Low-Dose Oral Minoxidil for Hair Loss Not Linked to Tachycardia, Large Study Suggests
USA: A new retrospective study published in the Journal of the American Academy of Dermatology (JAAD) reports that low-dose oral minoxidil (LDOM), widely used off-label for nonscarring alopecia, does not increase the risk of tachycardia in patients without pre-existing cardiac conditions.
Researchers from Thomas Jefferson University’s Sidney Kimmel Medical College, led by Zachary J.K. Neubauer and colleagues, analyzed data from more than half a million patients with androgenic alopecia or other forms of nonscarring hair loss, drawn from the TriNetX database spanning 2004 to 2024. Importantly, individuals with a prior history of hypertension, tachycardia, or arrhythmia were excluded from the study.
The analysis included 524,522 patients, of which 9,267 received LDOM (≤ 5 mg/day) and the rest served as minoxidil-naïve controls. The LDOM group tended to be older (average age 45.5 years versus 39.8 years in controls) and had a higher proportion of men (33% vs. 19%). The primary outcome assessed was the incidence of tachycardia.
The key findings of the study were as follows:
- Among those on LDOM, 126 patients (7.7%) developed tachycardia, with a median time to onset of approximately 245 days.
- When compared to controls, the risk difference was statistically insignificant.
- The hazard ratio (HR) for tachycardia in the LDOM group was 0.90, and after adjustments, it remained nonsignificant at 0.92.
- Men had a 36% lower risk of developing tachycardia compared with women (HR, 0.64).
- Asian patients also demonstrated reduced risk (HR, 0.81).
- Conversely, White individuals were more likely to experience tachycardia compared to other groups (HR, 1.29).
- Black individuals were also more likely to experience tachycardia compared to other groups (HR, 1.19).
According to the authors, these findings reinforce the safety of LDOM for patients without underlying cardiac issues. They noted that co-administration of beta-blockers—a practice sometimes considered to mitigate potential cardiovascular effects—is not warranted based on this evidence.
“This study represents the largest analysis to date evaluating the relationship between LDOM and tachycardia risk in nonscarring alopecia, and it is the only investigation to include a control group,” the researchers stated. However, they emphasized the need for prospective studies to validate these observations.
The findings provide reassurance for dermatologists and patients using LDOM for hair restoration, highlighting that the therapy does not appear to pose an additional risk for tachycardia when prescribed to individuals without cardiac risk factors.
Reference:
Neubauer ZJK, Lipner HI, Lipner SR. No association between low-dose oral minoxidil and tachycardia in a large retrospective cohort study of non-scarring alopecia patients. J Am Acad Dermatol. 2025 Aug 8:S0190-9622(25)02587-3. doi: 10.1016/j.jaad.2025.07.065. Epub ahead of print. PMID: 40784566.
Next Story