What is minoxidil topical?

Minoxidil is a treatment for hair loss that helps regrow hair and prevent future hair loss in men and women with certain types of hair loss. When used regularly, new hair growth may be seen as early as 2 to 4 months.

Minoxidil for women is used to help regrow hair if you have gradually thinning hair or gradual hair loss on the top of the head, which may only become noticeable after years of gradual loss. Minoxidil for women works best when it is used at the earlier stages of female pattern hair loss. Minoxidil for women foam is applied once daily to the affected scalp area, and the solution is applied twice daily.

Minoxidil for men is used to improve hair growth if you have inherited gradually thinning hair or gradual hair loss on the vertex at the top of the scalp. It is not intended for frontal baldness or a receding hairline. This medicine works best at the earlier stages of hair loss or thinning and is less effective when there is a larger area of hair loss. Minoxidil for men is available as a foam and solution and is applied twice daily to the affected scalp area.

The foam is easier to apply to larger areas, dries faster, and is less likely to drip, while the solution is better for applying to smaller areas or when the hair is longer. Minoxidil is available as a solution and foam with specific packaging for women or men.

Minoxidil topical is available as the Rogaine brand (Women’s Rogaine, Men’s Rogaine) and generic products are also available.

What is minoxidil used for?

Minoxidil for women

Minoxidil for women is FDA-approved to treat women 18 years and older with female-pattern hair loss, with gradual thinning hair or gradual hair loss on the top of the head, and a family history of this kind of hair loss.

Minoxidil for men

Minoxidil for men is FDA-approved for the treatment of hereditary hair loss in men 18 years and older to help reverse the progression of hair loss on the scalp. Hereditary hair loss is when men experience gradually thinning hair or gradual hair loss on the top of the scalp in the vertex area, which has affected other men in their family. It is not intended for frontal baldness or a receding hairline.

Minoxidil for beards and other hair loss issues

Minoxidil has been used for beards, eyebrows, and also for alopecia areata (AA), scarring alopecia, and hair shaft disorders to improve hair growth; however, these uses are all off-label.

How long does it take for minoxidil to work?

Minoxidil starts working in the first 2 to 4 months, with new soft, colorless hairs growing. From 4 to 6 months, new, thicker hair growth may become visible. To maintain hair regrowth, it is important to continue using minoxidil regularly. In the first 1 to 3 weeks of using minoxidil, you may have increased hair shedding.

How does minoxidil work?

Minoxidil works by increasing the length of time the hair follicle is in its growth (anagen) phase, which helps increase hair length and thickness. It also shortens the length of time in the shedding (telogen) phase, which means the follicles move more quickly into the growth phase.

Minoxidil’s mechanism of action for hair loss is not fully understood, it is thought to work by activating both extracellular signal-regulated kinase (ERK) and Akt and by preventing cell death by increasing the ratio of a protein called BCl-2/Bax.

Minoxidil topical side effects

Common minoxidil side effects

Common minoxidil side effects may include changes in the color or texture of your hair.

Serious minoxidil side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives, difficulty breathing, swelling of your face, lips, tongue, or throat.

Although the risk of serious side effects is low when minoxidil foam and solution is applied to the skin, side effects can occur if the medicine is absorbed into your bloodstream.

Minoxidil topical may cause serious side effects. Call your doctor at once if you have:

• severe scalp irritation;
• unwanted growth of facial hair;
• chest pain, fast heartbeats;
• swelling in your hands or feet, rapid weight gain;
• a light-headed feeling, like you might pass out;
• headache, dizziness, confusion; or
• flushing (warmth, redness, or tingly feeling).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA .

Warnings

Do not use this medicine if the skin on your scalp is red, swollen, irritated, or infected.

Before taking this medicine

Do not use this medicine if the skin on your scalp is red, swollen, irritated, or infected. This may allow more of the medication to be absorbed by your body, which could be dangerous.

Check the medicine label carefully to make sure this medicine will treat your specific type of hair loss.

Use only the minoxidil foam or solution that is made for your gender. Women should not use minoxidil topical products that are made specifically for men.

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have other medical conditions, especially heart disease.

Do not use this medicine on anyone under 18 years old.

Preganancy

Do not use this medicine if you are pregnant.

Breastfeeding

Do not use this medicine if you are breast-feeding a baby.

How should I use minoxidil foam or solution?

Dry your hair and scalp before applying minoxidil solution or foam.

Apply the recommended amount to the affected areas of the scalp.

Minoxidil 5% for men is usually applied twice daily, in the morning and at night.

Minoxidil for women foam (5%) is applied once daily. Minoxidil for women solution (2%) is applied twice daily.

Apply this medication only on your scalp. Do not use it on any other part of your body.

Wash your hands after applying minoxidil topical.

It may take up to 4 months or longer before you notice new hair growth. New hair may be soft, colorless, and barely visible. With further treatment, the hair should start to have the same color and thickness as your existing hair.

Talk to your doctor if you do not see any hair growth after 4 months of treatment.

Use exactly as directed on the label or as your doctor prescribes. Do not use in larger or smaller amounts or for longer than recommended.

Using more of this medicine than recommended will not speed up hair growth and may cause dangerous side effects.

This medicine comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Store at room temperature, away from moisture and heat.

Keep the topical foam canister away from open flames or high heat, such as in a car on a hot day. If it gets too hot, the canister may explode. Do not puncture or burn an empty canister.

Minoxidil dosing information (foam and solution)

Usual Adult Men’s Dose – Solution (5%)

Apply 1 mL with the dropper twice daily to the affected hair loss area on the scalp.

Usual Adult Men’s Dose – Foam (5%)

Apply half a capful twice a day.
Rinsed fingers in cold water and dry them to prevent foam from melting on warm hands.
Hold the can straight upside down to ensure the foam dispenses properly.
Press the nozzle to dispense half a capful of foam onto a cold surface such as cold hands or a dish.
Part your hair to expose the hair loss area and massage foam into the scalp (not the hair).
Replace the cap and wash hands and any surface thoroughly after use.

Usual Adult Women’s Dose – Solution (2%)

Apply 1 mL with the dropper twice a day directly onto the scalp in the hair loss area on the scalp.

Usual Adult Women’s Dose – Foam (5%)

Apply half a capful once a day.
Rinsed fingers in cold water and dry them to prevent foam from melting on warm hands.
Hold the can straight upside down to ensure the foam dispenses properly.
Press the nozzle to dispense half a capful of foam onto a cold surface such as cold hands or a dish.
Part your hair to expose the hair loss area and massage foam into the scalp (not the hair).
Replace the cap and wash hands and any surface thoroughly after use.

Comments:
-Evidence of hair growth may take 2 months or more of twice daily applications.
-If hair regrowth occurs, use must be continued for continued hair growth; re-grown hair may disappear within 3 to 4 months of stopping and the balding process will continue.
– If you do not see any results after 4 months, speak with your doctor.

What happens if I miss a dose?

Apply the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

An overdose of minoxidil topical is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line if anyone has accidentally swallowed the medication.

What should I avoid while using minoxidil foam or solution?

Avoid getting the foam or solution in the eyes, nose, or mouth. If this occurs, rinse the area with water.

Avoid using other skin products on the areas you treat with this medication unless your doctor tells you to.

Generic name: glycopyrronium tosylate [ glye-koe-pir-OH-nee-um-TOS-i-late ]
Drug class: Miscellaneous topical agents 

Uses for Qbrexza

Glycopyrronium tosylate is used to treat excessive underarm sweating (primary axillary hyperhidrosis).

This medicine is available only with your doctor’s prescription.

Before using Qbrexza

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of glycopyrronium tosylate in children younger than 9 years of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of glycopyrronium tosylate in the elderly.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bladder problems (eg, distended bladder, bladder-neck obstruction) or
• Enlarged prostate or
• Trouble passing urine—Use with caution. May make these conditions worse.

• Blood or vessel disease in acute bleeding, unstable or
• Glaucoma or
• Myasthenia gravis (nerve or muscle disease) or
• Sjogren’s syndrome (immune system disorder) or
• Stomach or bowel problems (eg, paralytic ileus, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis)—Should not be used in patients with these conditions.
• Kidney disease—Use with caution. The effects may be increased because of the slower removal of the medicine from the body.

Proper use of Qbrexza

Use this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.

Apply this medicine to clean, dry skin on your underarm areas only. Do not get it into your eyes, nose, or mouth. Do not swallow the medicine or apply over broken skin.

To use the cloth:

• Wash your hands with soap and water before and after you use this medicine.
• Tear open the pouch and pull out the cloth.
• Unfold the cloth and wipe across one underarm one time. Use the same cloth and wipe across the other underarm one time.
• Do not apply this medicine to broken skin. Do not cover the treated area with a bandage unless your doctor has told you to.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For topical dosage form (cloth):
  • For excessive sweating of the underarms:
    • Adults and children 9 years of age and older—Apply 1 cloth to both underarm areas once every 24 hours.
    • Children younger than 9 years of age—Use and dose must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep this medicine away from heat or flame.

Precautions while using Qbrexza

It is very important that your doctor check your or your child’s progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

Do not use this medicine to treat a skin problem your doctor has not examined.

This medicine may cause urinary retention (trouble passing urine or not fully emptying the bladder), especially if you have bladder blockage. Check with your doctor right away if you or your child has a decrease in urine volume, a decrease in the frequency of urination, difficulty in passing urine, feeling of full bladder, or painful urination.

This medicine may make it more difficult for your body to cool down. It might reduce how much you sweat. Your body could get too hot if you do not sweat enough. If your body gets too hot, you might feel dizzy, weak, tired, or confused. Avoid places that are very hot. Call your doctor if drinking cool water and moving away from the heat does not cool you down.

This medicine may cause blurred vision. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of Qbrexza

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

• Bigger, dilated, or enlarged pupils (black part of the eye)
• blurred vision
• different size pupils of the eyes
• trouble in urinating

Incidence not known

• Decrease in frequency of urination
• decrease in urine volume
• difficulty in emptying your bladder
• difficulty in passing urine (dribbling)
• painful urination

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Dry mouth
• fever
• headache
• increased sensitivity of the eyes to light
• muscle aches
• pain in the mouth or throat
• redness, burning, stinging, or itching of the skin
• sore throat
• stuffy or runny nose
• unusual tiredness or weakness

Less common

• Constipation
• dry eye
• dry skin
• dry throat
• nasal dryness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Commonly used brand name(s)

In the U.S.

• Qbrexza

Available Dosage Forms:

• Pad

Therapeutic Class: Cholinergic Antagonist

Pharmacologic Class: Antimuscarinic

What is Qutenza?

Qutenza (capsaicin 8% patch) is used to treat postherpetic neuralgia (PHN) or nerve pain of the feet caused by diabetic peripheral neuropathy (DPN). It is a prescription medication applied directly to the affected area by a healthcare professional for 30 to 60 minutes every 3 months.

Qutenza gained FDA approval on November 16, 2009. There is no generic available.

• Lower strength capsaicin patches, topical creams, and lotions can be brought from a drugstore without a prescription. 
• Qutenza is approximately 80 times stronger than typical OTC products.

Mechanism of action

Qutenza contains capsaicin, which is the substance that gives heat to chili peppers. Capsaicin works by selectively targeting TRPV1 receptors (pain receptors) in the skin. When applied it:

• Initially causes a burning or tingling sensation
• Gradually desensitizes the pain receptors
• Reduces the transmission of pain signals to the brain
• Provides prolonged pain relief even after the patch is removed.

FDA-Approved Indications

Qutenza is indicated for the treatment of:

• Postherpetic neuralgia (PHN): Persistent pain following a shingles infection
• Diabetic peripheral neuropathy (DPN): Pain in the extremities (typically feet or legs) caused by nerve damage from diabetes.

Qutenza side effects

Common Side Effects

The most common side effects of Qutenza are skin reactions where the patch was applied, such as:

• A burning sensation
• Pain
• Redness
• Itching
• Swelling
• Skin bumps and lumps (papules)
• Dryness.

A mild burning sensation may last several hours or days, especially after the first time Qutenza is applied.

Less Common Side Effects

• Temporary increases in blood pressure during and immediately after treatment
• Nausea
• Headache
• Cough
• Sneezing (due to breathing in airborne capsaicin).

Precautions and Warnings

Qutenza patches must only be applied by a healthcare professional. Never apply or remove Qutenza yourself.

Do not touch Qutenza or items exposed to capsaicin. Touching Qutenza and then accidentally touching other areas of your body can cause severe irritation of the eyes, mucous membranes, respiratory tract, and skin.

• This includes your eyes or other unintended target areas during the Qutenza application.
• Qutenza is not for use near eyes or mucous membranes.
• Do not sniff or inhale near Qutenza as this may cause you to cough or sneeze. Stop using Qutenza and call your doctor at once if you have trouble breathing or swallowing (after accidental inhalation of capsaicin odor or dried residue).
• If irritation of eyes or airways occurs or any side effects become severe, notify your doctor immediately.

You may experience substantial pain during the treatment. Tell your healthcare provider if you are experiencing pain; a cool compress or medicine for the pain can be provided to help lessen your discomfort.

• You may get frostbite if you cool your skin too much.
• You can use a cooling pack from the refrigerator (not the freezer) and avoid putting it directly on skin.
• Seek medical attention if you experience strong and continuous pain or skin lesions such as blisters after treatment.

Qutenza can cause serious side effects, including pain, severe burns, and increases in blood pressure during or right after treatment. Your healthcare provider should check your blood pressure during treatment with Qutenza.

• If you have high blood pressure that is not well controlled by medicine, or have had recent heart problems, stroke, or other vascular problems, you may be at increased risk and should discuss with your doctor whether Qutenza is right for you.

Tell your doctor if you have reduced sensation in the feet. You may notice that you have less feeling for hot or sharp pain where Qutenza was applied, but this is usually minor and temporary.

Treated areas may be sensitive to heat (such as hot water, direct sunlight, vigorous exercise) for a few days after treatment.

Hypersensitivity reactions. Qutenza may cause an allergic reaction in some people. Get emergency medical help if you have signs of an allergic reaction, such as hives; difficulty breathing; or swelling of your face, lips, tongue, or throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Before receiving this medicine

• Do not receive Qutenza if you are allergic to chili peppers, capsaicin, Qutenza, or any other ingredients in the formulation.
• Should not be used on broken or irritated skin.
• Not recommended to be applied to the face, scalp, or mucous membranes (for example, inside the nose or on the lips).

Before Qutenza is applied to your skin, tell your healthcare provider about all your medical conditions, including if you:

• have any allergies
• have high blood pressure or take medications for blood pressure
• have any skin conditions, such as eczema or psoriasis
• are pregnant or intend to become pregnant. It is not known whether Qutenza will harm an unborn baby
• are breastfeeding or intend to breastfeed. It is not known whether capsaicin passes into breast milk or if it could harm a nursing baby. Do not apply Qutenza to your breast area if you are breast-feeding a baby.

Qutenza is only approved for use in adults.

How is Qutenza applied?

Qutenza patches must only be applied by a healthcare professional. It should not be applied to open wounds or on sunburned, windburned, dry, chapped, or irritated skin. If this medicine gets in your eyes, nose, or mouth, rinse with water.

• Remove jewelry or metal objects from the treatment area.
• Your skin should be clean and dry before the patches are applied.
• Do not touch Qutenza, treatment areas, and all used supplies or other materials placed in contact with the treatment area without wearing nitrile gloves.
• This medicine is for use only on the skin.

Your healthcare provider will pre-treat the area with a topical anesthetic to reduce discomfort associated with the application of Qutenza.

• To keep the medication from getting on their hands, they will wear nitrile gloves. They will prepare the patches and press them on the skin.
• Once the patch has been applied, they will leave it in place for 60 minutes for postherpetic neuralgia, and 30 minutes for diabetic peripheral neuropathy of the feet.
• The treated skin should not be covered with a bandage or heating pad, because this can increase the burning sensation. It may be covered with clothing.

Post-Treatment Care

• The treated area may remain sensitive for a few days.
• Cooling measures (ice packs) may help alleviate discomfort.
• Avoid hot showers or baths immediately after treatment.
• Avoid vigorous exercise that might irritate the treated area.
• Keep the area clean and avoid applying other topical products unless directed.

Dosing information

Usual Adult Qutenza Dose for Postherpetic Neuralgia:

Up to 4 patches in a single, 60-minute application.

• Treatment may be repeated every three months or as warranted by the return of pain (but not more frequently than every 3 months).

Usual Adult Qutenza Dose for Diabetic Peripheral Neuropathy (DPN) of the Feet:

Up to 4 patches in a single, 30-minute application.

• Treatment may be repeated every three months or as warranted by the return of pain (but not more frequently than every 3 months).

What should I avoid while using Qutenza?

Avoid inhaling the odor or dried residue of Qutenza during treatment. Inhaling capsaicin can cause coughing, sneezing, or watery eyes, and can irritate your throat or lungs.

Avoid touching your eyes, mouth, nose, genitals, or rectum until the medication has been washed off the treatment area.

Avoid exposing treated skin to sunlight, sunlamps, tanning beds, or a hot tub. 

Do not use other medicated skin products, including muscle pain creams or lotions, on areas where Qutenza has been applied, unless your doctor has told you to.

Efficacy and Clinical Response

• Pain relief may begin within days after treatment.
• Clinical trials report the full effect typically develops over 1-2 weeks.
• Relief can last for up to 3 months, at which point treatment can be repeated.
• Not all patients respond equally; individual results may vary.

Insurance Coverage and Availability

• Requires a prescription from a healthcare provider.
• Coverage varies by insurance plan; prior authorization may be required.
• Available only as patches containing 8% capsaicin (179 mg).

Drug interactions

Qutenza is not known to have significant interactions with other medications as it acts locally with minimal systemic absorption.

Ingredients

Active: capsaicin 179 mg.

Inactive ingredients: diethylene glycol monoethyl ether, dimethicone, ethyl cellulose, polyester film, silicone adhesive, and white ink. 

Each Qutenza patch contains 8% capsaicin (640 mcg per cm²), for a total of 179 mg of capsaicin.

Who makes Qutenza?

Qutenza (capsaicin 8% patch) is manufactured by Averitas Pharma, Inc., a subsidiary of Grünenthal GmbH, headquartered in Aachen, Germany. Averitas Pharma, the U.S. subsidiary handling Qutenza, operates from its U.S. headquarters in Morristown, New Jersey. Other notable products by Grünenthal are:

• Tramadol (Ultram, Zydol) – for moderate to moderately severe pain
• Buprenorphine patches (Transtec) – for moderate to severe chronic pain
• Versatis (lidocaine medicated plaster) – a topical anesthetic for post-herpetic neuralgia
• Palexia SR (extended-release tapentadol) – a long-acting formulation for chronic pain management.