Study advises Caution for use of Oral Minoxidil in SLE Patients
Researchers have found in a new study that it is risky to use oral minoxidil for alopecia among patients with S.L.E.. Therefore, dermatologists should avoid prescribing 5 mg-per-day oral minoxidil for alopecia in patients with SLE due to the risk of pericardial side effects. If necessary, prescribing should be done with a cardiologist or rheumatologist to ensure patient safety.
A recent study suggests dermatologists should be cautious when prescribing 5 mg per day of oral minoxidil for alopecia in patients with systemic lupus erythematosus (SLE) due to potential pericardial side effects. Given limited data on the safety of low-dose oral minoxidil in patients with systemic lupus erythematosus (SLE), researchers at NYU Langone Health sought to evaluate its tolerability.
The study analysed 22 individuals with systemic lupus erythematosus (SLE) who received low-dose oral minoxidil (0.625–5 mg per day) between 2011 and 2023. Over a cumulative 21.3 patient-years, no pericardial side effects were observed at doses of 2.5 mg per day or lower.
However, two patients on the 5 mg daily regimen developed pericardial effusions, presenting with fluid retention symptoms such as edema or anasarca. Both had predisposing risk factors, including congestive heart failure, prior pericardial effusion, and chronic kidney disease. Discontinuation of minoxidil, along with appropriate interventions such as diuretics and pericardial window placement, led to symptom resolution.
Neither patient resumed treatment. Investigators noted that previous research aligned with these findings, reinforcing the overall safety of low-dose minoxidil at ≤2.5 mg per day for patients with systemic lupus erythematosus (SLE). Despite its retrospective nature and small sample size, this study is the first known cohort analysis assessing low-dose minoxidil tolerability in patients with **systemic lupus erythematosus (SLE) over two decades of cumulative exposure.
The findings suggest that while doses up to 2.5 mg daily appear safe, higher doses should be prescribed with caution, particularly in patients with additional cardiovascular risk factors. Dermatologists are advised to collaborate with cardiologists and rheumatologists when considering minoxidil for patients with systemic lupus erythematosus (SLE) to ensure appropriate monitoring and management of potential complications.
Reference:
Zaminski, D., Alhanshali, L., Shapiro, J., Caplan, A.S., Femia, A.N., Lo Sicco, K. and Mazori, D.R. (2025), Tolerability of Low-Dose Oral Minoxidil in Patients With Systemic Lupus Erythematosus: A Retrospective Cohort Study. Int J Dermatol. https://doi.org/10.1111/ijd.17734
