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minoxidil
generic
Black Box Warnings .
Appropriate Use
administer under close supervision usually in combo with therapeutic doses of beta blocker to prevent tachycardia and incr. myocardial workload; must also usually give with loop diuretic to prevent serious fluid accumulation; hospitalize patients with malignant HTN and if concomitant guanethidine for initial tx, monitor to avoid too rapid or large orthostatic decr. in blood pressure
Serious Cardiac Event Risk
powerful antihypertensive with serious adverse event risk including pericardial effusion sometimes progressing to tamponade and angina pectoris exacerbation; reserve for HTN patients without adequate response to max therapeutic dose of diuretic and 2 other antihypertensives; in animal studies several myocardial lesions and other cardiac adverse events occurred
Adult Dosing .
Dosage forms: TAB: 2.5 mg, 10 mg
HTN, refractory
- [5-40 mg/day PO divided qd-bid]
- Start: 5 mg PO qd, may incr. dose q3 days; Max: 100 mg/day
alopecia (off-label)
- [male patients]
- Dose: 1.25-5 mg/day PO divided qd-bid
- [female patients]
- Dose: 0.25-2.5 mg/day PO divided qd-bid
renal dosing
- [see below]
- renal failure: consider decr. usual dose
- HD: consider decr. usual dose, on dialysis days administer after dialysis; no supplement; PD: consider decr. usual dose; no supplement
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: TAB: 2.5 mg, 10 mg
HTN, refractory
- [<12 yo]
- Dose: 0.25-1 mg/kg/day PO divided qd-bid; Start: 0.1-0.2 mg/kg/dose PO qd, may incr. dose by 0.1-0.2 mg/kg/day q3 days; Max: 50 mg/day
- [>12 yo]
- Dose: 10-40 mg/day PO divided qd-bid; Start: 5 mg PO qd, may incr. dose q3 days; Max: 100 mg/day
HTN, acute severe (off-label)
- [1 yo and older]
- Dose: 0.1-0.2 mg/kg/dose PO q8-12h; Max: 10 mg/dose; Info: for patients with non-life-threatening symptoms
renal dosing
- [see below]
- renal failure: consider decr. usual dose
- HD: consider decr. usual dose, on dialysis days administer after dialysis; no supplement; PD: consider decr. usual dose; no supplement
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pheochromocytoma
- pericardial effusion
- caution: renal failure
- caution: post-MI
- caution: CHF
- caution: tachycardia
Drug Interactions .
Overview
minoxidil
peripheral vasodilator
- antihypertensive agent
Contraindicated
- isocarboxazid
Avoid/Use Alternative
- aldesleukin
- aripiprazole lauroxil
- lofexidine
Monitor/Modify Tx
- abiraterone acetate
- albuterol
- albuterol inhaled
- alfentanil
- alfuzosin
- almotriptan
- alprostadil intracavernous
- amantadine
- amifostine
- amitriptyline
- amoxapine
- amphetamine
- apomorphine
- apraclonidine ophthalmic
- arformoterol inhaled
- aripiprazole bimonthly injection
- aripiprazole monthly injection
- aripiprazole oral
- armodafinil
- articaine
- asciminib
- asenapine
- aspirin
- atogepant
- atomoxetine
- atropine ophthalmic
- avanafil
- axitinib
- benzphetamine
- berberine
- betamethasone
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bortezomib
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- budesonide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butorphanol
- cabergoline
- cabozantinib
- caffeine
- caffeine citrate
- canagliflozin
- cannabis
- carfilzomib
- cariprazine
- carteolol ophthalmic
- celecoxib
- chloroprocaine
- chlorpromazine
- cilostazol
- clofarabine
- clomipramine
- clonidine
- clozapine
- cocaine
- codeine
- coenzyme Q-10
- copanlisib
- corticotropin
- cortisone
- cyclosporine
- danazol
- dapagliflozin
- darbepoetin alfa
- deflazacort
- denileukin diftitox
- desflurane
- desipramine
- desmopressin
- desvenlafaxine
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- diazoxide
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- dihydrocodeine
- dihydroergotamine
- dinutuximab
- dipyridamole
- doxapram
- doxazosin
- doxepin
- dronabinol
- droxidopa
- duloxetine
- eletriptan
- empagliflozin
- entacapone
- entrectinib
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- epinephrine inhaled
- epoetin alfa
- epoprostenol
- eptinezumab
- erenumab
- ergotamine
- ertugliflozin
- esketamine
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethanol (alcoholic beverage)
- ethanol injection
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- etripamil nasal
- fenfluramine
- fenoprofen
- fentanyl
- ferumoxytol
- fingolimod
- flaxseed
- flibanserin
- fludrocortisone
- fluphenazine
- flurbiprofen
- formoterol inhaled
- foslevodopa
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galcanezumab
- garlic
- gilteritinib
- guanfacine
- haloperidol
- hoodia
- hydralazine
- hydrocodone
- hydrocortisone
- hydromorphone
- hydroxocobalamin IV
- ibrutinib
- ibuprofen
- iloperidone
- iloprost
- imipramine
- indomethacin
- iron sucrose
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- ketamine
- ketoprofen
- ketorolac
- landiolol
- lanreotide
- leflunomide
- lenvatinib
- levalbuterol inhaled
- levobunolol ophthalmic
- levodopa
- levomilnacipran
- levorphanol
- levothyroxine
- licorice
- lidocaine
- liothyronine
- lisdexamfetamine
- lorlatinib
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- lumateperone
- lurasidone
- luspatercept
- magnesium salicylate
- magnesium sulfate
- maraviroc
- meclofenamate
- mefenamic acid
- meloxicam
- meperidine
- mepivacaine
- methadone
- methamphetamine
- methohexital
- methoxy polyethylene glycol-epoetin beta
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- midazolam
- midodrine
- milnacipran
- milrinone
- milsaperidone
- mirabegron
- mirtazapine
- modafinil
- molindone
- morphine
- nabumetone
- nalbuphine
- naphazoline ophthalmic
- naproxen
- naratriptan
- nattokinase
- naxitamab
- niacin (vitamin B3)
- niraparib
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- obinutuzumab
- olanzapine
- oliceridine
- olodaterol inhaled
- opicapone
- opium
- osilodrostat
- oxaprozin
- oxazepam
- oxycodone
- oxymetazoline nasal
- oxymetazoline ophthalmic
- oxymetazoline topical
- oxymorphone
- oxytocin
- ozanimod
- paliperidone
- palopegteriparatide
- pazopanib
- pentamidine
- pentazocine
- pentobarbital
- pentoxifylline
- perphenazine
- pexidartinib
- phendimetrazine
- phenelzine
- phenobarbital
- phentermine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- piroxicam
- ponatinib
- ponesimod
- pralsetinib
- pramipexole
- prazosin
- prednisolone
- prednisone
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- protriptyline
- pseudoephedrine
- quetiapine
- ramucirumab
- rasagiline
- regorafenib
- remifentanil
- remimazolam
- rimegepant
- riociguat
- ripretinib
- risperidone
- rizatriptan
- ropinirole
- ropivacaine
- rotigotine transdermal
- sacubitril
- safinamide
- salmeterol inhaled
- salsalate
- selegiline
- selegiline transdermal
- selpercatinib
- sevoflurane
- sildenafil
- silodosin
- siponimod
- sodium ferric gluconate complex
- sorafenib
- sotagliflozin
- sotalol
- sparsentan
- sufentanil
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- terazosin
- terbutaline
- teriflunomide
- testosterone
- tetrahydrozoline ophthalmic
- thalidomide
- thioridazine
- thiothixene
- thyroid
- timolol ophthalmic
- tivozanib
- tizanidine
- tolcapone
- tolmetin
- tramadol
- trametinib
- tranylcypromine
- trazodone
- treprostinil
- triamcinolone
- trifluoperazine
- trimipramine
- ubrogepant
- vadadustat
- vamorolone
- vandetanib
- vardenafil
- vasopressin
- venlafaxine
- vilanterol inhaled
- viloxazine
- voclosporin
- vosoritide
- yohimbe
- zavegepant
- ziprasidone
- ziv-aflibercept
- zolmitriptan
Adverse Reactions .
Serious Reactions
- pericarditis
- pericardial effusion
- cardiac tamponade
- CHF
- angina exacerbation
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
Common Reactions
- hypertrichosis
- edema
- tachycardia
- breast tenderness
- weight gain
- paresthesia
- headache
- ECG abnormalities
Safety/Monitoring .
Monitoring Parameters
BUN/Cr at baseline
Look/Sound-Alike Drug Names
minoxidil confused with: fosinopril; methotrexate; midodrine; Minipress; Minocin; Monopril
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; possible risk of teratogenicity based on limited or conflicting human data and risk of hypertrichosis based on limited human data; no known risk of teratogenicity, though risk of fetal death based on animal data at 5x MRHD
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; inadequate human data available to assess risk of infant harm; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for minoxidil: liver extensively; CYP450: unknown
Excretion: for minoxidil: urine primarily (minimally unchanged); Half-life: 4.2h
Subclass: Cosmetic, Dermatologic ; Vasodilators/Nitrates
Mechanism of Action
for minoxidil: directly dilates peripheral vessels
Formulary .
No Formulary Selected
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