Is spironolactone combined with low-dose minoxidil safe for hair loss in women?

Combination therapy with oral spironolactone and low-dose oral minoxidil appears safe and tolerable among adult females with hair loss, reports a study. However, those using one or more blood pressure (BP)-altering medications are at increased risk of hypotension-related symptoms.

Overall, 432 females aged ≥18 years taking combination therapy for hair loss participated in this retrospective cohort study. The average doses of spironolactone and low-dose minoxidil at time of adverse drug effects were 87.6 and 1.8 mg, respectively.

The incidence of adverse effects (AEs) was 37.7 percent, occurring in 163 women. The most common AE was hypertrichosis (n=53, 12.3 percent), followed by dizziness, lightheadedness, or orthostasis (n=52, 12.0 percent).

Simultaneous initiation of treatment was noted to reduce hypertrichosis by as much as 64.8 percent (odds ratio [OR], 0.35, 95 percent confidence interval [CI], 0.13‒0.94; p=0.037).

Notably, concurrent use of one or more additional BP-altering medications led to an increased risk in orthostatic effects (OR, 3.29, 95 percent CI, 1.65‒6.58; p=0.001). Dosage and treatment initiation pattern were not associated with a significantly higher risk of BP effects.

The therapeutic regimen was unmodified in less than half of the participants (46.0 percent). Adjustments were done mostly in the outpatient setting (94.3 percent).

“Spironolactone and oral minoxidil are effective female alopecia monotherapies,” the investigators said. “Combination therapy is commonly used, though safety and tolerability data are limited.”

The study was limited by the lack of a control group and its retrospective descriptive design.