Peripheral Vasodilators-
Isoxsuprine hcl, Papaverine hcl, Hydralazine hcl, Minodoxil, Epoprostenol sodium,
Tresprostinil sodium,


Guanethidine-
Use in patients  on guanerthidine can result in profound orthostic effects.
If possible discontinue guanithidine well before minoxidil is instituted
If not possible, start minoxidil in the hospital and institutionalize the patient until severity effects are
no longer present .

Peripheral Vasodilators-
Isoxsuprine hcl, Papaverine hcl, Hydralazine hcl, Minodoxil, Epoprostenol sodium,
Tresprostinil sodium,
 

Cardiovascular- pericardial effusion and occasionally with tamponade (3%) . Changes in direction
and magnitude of T waves occur (app. 60%)

GI - nausea, vomiting

Haemotolgic- initially hematocrit , haemoglobin and erythrocyte count usually fall about 7% and
then recover to pretreatment levels.
Thrombocytopenia and leucopenia

Hypersensitivity- rashes, including bullous eruptions (rare) ansd Stevens- Johnson syndrome

Miscellaneous- temporary edema (7%) , breast tenderness fewer than ( 1%)

Hypertrichosis- elongation thickening and enhanced pigmentation of fine body hair develops within  3 to 6 weeks of startingtherapy in approx. (80%)  

 

Hypersensitivity to any component of the product.
Pheochromocytoma - because the drug may stimulate secretion of catecholamines from the tumor
through its antihypertensive action.

Warnings-
Mild hypertension- becasuse of serious adverse efects use in mild degrees of hypertension is not
recommended, the benefit -risk ratio in such patients is not defined

Animal toxicity-
Minoxidil has produced cardiac lesions in animals including grossly visible hemorrhagic lesions of
the atrium , epicardium, and walls of small arteries and arterioles

Fluid and electrolyte balance-
Monitor fluid and electrolyte balance andbody weight. Give with a diuuretic to prevent fluid retension
and possible CHF, a loop diuretic is usally required

Tachcardia/Angina-
Minoxidil increases heart rate. This can be prevented by co-administeration of a Beta adfrenergic
blocking drug or other sympathetic  nervous system suppresants eg. clonidine, methyldopa.

Hazard of rapid control of blood pressure-
Too rapid control of very severe blood pressure elevation can precipitate syncope, cerbrovascular
accidents, MI  and ischemia of special sense organs with resulting decrease  or loss of vision or
hearing.

Hospitalize any patient with malignant hypertension during initial tretment to assure that blood pressure
 is not falling rapidly than intended  

Hypertrichosis- elongation, thickening and enhanced pigmentationof fine hair developds within
3to 6 weeks after starting therapy in approximately 80% of patients. Upon discontinuation of the drug
new hair growth stops, but 1 to 6 months may be required for restoration to pretreatment appearance

Hypersensitivity reactions-
Manifested as a skin rash, and rare reports of bullous eruptions and Stevens-Johnson syndrome.
These reactions occur in fewer than 1% of patients

Severe hypertension

Alopecia and androgenetica (topical use ) Treatment of male pattern baldness

Adults- and children over 12 years of age-
Initial dose is 5mg /day as a single dose.
Daily dose can be increased to 10, 20, and then to 40mg in single or divided dose if required

Maximum dose is 100mg per day

Peripheral Vasodilators-
Isoxsuprine hcl, Papaverine hcl, Hydralazine hcl, Minodoxil, Epoprostenol sodium,
Tresprostinil sodium,
 

Peripheral Vasodilators-
Isoxsuprine hcl, Papaverine hcl, Hydralazine hcl, Minodoxil, Epoprostenol sodium,
Tresprostinil sodium,


Pharmacology-
Minodixil is direct acting peripheral vasodilator. Itb does not interfere with vasomotor reflux, therefore
it does not produce orthostatic hypotension. Drug does not affect ther CNS system.

Minoxidil elicts a reduction of peripheral arteriolar resistence. This action with the associated fall in
blood pressure, triggers sympathetic, vagal inhibitory , and renal hemostatic mechanisms, including
an increase in renin secretion, which leads to increase in cardiac rate and output, and salt and water
 retention.   These adverse effects can usually be minimized by coadministration of a diuretic and a
beta blocking agent or other sympathetic nervous suppressant.

Pharmacokinetics-
Minoxidil is not protein bound and is at least 90% absorbed from the GI tract. Plasma levels of the
parent drug reach a maximum within the  first hour and decline rapidly thereafter. The metabolites
are all exceted principally in the urine. Minoxidil and its metabolites are hemodialazable.
Average  plasma half life is 4.2 hours.    

Pregnancy-
No adequate or well controlled studies  in pregnant women
Use only when clearly needed.

Lactation-
safety for use in breast feeding mother has ot been established. Do not breast feed while taking minoxidil