An Off-Label Hair Loss Pill Is Going Mainstream, But Questions Remain

Preventing and treating hair loss might become a lot more convenient for many in the future. A large international group of dermatology experts is now advising that most people with hair loss might benefit from taking an affordable pill version of minoxidil, the active ingredient in the well-known topical medication Rogaine.

In a paper published Wednesday, dermatologists from 12 countries have gathered to provide recommendations surrounding the use of low-dose oral minoxidil—an emerging, but off-label, treatment for hair loss. The experts have agreed that oral minoxidil can be an appealing alternative for most teens and adults with hair loss who aren’t pleased with the topical version for whatever reason. The group’s endorsement will likely expand awareness of this treatment among dermatologists and their patients.

Topical minoxidil has been a standard, even over-the-counter, hair loss treatment for over three decades. More recently, however, some doctors have begun using a low-dose oral form of minoxidil for their patients instead, arguing that it may have unique advantages.

When applied topically to the scalp, for instance, minoxidil is known to sometimes cause redness and burning. People with cats or dogs also have to be careful when using it, since minoxidil is toxic to both animals. And some people might simply hate having to regularly leave a topical gel or foam in their hair. The pill version, taken daily, avoids many of these limitations, while being very cheap in cost. Some research has even suggested that oral minoxidil can be more effective for hair loss in general, perhaps in part because many people don’t easily absorb the drug through their scalp.

Right now, though, oral minoxidil is a niche treatment. One reason why is that it’s off-label, since only topical minoxidil is approved to treat hair loss. And while studies have continued to show support for oral minoxidil as a hair loss treatment over the years, it’s likely that most doctors know very little about it. That lack of knowledge could include how to correctly dose patients or the reasons why it might not be recommended for some people.

So the researchers behind this new paper, published in JAMA Dermatology, decided to craft a consensus on the topic. After reviewing the current evidence, the researchers surveyed 43 hair loss specialist dermatologists from 12 countries on a lengthy list of questions and statements concerning oral minoxidil and how it should be best used. All told, the experts agreed on 76 items, including that it should be a viable option for people who aren’t responding to or otherwise not gelling with topical minoxidil.

“The consensus suggests that low-dose oral minoxidil may be considered if topical minoxidil application is logistically challenging, or results in undesirable hair styling issues or scalp irritation, or has not been effective, or is more affordable,” study co-author Paradi Mirmirani, a California dermatologist, told Everyday Health.

Oral minoxidil is also used to lower blood pressure in people with severe hypertension, and this version of the drug comes with a black box warning that its use could possible raise the risk of heart issues. Some doctors administering oral minoxidil for hair loss have argued that the doses they prescribe are likely too low to pose a similar heart risk. But the experts of this consensus have agreed that people who have certain heart conditions like pericarditis should not be given oral minoxidil, while people with other heart or health conditions should first clear the use of the drug with their primary care doctor or relevant specialist.

Still, the guidelines should mean that doctors will be more able and willing to prescribe oral minoxidil to their patients with hair loss, the researchers say.

“Given that the use of oral minoxidil in dermatology is still quite new, many doctors do not yet feel comfortable prescribing it,” co-author Brittany Craiglow, an associate adjunct professor of dermatology at Yale University School of Medicine, told Everyday Health. “This consensus statement provides a lot of useful information regarding indications, dosing, and adverse effects that will hopefully give dermatologists more confidence in its use.”