Minoxidil interactions with other drugs

Since minoxidil is a popular treatment option for male and female pattern baldness, it is important to know about the possible minoxidil interactions with other drugs.

Knowing how other drugs and minoxidil interact is vital for our own safety and to understand who might be at risk.

When in doubt, always consult your doctor!

Let’s first examine the topical minoxidil interactions with other drugs.

 

Topical minoxidil interactions with other drugs

Image describing possible medication interactions.

Topical minoxidil is generally not associated with any major systematic drug interactions (those taken by mouth or intravenously) since there is less systematic absorption of topical minoxidil (less absorption into the whole body rather than just the applied area). That’s one of the reasons why minoxidil is typically safe for long-term use.

Oral minoxidil has a much higher systematic absorption rate in comparison.

There are however some drugs that are known to have moderately clinically significant interaction with topical minoxidil. This means that combining topical minoxidil and the following drugs should be avoided if possible. But, it can be used under certain circumstances. Always consult with your doctor before starting topical minoxidil treatment in these cases.

A

  • Alfuzosin
  • Alprostadil
  • Ambrisentan
  • Amyl nitrite
  • Avanafil

B

  • Bosentan

C

  • Cyclandelate
  • Deserpidine

D

  • Doxazosin

E

  • Epoprostenol
  • Ethaverine

G

  • Guanadrel
  • Guanethidine

H

  • Hydralazine

I

  • Iloprost
  • Isosorbide
  • Isosorbide dinitrate
  • isosorbide mononitrate
  • Isoxsuprine

M

  • Mecamylamine

N

  • Nesiritide
  • Nitroglycerin

P

  • Papaverine
  • Prazosin

R

  • Rauwolfia serpentina
  • Reserpine

S

  • Sapropterin
  • Selexipag
  • Sildenafil
  • Silodosin

T

  • Tadalafil
  • Tamsulosin
  • Terazosin
  • Treprostinil

V

  • Vardenafil
  • Verteporfin
 

Oral minoxidil interactions with other drugs

Image of 100 oral minoxidil tablets.

Oral minoxidil is known to interact with the antihypertensive drug guanethidine. Taking them together can lead to severe hypotension (low blood pressure), leading in some cases to extreme dizziness, blurry vision, nausea, confusion, and fainting. The drugs should not be taken together. Ideally, guanethidine should be stopped before minoxidil is started.

The following medications are known to interact with minoxidil and are highly clinically significant. This means that combining oral minoxidil with the following drugs should be avoided at all times.

G

  • Guanadrel
  • Guanethidine

T

  • Tizanidine

The following medications are known to interact with minoxidil and are moderately clinically significant. This means that combinations should be avoided if possible. But they can be combined under certain circumstances. Again, consult a professional before hopping on topical minoxidil.

A

  • Aldesleukin
  • Alfentanil
  • Alprazolam
  • Amifostine
  • Amisulpride
  • Amitriptyline
  • Amoxapine
  • Apomorphine
  • Apraclonidine ophthalmic
  • Arginine
  • Aripiprazole
  • Asenapine
  • Avanafil
B
  • Baclofen
  • Betamethasone
  • Brexpiprazole
  • Brimonidine ophthalmic
  • Brimonidine topical
  • Budesonide
  • Buprenorphine
  • Bupropion
  • Buspirone
  • Butabarbital
  • Butorphanol
C
  • Cabergoline
  • Canagliflozin
  • Cannabis
  • Cariprazine
  • Carisoprodol
  • Chloral hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Citrulline
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Codeine
  • Corticorelin
  • Corticotropin
  • Cortisone
  • Cosyntropin
  • Cyclobenzaprine
D
  • Dapagliflozin
  • Deflazacort
  • Dexamethasone
  • Dexmedetomidine
  • Diazepam
  • Dimenhydrinate
  • Diphenhydramine
  • Doxepin
  • Doxepin topical
  • Dronabinol
E
  • Empagliflozin
  • Epoprostenol
  • Ertugliflozin
F
  • Fenoldopam
  • Fentanyl
  • Fludrocortisone
  • Fluphenazine
  • Flurazepam
  • Furazolidone
G
  • Guanfacine
H
  • Haloperidol
  • Heroin
  • Hydrocodone
  • Hydrocortisone
  • Hydromorphone
  • Hydroxyzine
I
  • Iloperidone
  • Iloprost
  • Imipramine
  • Isocarboxazid
L
  • Levodopa
  • Licorice
  • Linezolid
  • Lithium
  • Lofexidine
  • Lorazepam
  • Loxapine
  • Lumateperone
  • Lurasidone
M
  • Maprotiline
  • Maraviroc
  • Meperidine
  • Meprobamate
  • Mesoridazine
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methotrimeprazine
  • Methylprednisolone
  • Midazolam
  • Minoxidil topical
  • Mirtazapine
  • Molindone
  • Morphine
N
  • Nabilone
  • Nalbuphine
  • Nefazodone
  • Nesiritide
O
  • Olanzapine
  • Oliceridine
  • Olopatadine nasal
  • Opium
  • Orphenadrine
  • Oxazepam
  • Oxycodone
  • Ozanimod
P
  • Paliperidone
  • Paraldehyde
  • Pentazocine
  • Pentoxifylline
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Prednisolone
  • Prednisone
  • Procarbazine
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propiomazine
  • Propoxyphene
  • Pyrilamine
Q
  • Quetiapine
R
  • Rasagiline
  • Remimazolam
  • Riociguat
  • Risperidone
S
  • Safinamide
  • Sapropterin
  • Secobarbital
  • Selegiline
  • Selexipag
  • Sildenafil
  • Sodium nitrite
  • Sodium oxybate
T
  • Temazepam
  • Tetrabenazine
  • Thiethylperazine
  • Thioridazine
  • Thiothixene
  • Tranylcypromine
  • Trazodone
  • Treprostinil
  • Triamcinolone
  • Trifluoperazine
  • Triflupromazine
  • Trimeprazine
  • Trimipramine
V
  • Vardenafil
  • Vericiguat
  • Verteporfin
Z
  • Zaleplon
  • Ziprasidone
  • Zolpidem

The following medications interact only mildly with minoxidil and are minimally clinically significant. Thus, it is advised to monitor side effects, but it is generally considered safe.

G
  • Garlic
T
  • Tadalafil
 

Minoxidil disease interactions

The following diseases are highly clinically significant interactions with minoxidil. As such, they should be avoided at all cost.[1]https://www.drugs.com/disease-interactions/minoxidil-topical.html

  • Fluid retention/congestive heart failure
  • Arrhythmias
  • ischemic heart disease
  • Pheochromocytoma

The following disease has a moderate clinically significant interaction with minoxidil. Combinations should be avoided if possible. But can be used under certain circumstances. Always consult with your doctor when considering topical minoxidil in these specific cases.

  • Renal failure/dialysis
 

Rogaine interactions with other drugs

Image of Men's 5% topical Rogaine.

Since the above are minoxidil interactions with other drugs, it also means that these are rogaine interactions with other drugs, since rogaine is a brand of minoxidil.

This also means that topical rogaine interactions will generally be much milder than oral rogaine interactions with medication combinations are, due to less systematic absorption.

 

Finasteride and minoxidil combination

The following study with level of evidence III deems the combination of finasteride and minoxidil to be safe for use for androgenetic alopecia (AGA). It also deems minoxidil combined with finasteride to be more effective than just monotherapy with only finasteride or minoxidil.[2]https://pubmed.ncbi.nlm.nih.gov/32166351/

Another study with oral finasteride and topical minoxidil concluded that finasteride is superior to 5% minoxidil, while the combined medication showed the best efficacy. They also concluded that adverse reactions were rare (finasteride, 1.8%; minoxidil, 6.1%), and disappeared right after drug withdrawal.[3]https://pubmed.ncbi.nlm.nih.gov/26031764/

Another randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in the treatment of male androgenetic alopecia concluded the following:

Treatment with topical solution of 0.25% finasteride admixed with 3% minoxidil was significantly superior to 3% minoxidil solution for promoting hair growth in male androgenetic alopecia, and well tolerated.)[4]https://pubmed.ncbi.nlm.nih.gov/29972712/

Finasteride side effects

Image of oral finasteride tablets.

Although those results of finasteride and minoxidil combination seem promising at first, caution should still be taken since finasteride could have some rare, although significant side effects.

This study reviewed the clinical studies of continual sexual and nonsexual harmful effects associated with finasteride in younger men who took the medication for treatment of male pattern hair loss. It found out the following:

Persistent adverse effects of finasteride in younger men include erectile dysfunction, low libido, lack of orgasms, depression, and decreased alcohol consumption.

One study has found lower levels of several neurosteroids in this population.

Out of the various persistent side effects, erectile dysfunction and decreased alcohol consumption have been the most studied in animal models. Further research is needed on who is susceptible to the persistent adverse side effects of finasteride and on the underlying mechanisms of the medication. Irwig MS. Persistent sexual and non-sexual adverse effects of finasteride in younger men. Sex Med Rev 2014;2:24-35.

Is the rogaine finasteride combination safe?

Again, there are plenty of minoxidil interactions with other drugs. As such, it has been shown that finasteride and minoxidil combined are very effective to treat male and female pattern baldness.

This also means that the rogaine finasteride combination would probably be more effective than just monotherapy with topical minoxidil. But, there are more known severe side effects associated with finasteride. As such, monotherapy with just topical minoxidil would be my recommendation.

In non-responsive patients, it can be considered to combine minoxidil with finasteride as another viable treatment option. Always consult your doctor before starting treatment with finasteride!

 

Conclusion

Topical minoxidil is generally very well tolerated and is considered safe in most cases. However, in some rare specific cases even topical minoxidil might interact with some drugs and could cause harm to the vulnerable people suffering from certain diseases. This means that some people shouldn’t use minoxidil in these contraindicated cases.

Due to the increased systematic absorption rate of oral minoxidil, it more heavily interacts with certain drugs. As such, one should be very careful of combining certain drugs and consult a doctor when in doubt!

Be mindful that combining minoxidil and finasteride is a very effective treatment for hair growth, but that finasteride is known to create certain side effects in some cases. Again, always confer with a professional before starting with finasteride as your treatment.

 

References

References
1 https://www.drugs.com/disease-interactions/minoxidil-topical.html
2 https://pubmed.ncbi.nlm.nih.gov/32166351/
3 https://pubmed.ncbi.nlm.nih.gov/26031764/
4 https://pubmed.ncbi.nlm.nih.gov/29972712/