JAMA Dermatol

Oral minoxidil for hair loss: Expert consensus statement

January 6, 2025

A group of experts reached consensus on off-label use of low-dose oral minoxidil (0.625 mg - 5 mg daily) for various types of hair loss in adult/adolescent women and men. While several small studies suggest that low-dose oral minoxidil may be safe and effective, large trials and evidence-based guidelines are lacking.

Process: A modified Delphi consensus process involved 43 dermatologists specializing in hair loss from 12 countries. Consensus threshold: 70% of specialists responding “agreed” or “strongly agreed” on a 5-point Likert scale survey.

Consensus was achieved on these topics:

• Diagnoses for which low-dose oral minoxidil may be beneficial (e.g., androgenetic alopecia, age-related patterned thinning, alopecia areata, chemotherapy-induced alopecia, traction alopecia).
• Recommendations for low-dose oral vs. topical minoxidil (e.g., cost, logistics, scalp irritation).
• Commonly prescribed dosing for adults 18+ years (e.g., starting dose 1.25 mg/day for females, 2.5 mg/day for males) and adolescents 12 - 17 years (e.g., starting dose 0.625 mg/day for girls, 1.25 mg/day for boys). However, consensus wasn’t reached for use or dosing for children under age 12 years. Consensus wasn’t reached for titration protocols or dosing escalation, either.
• Contraindications (e.g., pericardial disease, pregnancy, lactation, congestive heart failure, drug interactions), precautions (e.g., kidney impairment, arrhythmia, hypotension), baseline evaluation, monitoring, adjunctive therapy, and specialty consultation recommendations.

Source:

Akiska YM, et al. (2024, November 20). JAMA Dermatol. Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement. https://pubmed.ncbi.nlm.nih.gov/39565602/