Topical Minoxidil Withdrawal and Discontinuation Syndrome: What to Expect When You Stop

Is there such a thing as topical minoxidil withdrawal?

Withdrawal in the medical sense means a physical syndrome after a drug is stopped. The OTC labels list no such symptoms; what they describe is what happens to the hair when application ends [1][2].

What the labels say happens when you stop

The men's 5% solution and the women's 5% foam carry the same sentence: continued use is necessary to increase and keep hair regrowth, or hair loss will begin again [1][2]. The labels do not say how quickly hair loss returns.

The labels tie results to months of use rather than weeks. The men's 5% solution label, for twice-daily use of 1 mL, says results may occur at 2 months and some men may need at least 4 months; the women's 5% foam label, for half a capful once daily, says 3 months and some women may need at least 6 months [1][2].

Unwanted hair after stopping

In a case series of five women using 5% topical minoxidil, all five developed severe hypertrichosis of the face and limbs after 2 to 3 months of treatment. After minoxidil was discontinued, the hypertrichosis disappeared from the face and arms in 1 to 3 months and from the legs in 4 to 5 months; the authors hypothesized systemic absorption and a high sensitivity to minoxidil of the follicles in these areas [3].

Hypertrichosis was also more frequent with 5% than with 2% or placebo in the 48-week trial of 381 women, along with more itching and scalp irritation [5].

What the labels list as reasons to stop use

The labels say to stop use if chest pain, rapid heartbeat, faintness or dizziness occurs, if sudden unexplained weight gain occurs, if the hands or feet swell, if scalp irritation or redness occurs, if unwanted facial hair growth occurs, or if there is no hair regrowth after 4 months (men's 5% solution) or 6 months (women's 5% foam) [1][2]. Both labels also list heart disease as a precaution before use [1][2].