minoxidil (Rx)

Brand and Other Names:Loniten, Minodyl, more...Minoxidil HTN
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 2.5mg
  • 10mg
more...

Severe or Refractory Hypertension (HTN)

Initial: 5mg PO qDay, increase every 3 days PRN

Maintenance: 2.5-80 mg/day qDay or q12hr; not to exceed 100 mg/day

Dosage Forms & Strengths

tablet

  • 2.5mg
  • 10mg
more...

Severe or Refractory Hypertension (HTN)

< 12 years

  • Initial: 0.1-0.2 mg/kg; not to exceed 5 mg/day PO; titrate to response every 3 days  
  • 0.25-1 mg/kg/day PO qDay or q12hr; not to exceed 50 mg/day

> 12 years

  • Initial: 5mg PO qDay, increase every 3 days PRN
  • Maintenance: 2.5-80 mg/day qDay or q12hr; not to exceed 100 mg/day

Hypertension

2.5 mg PO qDay; titrate to response gradually

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Interactions

Interaction Checker

and minoxidil

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Hypertrichosis (80%)

            Abnormal ECG (60%)

            1-10%

            Pericardial effusion (3%)

            Frequency Not Defined

            Angina

            Cardiac tamponade

            Fluid and sodium retention

            Hypotension

            Pericarditis

            Tachyarrhythmia

            Stevens-Johnson syndrome (rare )

            Hirsutism

            Leukopenia (rare)

            Thrombocytopenia (rare)

            Toxic epidermal necrolysis

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            Warnings

            Black Box Warnings

            Can precipitate effusion, occasionally progressing to tamponade

            May exacerbate angina pectoris

            Reserve for patients who do not respond adequately to maximum therapeutic doses of a diuretic and 2 other antihypertensives

            In experimental animals, minoxidil caused several kinds of myocardial lesions as well as other adverse cardiac effects

            Must be administered under close supervision, usually concomitantly with therapeutic doses of a beta-adrenergic blocking agent to prevent tachycardia and increased myocardial workload

            Usually given with a diuretic (typically loop diuretic) to prevent serious fluid accumulation

            Patients with malignant hypertension and those already receiving guanethidine should be hospitalized when minoxidil first administered (monitoring required because risk for rapid/large decrease in BP)

            Contraindications

            Hypersensitivity to minoxidil

            Pheochromocytoma

            Cautions

            Use with B-blocker or centrally-acting drug and a diuretic

            Reserve for severe hypertension refractory to other drugs

            Pericarditis and pericardial effusion with tamponade reported; observe patients closely for any suggestion of cardiac disorder; perform echocardiographic studies if cardiac disorder suspected; may treat with diureticsdialysis, pericardiocentesis or surgery; discontinue therapy if effusion persists

            In patients with severe blood pressure elevation, too rapid control of blood pressure, especially with intravenous agents, can precipitate syncope, cerebrovascular accidents, myocardial infarction and ischemia of special sense organs with resulting decrease or loss of vision or hearing; patients with compromised circulation or cryoglobulinemia may also suffer ischemic episodes of affected organs

            Patients with malignant hypertension should have initial treatment with minoxidil carried out in a hospital setting, both to assure that blood pressure is falling and to assure that it is not falling more rapidly than intended

            Tablets have not been used in patients who have had a myocardial infarction within preceding month; use caution

            Neonatal hypertrichosis reported following exposure to minoxidil during pregnancy

            May exacerbate heart failure

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: controversial; excreted in breast milk, not recommended for long term use if breastfeeding

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Direct vasodilator; dilate arterioles with little effect on vein, decreases systemic resistance, which subsequently decreases blood pressure.

            Pharmacokinetics

            Half-Life: 4 hr

            Excretion: Urine (12% as unchanged drug)

            Duration: 2-5 Days

            Peak Plasma Time: PO (HTN): 1 hr

            Bioavailability: PO (HTN): 90%

            Protein Bound: Negligible

            Metabolism: liver, 88% via glucuronidation

            Metabolite: minoxidil-0-glucuronide (active)

            Onset

            • Initial effect: PO (HTN): 30-60 min
            • Max effect: PO (HTN): 4-8 hr
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            Images

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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