Latest news with #spironolactone
Medscape
02-07-2025
- Health
- Medscape
Rapid Rx: Hair Loss Treatments
Hair loss due to androgenetic alopecia remains a widespread concern for patients across the globe, as it severely affects their quality of life and self-esteem. With deeper insights into the biological mechanisms behind hair loss, a broader range of interventions are becoming available. Innovative methods ranging from laser-based treatments to microneedling and regenerative techniques are now entering clinical practice. These novel strategies offer promising alternatives, particularly for individuals who have seen limited benefit from traditional options or seek treatments with fewer systemic effects. How well do you understand the latest advances in managing hair loss? Test your knowledge with this quick quiz. Spironolactone reduces the influence of androgens, which are hormones that contribute to follicular miniaturization and hair thinning. In managing female-pattern hair loss, oral spironolactone is emerging as a novel therapeutic approach. It is commonly used to treat acne and hirsutism in females, especially those diagnosed with polycystic ovary syndrome (PCOS). Patients with PCOS are often diagnosed with androgenetic alopecia. Topical spironolactone can be used for both men and women. Botulinum toxin is a treatment currently being studied for hair loss, although more research is needed before it can be recommended as a standard treatment. Low-level laser therapy can be used for both men and women. Low-dose oral finasteride (1 mg) has shown limited benefit in women but has not been as effective in postmenopausal women. Learn more about low-level laser therapy. Hair transplantation is a surgical procedure that harvests follicles from non-androgen-sensitive areas to areas affected by androgenetic alopecia. This procedure is best suited to individuals with nonscarring, patterned hair loss (typically androgenetic alopecia) who have a consistent and healthy donor area. Scarring conditions such as cicatricial alopecia damage the scalp and hair follicles permanently. For an effective surgery, the hair loss should be stable, and the patient should have a reliable zone from which follicles can be harvested. Similarly, widespread thinning across the scalp (diffuse unpatterned alopecia) compromises donor-site quality. In alopecia areata, the immune system targets hair follicles unpredictably, making transplant outcomes unreliable. Learn more about cicatricial alopecia. For women with androgenic alopecia who wish to evade systemic hormonal effects, topical finasteride offers a practical alternative. Unlike oral formulations, which circulate throughout the body and might affect hormone levels (potentially causing adverse effects such as irregular periods or reduced libido), topical finasteride delivers its action more locally, with minimal absorption. Although not formally approved by the FDA for this use, it has shown promising results in reducing hair loss. Oral dutasteride and high-dose oral finasteride are generally avoided in women of childbearing age due to their broad hormonal influence and risk for birth defects. Although topical minoxidil is a well-established treatment, it does not directly address the androgen-driven aspect of the condition. Learn more about androgenetic alopecia. Micronutrients, such as vitamins and minerals, probably play an important role in follicle function. According to a systematic review, zinc is supported by research as a possible nutritional intervention for hair loss. The average dietary intake of vitamin A and biotin is adequate. Excess levels of vitamin A can cause hair loss, and neither biotin (vitamin B7) nor vitamin E supplementation are supported by the literature. In addition, biotin supplementation can cause potentially dangerous false troponin laboratory results. Learn more about zinc supplementation. Low-dose oral minoxidil (doses ranging from 0.25 mg to 2.5 mg daily) has been used off-label with good clinical efficacy and safety. Caution is advised when prescribing low-dose oral minoxidil to individuals with preexisting heart or vascular conditions. Although it is commonly used off-label to address hair loss in both female- and male-pattern hair loss due in part to its ability to enhance blood flow to the scalp, minoxidil was originally designed to lower blood pressure. Rare but potentially serious systemic effects such as increased heart rate or shifts in blood pressure could worsen underlying cardiovascular problems with its use. The magnitude of cardiovascular adverse effects is dose dependent, with 1 mg oral minoxidil being generally safe and well tolerated. (Oral minoxidil might also contribute to facial hypertrichosis, and it is not advised for use in pregnant women or in those who are breastfeeding.) Minoxidil is not the treatment of choice for autoimmune-related hair loss, such as with lupus and alopecia areata, but it could be used as an adjunct therapy. Adolescents with alopecia areata can be treated with minoxidil, which had similar efficacy to that in adults. Learn more about minoxidil.
Medscape
09-06-2025
- Health
- Medscape
Spironolactone Offers No CV Benefit in Dialysis Patients
VIENNA — Spironolactone, a mineralocorticoid receptor antagonist (MRA), does not reduce the rates of cardiovascular (CV) death or heart failure in patients undergoing maintenance dialysis, according to ACHIEVE trial results. In addition, the relatively high rates of hyperkalemia associated with the drug — despite a run-in period — limit its use, said lead investigator Michael Walsh, MD, PhD, Renal Research Program, Population Health Research Institute, Hamilton, Ontario, Canada, who presented the results at the 62nd European Renal Association Congress on June 6. He added: 'Cardiovascular mortality remains very high' in these patients, at the 'somewhat astounding' rate of 11% per year in the current trial. The ACHIEVE Trial Previous trials have suggested that MRAs are perhaps the 'most promising therapies' in this space, Walsh noted. He and his colleagues undertook the Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease (ACHIEVE) trial to evaluate the efficacy and safety of spironolactone. The study included patients (age, ≥ 45 y or ≥ 18 y with history of diabetes) with kidney failure receiving maintenance dialysis who were at risk of CV death. All patients underwent an active run-in where they were prescribed open-label spironolactone 25 mg/day for at least 7 weeks with no dosing adjustments followed by a final eligibility assessment to ensure they were ≥ 80% adherent to the medication and that their serum potassium levels did not exceed 6.0 mmol/L. After the run-in period, 2538 of the originally selected 3565 patients were randomized to either spironolactone 25 mg/day or matching placebo. Follow-up was at 3 months, 6 months, and then every 6 months after, assessing for outcomes, safety, drug adherence, and drug resupply. Unlike the run-in period, clinicians could reduce the dose to 25 mg/three times a week if appropriate. The average age of the patients was approximately 62 years, roughly 37% were female, and the median time that the patients had been receiving dialysis was 2 years. The primary cause of kidney failure was diabetes, in just over 40% of patients, followed by hypertension/ischemia in slightly over 25%. The trial was stopped early by the external safety and event monitoring committee for futility, meaning it did not reach the target number events, even after the target had been revised downward due to better-than-expected adherence. Walsh stated that the trial did not reach its primary outcome, with no significant difference in rates of CV death or heart failure hospitalization between the spironolactone and placebo groups at a hazard ratio (HR) of 0.92 ( P = .35). There was also no significant difference between the two treatments when stratifying the patients by sex, previous heart failure, previous coronary artery disease, and the length of time they had been receiving dialysis. Further analysis indicated there was no benefit from spironolactone over placebo when looking at cardiac and vascular deaths separately and when considering first and total heart failure hospitalizations individually. However, spironolactone was associated with an increased risk of hyperkalemia, with 123 events in the spironolactone-treated group vs 80 in the placebo group (HR, 1.54; 95% CI, 1.07-2.22). Walsh noted that, despite the strengths of its large size and the high rates of adherence, the trial is limited by having a low statistical power due to being stopped early, the use of a composite primary outcome, and the challenge in defining the patients most likely to benefit from the intervention. Important Clinical Question Session co-Chair Ronald T. Gansevoort, MD, PhD, professor of medicine and a nephrologist at the Department of Nephrology, University Medical Center Groningen, Netherlands, told Medscape Medical News that the study addressed an 'important clinical question,' and it is 'a pity that it didn't work out.' He noted there have been numerous studies of CV disease in patients with chronic kidney disease who are not on dialysis, but 'there have been so few trials in dialysis patients,' and there consequently remains a lot to learn in this space. As to what the current findings mean for MRAs in general in preventing CV outcomes, Gansevoort said he is 'not sure, because there are drug-specific differences between the first, second, and third generation, and we cannot extrapolate the findings with the first generation to the third.' 'Whether there ever will be a trial with the third generation in dialysis patients, I doubt, because industry will not want to fund it,' he continued, and so it will 'remain an important question.' Christoph Wanner, MD, PhD, professor of medicine and head of the Division of Nephrology, University of Würzburg, Germany, noted that even if the number of patients in the trial were increased to 4000 or 5000 it would still not 'resolve the issue.' 'I think it's the end for MRAs in dialysis,' he told Medscape Medical News , and 'we have to think about what's going wrong in dialysis patients.' 'We started with statins. They didn't work. Hemodialysis/ hemodiafiltration does work, but drugs do not work. Why is this the case? What's going on? Did we design the right trials?' Wanner continued, 'I think this is still a [relevant research] question, but at the moment, with the ACHIEVE trial, the story of MRAs in dialysis is coming to an end.' 'Everyone who deals with dialysis patients realizes there is an excess of mortality, despite advancements in the technology of dialysis over the last 50 years,' noted Walsh at the start of his presentation. He continued that there have been reductions in deaths from atheromatous CV disease among patients receiving dialysis for kidney failure, but 'importantly, the other kinds of reasons, including non-atheromatous cardiovascular disease, remain extremely high,' accounting for approximately 40% of all deaths in these patients. 'Trying to understand why there is such a high risk of cardiovascular death has been challenging,' Walsh added. ACHIEVE was funded by grants from the Canadian Institutes of Health Research (Canada), the Medical Research Future Fund (Australia), the Health Research Council (New Zealand), the British Heart Foundation (United Kingdom), the Population Health Research Institute (Canada), St. Joseph's Healthcare Hamilton Division of Nephrology (Canada), Accelerating Clinical Trials (Canada), the CanSOLVE CKD Network (Canada), and the Department of Medicine, Dalhousie University (Canada). No relevant financial relationships declared.
Health Line
27-05-2025
- General
- Health Line
Everything You Need to Know About Hair Loss Medications: Where to Buy, Side Effects, and More
Key takeaways Though there are various options for hair loss medications, sticking to treatments approved by the Food and Drug Adminstration (FDA) may be best to minimize the chance of any side effects. The most effective prescription medications include finasteride and spironolactone, though spironolactone is not FDA-approved for hair loss. You try telehealth providers like Roman to get a consultation for hair loss medications that best suit your needs. A quick look for the best hair loss medications Dealing with hair loss can be frustrating, and with all the available products, it can add to the overwhelm. Additionally, visiting a dermatologist or hair loss specialist can be expensive. Medications are available to treat male and female pattern hair loss, and they can help with slowing hair loss, stimulating hair growth, or both. To simplify your options, we dive into the best hair loss medications, their effectiveness, and their side effects. We also give a few of our picks you can look through and see if it's right for you. Language matters In this article, we use 'male and female' to refer to someone's sex as determined by their chromosomes, and 'men and women' when referring to their gender (unless quoting from sources using nonspecific language). Sex is determined by chromosomes, and gender is a social construct that can vary between time periods and cultures. Both of these aspects are acknowledged to exist on a spectrum both historically and by modern scientific consensus. What is the best medication for hair loss? With so many medications available for people experiencing hair loss, it is not easy to declare which one works the best overall. User experiences and results will vary from person to person and you may not see the same results as someone else using the same medication. We will take a look at the most popular hair loss medications, both prescription and over-the-counter options, to help you familiarize yourself with the treatments that a medical professional might recommend. Minoxidil When you think of hair loss medications, the brand name Rogaine may come to mind. The active ingredient in Rogaine is minoxidil, a non-prescription hair loss medication that is available over the counter. Minoxidil is approved by the Food and Drug Administration (FDA) as a treatment for male and female pattern hair loss. But it's used off-label for a variety of hair loss conditions. While Rogaine is a popular and common brand of minoxidil products, it's not the only option. Minoxidil is available in a variety of over-the-counter hair loss products that are applied topically. Minoxidil formulas typically consist of liquids, foams, and shampoos. In studies, minoxidil was applied to hair that was completely dry. Most manufacturers suggest you apply it to dry or towel-dried hair. It can take at least 4 months to see results. How does minoxidil work? This medication works, in part, by shortening the resting phase of the hair growth cycle and moving hairs into the active growth phase. However, the exact mechanism by which minoxidil works isn't fully understood yet. Finasteride Finasteride is an FDA-approved prescription hair loss medication that is taken orally. It's also available in a few prescription products that are applied topically and are not FDA-approved. However, the FDA has released a warning about the potential side effects of this topical formula, such as irritation and burning. This hair loss medication can be used to treat male pattern hair loss. A 2021 study showed that finasteride can be used to slow hair loss and help stimulate new hair regrowth in men. How does finasteride work? This medication works by blocking the action of an enzyme (5-alpha reductase) that converts the hormone testosterone to another hormone, dihydrotestosterone, that contributes to hair loss. Spironolactone Some medications used for hair loss are actually medications for other health conditions. Spironolactone is a diuretic pill that's used to treat high blood pressure, and it can also be used off label as a hair loss treatment for women. It's a prescription drug taken orally. Aldactone is a brand of medication containing spironolactone, but generic versions are also available. When it comes to hair loss, spironolactone is specifically used for women because it targets certain hormones. A 2013 review looked at spironolactone as a medication for female pattern hair loss. Research showed it to be an effective treatment for reducing hair loss, especially when combined with minoxidil. Also, a 2023 review showed that topical and oral spironolactone was an effective treatment for androgenic alopecia and was safe for both men and women. How does spironolactone work? This medication works by slowing down male hormones called androgens, which includes testosterone. It slows down hair loss due to androgenic alopecia and helps hair regrowth. Dutasteride Dutasteride is an oral prescription drug used to treat an enlarged prostate in males. It may also be a treatment option for those with androgenic alopecia. A 2019 review showed it to have a higher effectiveness than finasteride, and the two have comparable side effects. It works similarly to finasteride, so it should not be taken by females. How does dutasteride work? This medication works much like finasteride. It inhibits the enzyme that converts testosterone into dihydrotestosterone. What are the side effects of hair loss medication? When using any topical products or taking oral medications, there may be side effects or possible interactions. If you are concerned about certain side effects or want to know if you can take a hair loss medication with other drugs, consult your doctor or pharmacist. Side effects of topical hair loss treatments like minoxidil can include: darkening of body hair growth of body hair irritation and dermatitis on the scalp headaches lightheadedness leg swelling Hair loss medications, such as finasteride and dutasteride, can have side effects related to sexual and mental health, such as: low sex drive trouble getting an erection and ejaculating increased breast size depression Side effects of spironolactone can include: dizziness lightheadedness nausea headache hyperkalemia gynecomastia Spironolactone can also be associated with developmental issues for a fetus. Avoid getting pregnant while taking it. If you experience any side effects while taking hair loss medications, notify your doctor or pharmacist immediately. Other treatments for hair loss Some at-home strategies and lifestyle changes may help minimize hair loss. Certain vitamins and supplements may be helpful. Vitamin A, vitamin C, B vitamins, and vitamin D are all beneficial for hair health. Iron and zinc may also curb hair loss. A high protein diet may be recommended. Hair is made up of protein, so getting enough protein in your diet is important for hair growth. Other professional treatments include laser devices and microneedling. Hair transplants, and platelet-rich plasma procedures may be options to consider as well. Steroid injections are more common treatments for inflammatory hair loss. When to talk with a doctor It may be a surprise to you when you first start noticing your hair thinning or begin to see the early signs of hair loss. Maybe, it's even something that you've been aware of for a while and are starting to wonder which medications are available. Either way, addressing hair loss as soon as possible could help you hold onto your hair, slow hair thinning, or even promote hair regrowth. If you aren't ready to meet with a doctor just yet, there are over-the-counter treatments you could consider using, but those results may take several months to see. However, if you aren't seeing the results you expect after a few months of use, consider making an appointment with your doctor. Connecting with a doctor as soon as you see the early signs of hair loss may result in an early diagnosis and both of you can discuss which options are available. If your doctor recommends a medication or dosage that's not available over-the-counter, they can write you a prescription for a stronger medication and can explain the side effects and risks tied to its use. Frequently asked questions about hair loss medications What would a dermatologist prescribe for hair loss? A dermatologist may recommend over-the-counter (OTC) topical minoxidil as a first treatment option. A doctor might also prescribe oral finasteride, which is FDA-approved for certain conditions that cause hair loss. Other prescription medications, such as spironolactone, may be available as an off-label use for hair loss. A dermatologist may recommend over-the-counter (OTC) topical minoxidil as a first treatment option. A doctor might also prescribe oral finasteride, which is FDA-approved for certain conditions that cause hair loss. Other prescription medications, such as spironolactone, may be available as an off-label use for hair loss. Which vitamin and mineral deficiencies can cause hair loss? Hair loss may be a side effect of some nutritional deficiencies. Low levels of vitamin D, selenium, zinc, and iron may cause hair loss. Over-supplementation of some nutrients, such as vitamin A, vitamin E, and selenium, may also cause hair loss. Hair loss may be a side effect of some nutritional deficiencies. Low levels of vitamin D, selenium, zinc, and iron may cause hair loss. Over-supplementation of some nutrients, such as vitamin A, vitamin E, and selenium, may also cause hair loss. Takeaway Your appearance, and therefore your hair, can be a source of confidence. When you notice the signs of hair loss, your confidence may waver. If you're experiencing hair loss, you're not alone. Many people experience hair loss at some point in their lives, and there are many treatments available. Medications have been shown to be an effective treatment option for hair loss. Many are easy to find using online telemedicine services or after an evaluation with a healthcare professional.
