Season 6 Episode 3 (Oral Minoxidil and Blood Pressure)

[@zhyloNN]

How can LDOM result in sexual side effects? I think Minoxidil has the potential of different side effects because ultimately how it works (potassium channel opener?) and its effect at a cellular level is not well understood

[@dbrown1500]

I was having a great result with Oral Minoxidil, but then began to think that the burning in both feet was not due to my sciatica. Burning in my feet and genitals like Peripheral Nueropathy.....was getting worse when I take a higher dose of Oral Minoxidil( I was alternating between 1.25 and 2.5 mgs per day. I quit cold turkey. I had never heard of this side effect.

[@adarshvenukuttan7470]

Did the result stay? Or gone worse?

[@dbrown1500]

@@adarshvenukuttan7470 I did go away when I quit the oral Minoxidil, but I later got on a topical plus oral finasteride, and got my results back

[@MyLifeInTheDesert]

Dr. I also want to add that I use both a whoop strap and a Fitbit and it would appear as though oral minoxidil lowers HRV and increases resting heart rate. Obviously can’t prove causation but the data before and after starting the medication seems to suggest a relationship. If your patients use a wearable device like an Apple Watch have them watch for changes

[@donovanmedical9780]

Thanks. Yes minoxidil can increase heart rate 2-6 beats per minute depending on dose. As a person goes beyond 5 mg those are even more. High dose Oral minoxidil in the 1970s (10-40 mg) increased heart rate so much that beta blocker heart rate controlling medication was needed. So yes, it is well established that oral minoxidil can affect heart rate in some patients.

[@jayhathaway4720]

Hi Dr. Donovan. I'm curious on your opinion of taking divided doses like 1.25mg BID rather than 2.5mg Daily to ease side effects. Also, it seems 5mg finasteride is more effective than 1mg finasteride in Women, but it seems this is not the case it men. I wonder why.

[@gass3764]

Have you ever had any cases where 10mg is used for hairloss?

[@donovanmedical9780]

sure. not something I recommend but yes. heart rate goes up with those kinds of doses!!!!!!!

[@gass3764]

@@donovanmedical9780 thanks was just curious, I wouldn’t personally. Do you have any general advice for someone who’s on 5mg and switched from topical last year but not regained their topical results?

[@MyLifeInTheDesert]

I had to cut my dose from 2.5 mg to 1.25. I had headaches and I felt anxious or maybe it was palpitations I’m not sure. I cut the pill in half now. (I am a female) with androgenetic alopecia and lichen planopilaris. I think it works really well though. Reduced shed for sure. I prefer this over the foam. I imagine with the minoxidil foam application you are still getting the drug into your bloodstream via the transdermal route.

[@donovanmedical9780]

Well, with topical one gets very very little into the blood but yes there is some. 2.5 mg is not tolerated by all women. It’s a popular dose nowadays but not a dose I particularly like for my patients. Many patients just don’t tolerate 2.5 mg. Many many tolerate 1.25 mg and sometimes 1.875 mg.

[@Msh3el52]

Hey Dr , i hope you really answe these two questions i have Two questions about two scenarios, first question ? if i use minoxodil but im one of the minority that minoxodil doesn’t work for me , but i haven’t noticed that its not working, so i kept applying it for a long time lets say a year , btw i was using the topical solution form which contains alcohol, will that minoxodil that isn’t working make my situation worse does it make it like im only applying the alcohol? Second question if i got missdiagnosed with androgenetic alopecia lets say, so i use minoxodil for a while ,since in misdiagnosed minoxodil is not gonna help me can it cause adverse effects can it make my hair thinner , due to its daily application on the scalp thinking i have androgenetic alopecia? My point is Imagine minoxodil doesn’t work for me ,ok? Now imagine if ur applying topical solution minoxodil which only has minoxodil and alcohol, now since minoxodil isn’t working, what happens overtime if ur only applying alcohol? We know alcohol is very bad for hair follicles , but in the situation of minoxodil working i know that alcohol helps with absorption. So what if minoxodil isn’t working for me?

[@copetillirope178]

Hey doctor great video as always . I took OM 5mg for 6 months but stopped recently due to increased chest pain and lack of results. I had a question concerning lpp and ffa due you think topical retinoid / retin a cream could be usefull especially on eyebrow lpp / ffa ? I know there are no data or studies but considering oral retinoid are part of the gold standard mqybe it could be a good add on . And also do viviscal help ffa/ lpp ? Thanks with all ly respect

[@donovanmedical9780]

I'm not a great fan of retinoids for eyebrow. There is no evidence for one. second, if it runs in the eye, there is potentially a problem. I would rather a patient consider pimecroliumus or tacroliumus or topical tofacitinib (compounded) or topcial ruxolitinib or even steroid injections. I don't use retinoids on the eyebrows. Viviscal has no evidence whatsoever at the moment of being helpful in FFA/LPP.

[@andre4282]

Is shedding reversible after cold turkey when switching from topical to oral minoxidil?

[@donovanmedical9780]

Switching from topical to oral minoxidil may or may not give much shedding. It depends on the person and also on the dose of oral minoxidil to be used. In some cases that shedding is going to be short duration and in other cases it’s going to be a long time. For example, for females it should be noted that 5 % topical minoxidil is similar more or less to 1 mg oral minoxidil. So you can imagine that if a female patient switches cold turkey from topical minoxidil to 0.25 mg or 0.625 mg there is going to be a problem. Hair follicles are receiving less minoxidil when 0.625 mg is used compared to when topical minoxidil is used. So the result is shedding, shedding shedding. The duration of shedding will depend a bit on the person as well as the duration the topical minoxidil had been used. If topical minoxidil had been used 20 years, there’s going to be more of a problem compared to if it was used 20 days. So there are many factors that go into evaluating the risk of shedding when a patient switches from topical to oral minoxidil. It’s not always so straightforward!

[@andre4282]

Thank you so much for your answer!

[@dbrown1500]

A fun fact, I an pretty sure Oral Minoxidil caused Foot and leg burning in me-Peripheral Neuralgia. It is a very unusual thing. Had been on topical for years with no problem. I got off of Oral a week ago. This was VERY scary

[@donovanmedical9780]

Certainly possible it's from minoxidil, but I would still encourage you to see your doctor. Basic blood tests are often still indicated in many (CBC, B12, TSH, glucose, hemoglobin A1c, sodium, potassium, ESR, CRP, AST, ALT, creatinine, SPEP, zinc and sometimes many others!!),. Your doctor will want to perform a really good history and really good physical examination including a good sensory and motor neurological examination. Once the first set of blood tests come back, we sometimes order a second (different panel) depending on what was uncovered during the history and examination and the first set of tests. There are up to 50 tests that are possible but we don't order all of them! In some patients, the minoxidil promotes slight fluid retention which causes this. In others, it may be a different mechanism. Other medications (statins, etc) in addition to the minoxidil need to be considered as well as other medical comorbidities (heart disease, blood pressure issues, diabetes, peripheral artery disease, venous insufficiency) and recent infections. I have seen patients with leg related symptoms from oral minoxidil. Sometimes it's the oral minoxidil causing swelling that sets things off but sometimes it's the slight swelling that uncovers or unmasks another issue that was subclinical (or running under the radar). So be sure to see your doctor for a full and comprehensive assessment. If symptoms persist, you may need vascular and elctrodiagnostic studies. But hopefully all settles and returns perfectly back to normal. I always encourage everyone with symptoms like this (even if short term and temporary) to have a proper evaluation.

[@weeteelim3749]

Love oral minoxidil except for causing leg oedema

[@donovanmedical9780]

Yea, a dose dependent and frustrating side effect in 1-10 % of users! donovanmedical.com/hair-blog/ldom