Version May 2024
Minoxidil may produce serious adverse effects. It can cause pericardial effusion, occasionally progressing to tamponade, and it can exacerbate angina pectoris. Reserve for hypertensive patients who do not respond adequately to maximum therapeutic doses of a diuretic and 2 other antihypertensive agents.
In experimental animals, minoxidil caused several kinds of myocardial lesions and other adverse cardiac effects.
Administer under close supervision, usually concomitantly with therapeutic doses of a beta-adrenergic blocking agent, to prevent tachycardia and increased myocardial workload. Usually, it must be given with a diuretic, frequently one acting in the ascending limb of the loop of Henle to prevent serious fluid accumulation. When first administering minoxidil, hospitalize and monitor patients with malignant hypertension and those already receiving guanethidine to avoid too rapid or large orthostatic decreases in blood pressure.
Hypertension (alternative agent) (adjunctive agent):
Note: Before prescribing, consider referral to a clinician with expertise in managing hypertension. Reserve for patients with resistant hypertension who do not respond adequately to an optimized 4-drug regimen, ideally consisting of a thiazide-like diuretic (eg, chlorthalidone) and a mineralocorticoid-receptor antagonist (eg, spironolactone). Use in combination with a beta-blocker to prevent reflex tachycardia. Fluid retention may occur and may require additional diuretic therapy (Ref).
Oral: Initial: 5 mg once daily, increase dose gradually in intervals of ≥3 days; usual effective dose: 10 to 40 mg/day in 1 to 3 divided doses; maximum dose: 100 mg/day in 1 to 3 divided doses. During therapy, if supine diastolic pressure is reduced <30 mm Hg, administer total daily dose once daily; if supine diastolic pressure is reduced >30 mm Hg, administer in divided doses (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no specific dosage recommendations provided in the manufacturer's labeling; however, the manufacturer suggests that patients with renal failure and/or receiving dialysis may require a dosage reduction.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution and titrate gradually (minoxidil AUC increased 50% and its clearance decreased in mildly cirrhotic patients (Ref)).
Refer to adult dosing.
(For additional information see "Minoxidil (systemic): Pediatric drug information")
Hypertension (alternate agent):
Acute severe hypertension with significant but not life-threatening symptoms (eg, severe headache, vomiting but no seizures):
Children and Adolescents: Oral: Initial: 0.1 to 0.2 mg/kg/dose; may repeat every 8 to 12 hours; maximum dose: 10 mg/dose (Ref). Note: In situations where rapid blood pressure management required, may increase dose after 6 hours with careful monitoring.
Chronic hypertension:
Note: Recommended for use in refractory hypertension with persistent symptoms or target organ damage despite maximal treatment with a diuretic and 2 antihypertensive agents.
Children <12 years: Oral: Initial: 0.2 mg/kg/dose once daily; maximum initial dose: 5 mg/dose; titrate to effect, may increase daily dose by 50% to 100% (eg, 0.1 to 0.2 mg/kg/day) every 3 days; may need to divide doses 1 to 3 times daily; usual daily dose: 0.25 to 1 mg/kg/day in 1 to 3 divided doses; maximum daily dose: 50 mg/day (Ref). Note: In situations where rapid blood pressure management required, may increase dose after 6 hours with careful monitoring.
Children ≥12 years and Adolescents: Oral: Initial: 5 mg once daily; titrate to effect; may increase every 3 days by doubling daily dose (10 mg/day, 20 mg/day, and then 40 mg/day); may need to divide doses 1 to 3 times daily; usual daily dose: 10 to 40 mg/day in 1 to 3 divided doses; maximum daily dose: 100 mg/day (Ref). Note: In situations where rapid blood pressure management required, may increase dose after 6 hours with careful monitoring.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Altered kidney function: Children and Adolescents: Oral: There are no specific dosage recommendations provided in the manufacturer's labeling; however, the manufacturer suggests that patients with renal failure may require a dosage reduction.
Hemodialysis: Dialyzable. Children and Adolescents: Oral: There are no specific dosage recommendations provided in the manufacturer's labeling; however, the manufacturer suggests that patients receiving dialysis may require a dosage reduction.
Children and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling; use with caution and titrate gradually (minoxidil AUC increased 50% and its clearance decreased in mildly cirrhotic adult patients (Ref)).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not always defined.
Cardiovascular: ECG changes (T-wave changes 60%), edema (reversible, 7% to 10%), pericardial effusion (occasionally with tamponade, 3%), angina pectoris, cardiac failure, pericarditis, tachycardia
Dermatologic: Hypertrichosis (80%), bullous rash (rare), skin rash, Stevens-Johnson syndrome (rare), toxic epidermal necrolysis
Endocrine & metabolic: Sodium retention, water retention, weight gain
Gastrointestinal: Nausea, vomiting
Hematologic & oncologic: Decreased hematocrit (transient, hemodilution), decreased red blood cells (transient, hemodilution), hemoglobin (transient, hemodilution), leukopenia (rare), thrombocytopenia (rare)
Hepatic: Ascites, increased serum alkaline phosphatase
Renal: Increased blood urea nitrogen (transient), increased serum creatinine (transient)
Respiratory: Pulmonary edema (Lee 2011)
<1%, postmarketing, and/or case reports: Breast tenderness (rare)
Hypersensitivity to minoxidil or any component of the formulation; pheochromocytoma
Canadian labeling: Additional contraindications (not in US labeling): Pulmonary hypertension associated with mitral stenosis; severe hepatic impairment
Concerns related to adverse effects:
• Fluid retention: May cause salt and water retention; administer with a diuretic, preferably a loop diuretic (eg, furosemide) to prevent fluid retention and subsequent local and generalized edema. Use with extreme caution in patients with heart failure.
• Pericardial effusion/tamponade: [US Boxed Warning]: May cause pericarditis and pericardial effusion that may progress to tamponade; patients with renal impairment not on dialysis may be at higher risk. Use with caution in patients with heart failure; observe patients closely. If effusion persists, consider discontinuation of minoxidil.
• Rapid blood pressure control: Rapid control of blood pressure in patients with severe hypertension can lead to syncope, cerebrovascular accidents, MI, and/or ischemia of other special sense organs resulting in decrease or loss of vision or hearing. Patients with compromised circulation or cryoglobulinemia may also suffer ischemic episodes of the affected organs.
• Sinus tachycardia: [US Boxed Warning]: May increase oxygen demand and exacerbate angina pectoris; concomitant use with a beta-blocker (if no contraindication exists) may help reduce the effect. Use with caution in patients with ischemic heart disease.
Disease-related concerns:
• Acute myocardial infarct (MI): Avoid use for a month after acute MI as use may increase oxygen demand due to reflex tachycardia. Use with extreme caution; ensure patient is receiving a beta blocker prior to initiation.
• Heart failure: Compared to placebo minoxidil increased the frequency of clinical events, including increased need for diuretics, angina, ventricular arrhythmias, worsening heart failure and death (Franciosa 1984). In a scientific statement from the American Heart Association, minoxidil has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: moderate) (AHA [Page 2016]).
• Renal impairment: Use with caution in patients with significant renal impairment; renal failure and dialysis patients may require a smaller dose. Monitor closely to prevent exacerbation of renal failure.
Special populations:
• Older adult: Use with caution in the elderly; initiate at the low end of the dosage range and monitor closely.
Other warnings/precautions:
• Appropriate use: [US Boxed Warning]: Maximum therapeutic doses of a diuretic and two other antihypertensives should be used before this drug is ever added. Should be given with a diuretic to minimize fluid gain and a beta-blocker (if no contraindications) to prevent tachycardia and increased myocardial workload. Patients with malignant hypertension and those already receiving guanethidine should be hospitalized with close medical supervision to ensure blood pressure is reducing and to prevent too rapid of a reduction in blood pressure.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Generic: 2.5 mg, 10 mg
Yes
Tablets (Minoxidil Oral)
2.5 mg (per each): $0.59 - $0.78
10 mg (per each): $1.29 - $1.69
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Loniten: 2.5 mg, 10 mg
Oral: May be administered without regard to food
Hypertension: Management of hypertension that is symptomatic or associated with target organ damage, and is not manageable with maximum therapeutic doses of a diuretic plus 2 other antihypertensives. Use in milder degrees of hypertension is not recommended because the benefit-risk ratio in such patients has not been defined. Note: Not recommended for the initial treatment of hypertension (ACC/AHA [Whelton 2018]).
Loniten [CAN] may be confused with Lipitor
Minoxidil may be confused with metOLazone, midodrine, Minipress, Minocin, Monopril, Minoxidin (dietary supplement), Noxafil
Noxidil [Thailand] may be confused with Noxafil brand name for posaconazole [US and multiple international markets]
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification
Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy
Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Atazanavir: May increase the serum concentration of Minoxidil (Systemic). Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination
CycloSPORINE (Systemic): May enhance the adverse/toxic effect of Minoxidil (Systemic). Severe hypertrichosis has been reported with this combination. Risk C: Monitor therapy
Dapoxetine: May enhance the orthostatic hypotensive effect of Minoxidil (Systemic). Risk C: Monitor therapy
Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy
Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy
Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy
Loop Diuretics: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy
Probenecid: May increase the serum concentration of Minoxidil (Systemic). Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy
Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy
Valproate Products: May increase the serum concentration of Minoxidil (Systemic). Risk C: Monitor therapy
Adverse events were observed in some animal studies. Neonatal hypertrichosis has been reported following exposure to minoxidil during pregnancy.
Excretion in breast milk has been reported in one case report of a woman receiving 10 mg/day orally. Due to the potential for adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer.
Blood pressure; heart rate; signs/symptoms of pericardial effusion or cardiac tamponade; signs/symptoms of angina; fluid and electrolyte balance and body weight. Any tests that are abnormal at the time of initiation (including, renal function tests, ECG, echocardiogram, chest x-ray) should be repeated initially every 1 to 3 months then every 6 to 12 months once stable.
Produces vasodilation by directly relaxing arteriolar smooth muscle, with little effect on veins; effects may be mediated by cyclic AMP; stimulation of hair growth is secondary to vasodilation, increased cutaneous blood flow and stimulation of resting hair follicles
Onset of action: Hypotensive: ~30 minutes
Peak effect: 2 to 3 hours
Duration: Up to 2 to 5 days
Protein binding: None
Metabolism: ~90%, primarily via glucuronidation
Bioavailability: 90%
Half-life elimination: 3.5 to 4.2 hours
Excretion: Urine (12% as unchanged)
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
