Oral vs topical minoxidil: what is the difference?

Licensing

Topical minoxidil is licensed in the UK for androgenetic alopecia (pattern hair loss). The Regaine range includes a 5% solution and 5% foam for men, and a 2% solution and 5% once-a-day foam for women, all for adults aged 18 to 65. Some are on the General Sales List, so they can be bought without a prescription.

Oral minoxidil (Loniten) is a prescription-only medicine. Its SmPC says it "is indicated for the treatment of severe hypertension". Using it for hair loss, at much lower doses, is off-label, which your prescriber must explain.

WMG Meds can prescribe low-dose oral minoxidil and compounded topical minoxidil after assessment. Our topicals are unlicensed specials, made to order by a UK pharmacy, not licensed products.

Side effects

Topical: effects are mostly on the scalp. The Regaine leaflet lists itching or dermatitis, and scalp redness, dryness and flaking that may be due to the propylene glycol in the product. Unwanted hair on the face can happen if the product spreads beyond the scalp. If minoxidil gets into the bloodstream, which is more likely with overuse or a damaged scalp, it can cause chest pain, a fast heartbeat, faintness or swollen hands and feet. See topical minoxidil and scalp irritation.

Oral: effects are on the whole body. The Salford Royal leaflet says side effects are dose-related and lists fluid retention (weight gain or ankle swelling), a faster heart rate, low blood pressure, pericarditis or fluid around the heart, and increased body hair. The Loniten SmPC says extra hair usually appears 3 to 6 weeks after starting, first on the face, and reverses one to six months after stopping. Our page on oral minoxidil and the heart explains the warning signs.

Choosing between them

We do not rank one above the other. Which, if either, is appropriate depends on your health, your hair loss, your preferences and how you have got on with treatment before. The Salford Royal clinic, for example, considers oral minoxidil when topical minoxidil has not helped or has not been tolerated.

Non-drug options exist too: the BAD mentions camouflage fibres and wigs, and choosing no treatment is a valid choice. If you would like a doctor to talk the options through with you, start the free online assessment.