammation around the heart, congestive heart failure, worsening angina and severe skin reactions.
Most of those adverse drug reactions have been reported by people taking high oral doses for hard-to-treat high blood pressure. At the very low doses of oral minoxidil, or OM, currently being prescribed off label for hair loss, such problems appear uncommon ( Journal of the American Academy of Dermatology, Oct. 14, 2023).
We could find no large, wellcontrolled trials of low-dose OM for hair loss. A review in the Journal of the American Academy of Dermatology (March 2021) concluded, however, “Oral minoxidil was found to be an effective and well-tolerated treatment alternative for healthy patients having difficulty with topical formulation.”
Q: I read recently that the Food and Drug Administration is changing the classification of natural desiccated thyroid extracts. They will now be considered “biologics.” I fear that this will increase the price a lot, even though these medicines are not expensive to produce.
The company that makes Armour Thyroid is not objecting to this change. To my mind, that could mean they stand to benefit financially. Can you enlighten your readers about what is going on?
A: The FDA appears to be skeptical about the value of desiccated thyroid extract. Even though a major pharmaceutical company (AbbVie) makes both synthetic levothyroxine (Synthroid) and Armour Thyroid, the FDA cites safety, effectiveness and quality issues with natural thyroid extract.
The FDA has classified DTE as a “biological product.” That means the agency could require a special license for these medicines. Whether the agency will ban natural thyroid remains to be seen.
To understand more about synthetic and natural thyroid products, as well as testing for thyroid problems, you may wish to consult our “eGuide to Thyroid Hormones.” This online resource is available under the Health eGuides tab at PeoplesPharmacy.com.
Q: I have had trouble over the years with cracks at the corners of my mouth. To treat them, I tried everything from antifungals to antibiotics to vitamins B and D.
Nothing worked for me until I came across an article about a sensitivity to SLS, sodium lauryl sulfate. I discovered that my toothpaste contains SLS. Once I changed to non-SLS toothpaste, I’ve had no more splits at the corners of my mouth!
A: There are many possible causes of angular cheilitis (red cracks at the corners of the mouth). Some readers report benefit with vitamin supplements, while others find topical cortisone plus antifungal cream helpful. You are not the first to discover that SLS, the foaming agent in many toothpastes, can trigger irritation.