Minoxidil is used in the management of severe hypertension that is symptomatic or associated with end-organ damage. Because of the frequency and severity of adverse effects, minoxidil generally is reserved for hypertension that is not manageable with maximal therapeutic dosages of a diuretic and 2 other hypotensive drugs. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, calcium-channel blockers, and thiazide diuretics are the preferred antihypertensive agents for the initial management of hypertension in adults.Direct vasodilators, including minoxidil, may be used in combination with other antihypertensive therapies (e.g., a diuretic and a β-adrenergic blocking agent, an ACE inhibitor, a calcium-channel blocking agent, and/or an angiotensin II receptor antagonist) to achieve target blood pressure goals.
Minoxidil often is effective in the management of hypertension resistant to other drugs. It should be considered that some clinicians and the manufacturers state that minoxidil should not be used in mild or moderate hypertension or severe hypertension that can be controlled with other drugs (i.e., reserved for refractory hypertension), because the benefit-to-risk ratio has not been clearly determined. However, some clinicians state that aggressive approaches to the management of severe hypertension may be necessary in some patients, reducing the intervals between changes in the antihypertensive regimen and maximum dosages employed, and they recommend that clinicians not hesitate to use the most potent agents, including minoxidil, when warranted, especially in patients with impaired renal function. Patients with markedly elevated blood pressure without acute target organ damage usually do not require hospitalization. Such patients should receive immediate oral combination antihypertensive therapy. Clinicians should carefully evaluate these patients and monitor them for development of hypertension-induced heart and kidney damage and identify causes of hypertension.
For additional information on overall principles and expert recommendations for treatment of hypertension,
Minoxidil is used topically to stimulate regrowth of hair in patients with androgenetic alopecia (male pattern alopecia, hereditary alopecia, common male baldness) or alopecia areata. Because the safety and efficacy of extemporaneously prepared formulations of topical minoxidil in promoting hair growth have not been fully evaluated and because such preparations may vary in strength and efficacy, the FDA requests that physicians and pharmacists refrain from preparing extemporaneous topical formulations using the commercially available tablets. Instead, commercially available topical minoxidil preparations (e.g., Rogaine) should be used. If minoxidil tablets are used to prepare extemporaneous topical formulations, such preparations should be considered to share the toxic potentials of the systemically administered drug; in addition, skin intolerance to minoxidil and/or an ingredient(s) in the formulation may occur.