Last update July 25, 2022

Minoxidil

Low Risk

Moderately safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

An antihypertensive agent indicated in severe arterial hypertension. Oral administration of 5 to 40mg daily in one or two doses, with the possibility of reaching 100mg daily. Low doses of oral Minoxidil, from 0.5 to 2.5 mg daily, and topiclal Minoxidil 2 - 5% are being used to treat alopecia in women. (Sinclair 2018, Perera 2017)

It is excreted in breastmilk in clinically insignificant amounts and no problems have been observed in an infant whose mother was taking it at an antihypertensive dose of 7.5 to 10 mg per day. (Valdivieso 1985)

The highest relative dose (RD) (5%) was obtained at the time of taking the medication, decreasing RD at three hours to 1.2%, at six hours to 0.3% and at nine hours to 0.1%. You can therefore minimize the risk by avoiding breastfeeding at the time of taking the medication, which is when the levels in milk are higher.

The low oral doses that are prescribed for the treatment of alopecia pose few problems for breastfeeding. 

Several medical societies, experts and expert consensus, consider the use of this medication to be safe or very probably safe during breastfeeding (Malachias 2016). American Academy of Pediatrics: it is a medication which is usually compatible with breastfeeding. (Malachias 2016, AAP 2001)

Some authors do not consider it to be safe or only in case of breastfeeding older infants (Anderson 2018, Schaefer 2015). There are no published reports with antihypertensive doses greater than 10 mg per day, so in these cases, safer known alternatives may be preferable, especially in the neonatal period and in case of prematurity. (Anderson 2018)

TOPICAL USE:

The small dose and low plasma absorption of most topical dermatological preparations make transfer in significant amounts into breastmilk very unlikely. 
Only 1.4% (0.3-4.5%) of minoxidil reaches blood plasma when it is used topically on the skin. (Butler 2014, Johnson 2014, Galderma 2013)

A case of transient hypertrichosis on the forehead of a 2-month-old infant whose mother applied topical minoxidil 5% twice daily has been reported. The causality is not well clarified in the publication. (True 2022)

It is normal to lose hair in the months following pregnancy and this has nothing to do with breastfeeding but with stopping the resting phase in hair loss that occurs during pregnancy. Within 12 months after delivery, the hair grows back without leaving alopecia.

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Minoxidil in other languages or writings:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 90 - 95; dermat: 1.4 %
Molecular weight 209 daltons
Protein Binding 0 %
pKa 4.6 -
Tmax 1 hours
4.2 hours
M/P ratio 0.65 - 1 -
Theoretical Dose 0.0001 - 0.008 mg/Kg/d
Relative Dose 0.1 - 6.6 %

References

  1. Trüeb RM, Caballero-Uribe N. Minoxidil-induced hypertrichosis in a breastfed infant. J Eur Acad Dermatol Venereol. 2022 Mar;36(3):e224-e225. Consulted on July 25, 2022 Abstract
  2. Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018 Abstract
  3. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  4. Perera E, Sinclair R. Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study. F1000Res. 2017 Abstract
  5. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source) Full text (in our servers)
  6. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  7. Pfizer. Minoxidil (Loniten). Ficha técnica. 2015 Full text (in our servers)
  8. Pfizer. Minoxidil (Loniten). Drug Summary. 2015 Full text (in our servers)
  9. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, Third Edition. 2015
  10. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014 Mar;70(3):417.e1-10; quiz 427. Abstract
  11. Johnson & Johnson. Minoxidil (Rogaine). Drug Summary. 2014 Full text (in our servers)
  12. Galderma. Minoxidil tópico (Lacovin). Ficha técnica. 2013 Full text (in our servers)
  13. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  14. Valdivieso A, Valdés G, Spiro TE, Westerman RL. Minoxidil in breast milk. Ann Intern Med. 1985 Abstract

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