Commentary Flags Risks in Minoxidil Use Among Older Adults

Key Takeaways

• A new commentary stresses the need for renal function monitoring when prescribing LDOM to elderly patients.

• Authors point to high rates of polypharmacy and potential drug interactions in this population.

• Future studies should include renal metrics and medication analysis to optimize LDOM safety in older adults.

In a recent commentary published in the Journal of the American Academy of Dermatology, Funda Datli Yakaryilmaz, MD, and Dursun Turkmen, MD, raise concerns about safety monitoring for low-dose oral minoxidil (LDOM) in older adults, emphasizing the need for renal function assessments and polypharmacy considerations in this population.

Their letter responds to a multicenter retrospective study by Jimenez-Cauhe et al., which reported a favorable safety profile for LDOM in patients aged 65 and older. The original study included 321 participants and suggested that dosing for this group could mirror younger patients, despite frequent comorbidities and medication use.

Yakaryilmaz and Turkmen commend the study’s contribution but caution that the absence of renal function data limits the generalizability of its findings. They note that minoxidil is primarily renally excreted, and age-related decline in glomerular filtration can elevate systemic exposure and the risk of adverse effects. Renal assessments, they argue, are critical for appropriate dose adjustment and safety evaluation in elderly patients.

Additionally, they highlight the risk of pharmacodynamic interactions, particularly in patients taking antihypertensives. In the referenced study, 25.2% of participants were on such medications, yet adverse events were not detailed by drug class, complicating clinical interpretation. “Due to the potent vasodilator properties of minoxidil, the risk of pharmacodynamic interactions… is high,” they write.

“In conclusion, this valuable study… provides important safety data… We believe that detailed recording and incorporation of renal function parameters and polypharmacy status in future prospective studies will further contribute to the development of LDOM dose optimization and safe use guidelines in elderly patients,” the authors wrote.