Panel Agrees on Key Recommendations for Oral Minoxidil Use

Key Takeaways

• An international panel of dermatologists agreed on recommendations for low-dose oral minixodil use.
• Key areas for future research include pediatric use, titration protocols, and long-term safety.
• This interim guidance provides a resource for dermatologists until more robust, evidence-based trials are conducted.

A new international consensus statement offers guidance on the off-label use of low-dose oral minoxidil (LDOM) for managing hair loss.

The consensus, published in JAMA Dermatology, was developed by 43 dermatologists across 12 countries, and according to the group provides recommendations on diagnoses, indications, dosing, contraindications, and monitoring of LDOM.

The team used a modified Delphi method to analyze existing literature (328 items). Seventy-six items met the required 70% agreement threshold, covering diverse topics such as the benefits of LDOM over topical formulations, dosing protocols for adults and adolescents, baseline evaluations, adjunctive therapies, and precautions. Recommendations for pediatric use and LDOM titration protocols failed to achieve consensus, highlighting areas for future research.

The panel emphasized need for further studies on the efficacy of topical vs. oral minoxidil; long-term safety; and the use of alternative formulations, such as sublingual or compounded oral minoxidil. Limitations of the current consensus include A lack of representation from specialists experienced in treating pediatric patients, was cited as a limitation of the current consensus statement. 

"LDOM is an increasingly popular off-label treatment for patients with hair loss; this international expert consensus statement on LDOM use for patients with hair loss can help inform clinical practice until high-quality evidence-based data emerge," the authors wrote.

Source: Akiska Y, et al. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.4593