I Am Experiencing Side Effects From Topical Minoxidil. What Should I Do?

I Am Experiencing Side Effects From Minoxidil. What Should I Do?

If experiencing side effects from minoxidil, it’s best to speak with the prescribing physician as soon as possible to discuss next steps. Discontinuing use, however, is not the only option. There are strategies to reduce minoxidil’s side effects (while still benefiting from the drug) in both topical and oral formulations. This article will focus on reducing adverse events from topical minoxidil, depending on the side effect you’re experiencing:

• Skin irritation, dandruff, and/or dermatitis
• Water retention, skin aging, and/or bags under eyes
• Headaches and/or heart palpitations

Topical Minoxidil: Reducing the Side Effects

For the most part, side effects from minoxidil are minor. Here are a few adverse events reported in the clinical literature (and online), the percent of people they tend to affect, and strategies on how to go about reducing or resolving them.

Skin Irritation, Dandruff, and/or Dermatitis (2-7% of users)

Skin irritation, dandruff, and/or dermatitis are the most frequently reported side effect from minoxidil. These tend to be reported by 2-7% of topical minoxidil users. 

One study demonstrated that 80% of these reports were not actually due to minoxidil, but the carrier ingredient used to help minoxidil penetrate into the dermis: propylene glycol.^[1]thaiscience.info/…ticle/JMAT/10986429.pdf

In these cases, simply switching to a minoxidil product without propylene glycol solved most reports of skin irritation. As such, if you’re experiencing these problems, you may want to experiment with switching minoxidil brands or formulations — specifically to a product that does not contain propylene glycol. Examples include:

• Essengen-5 NO PG FAST DRY (from MinoxidilMax)

If skin irritation persists on these new formulations, consider titrating the dose of topical minoxidil. You can achieve this by moving from twice-daily 5% minoxidil to once-daily 5% minoxidil. If that doesn’t work, try moving from once-daily 5% minoxidil to once-daily 2% minoxidil. If that doesn’t work, consider trying oral minoxidil at doses from 0.25mg to 5.0mg (more on this below).

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Water Retention, Skin Aging, and/or Under-Eye Bags (prevalence unknown)

Some topical minoxidil users have reported under-eye bags and/or signs of accelerated skin aging. However, these reports are not reflected in the clinical literature; they’re anecdotal. Even still, while there’s currently no evidence (to which we’re aware) that minoxidil accelerates aging, there is a mechanistic argument to be made that topical minoxidil might increase the perception of skin aging and/or under-eye bags. This is likely due to two factors:

1. Skin irritation/dryness from applying the drug, which can make the skin appear to be “more aged”. Keep in mind that studies suggest that 80% of these side effects are caused by propylene glycol and not the minoxidil itself. Therefore, switching brand formulations should resolve this dryness, and thereby the perception of accelerated skin aging.
2. The drug leading to more water retention near the areas where it is applied. If this occurs in facial tissues, that water retention comes with the possibility of exaggerating the appearance of under-eye bags, and thereby skin aging.

If these side effects reflect your own experiences with topical minoxidil, consider the following:

1. Wait and watch. For many people, the water-retaining effects of minoxidil are transient and go away with continued use of the drug.
2. Switch formulations. Finding a minoxidil formulation without propylene glycol should go a long way toward resolving side effects related to dryness or skin irritation.
3. Reduce salt intake. Salt is also water retentive, and it’s possible that people consuming lots of salt and using topical minoxidil might be at a higher risk of experiencing more exaggerated water-retentive effects from the drug. By lowering salt intake, this may be enough to resolve excessive water retention and diminish the presence of under-eye bags while still using minoxidil.

In most cases, these changes make enough of an impact to reduce, mitigate, or even eliminate these side effects altogether.

Headaches and/or Heart Palpitations(~1% of users)

In rarer cases, topical minoxidil results in heart palpitations or headaches. In some cases, these side effects are related to the formulation of minoxidil; in others, they’re due to the drug itself. If you don’t intend on quitting the drug outright after having experienced these effects, it’s critical to tease out which category you fall into — and to approach troubleshooting very carefully.

Headaches

If you’re experiencing a headache after topical minoxidil applications, the first question to ask is: is it the minoxidil itself, or an ingredient applied alongside the minoxidil that’s causing this experience?

In many cases, the scent of topical minoxidil is what’s causing someone’s headache after applying the drug topically. This can be due to a scent added to the formulation, or even the off-gassing of the alcohol (if you’re using a topical that contains ethanol or an alcohol as a carrier ingredient).

Under these circumstances, simply switching topical minoxidil brands to something that is (1) unscented, and (2) does not contain alcohol should be enough to resolve symptoms. If this doesn’t work, it’s likely that the headaches are a direct result of the minoxidil itself.

If this is the case, consider titrating the dose of minoxidil from twice-daily 5% minoxidil to once-daily 5% minoxidil. If that doesn’t work, consider trying nanoxidil — a minoxidil analogue that has a lower molecular weight and may confer a slightly better safety profile (at least according to very biased research from the company selling nanoxidil, DS Laboratories). Anecdotally, members of our community who have made this switch have mostly reported resolution of headaches secondary to topical minoxidil after switching to topical nanoxidil. So it’s not a bad idea.

If that doesn’t work, minoxidil may not be the right medication for you — at least when it comes to fighting hair loss. The good news is there are many other options.

Heart Palpitations

If you’ve noticed that, after applying topical minoxidil, your heart feels as though it “skips a beat” or begins beating irregularly, these signs are indication of a drug sensitivity to minoxidil itself. These effects are rare, but they likely impact up to 1% of people who have tried topical minoxidil.

If this is your experience, please speak to a medical professional and strongly consider discontinuing the medication. We do know of people who’ve managed these side effects by titrating the dose of topical minoxidil from twice-daily 5% to once-daily 5%, and even lower. Having said that, it’s critical to remember that our heart is more important than our hair. There are many other treatment options aside from topical minoxidil for your hair loss, and if you’re getting heart palpitations after applying the medication, it’s probably best to start exploring those rather than manage a medication that — despite being FDA-approved — still has lower qualities of evidence supporting its long-term use.