People’s Pharmacy: Will low-dose oral minoxidil substitute for Rogaine?

Q. I am concerned about my thinning hair. I tried Rogaine and it worked well until I developed an allergic reaction.

I just read about low-dose oral minoxidil. What can you tell me about it?

A. Science writer Gina Kolata stirred up a lot of excitement in her New York Times article (Aug. 23, 2022). She described the off-label use of low-dose oral minoxidil as an alternative to topical Rogaine (minoxidil). Several dermatologists have reported success prescribing low doses of this blood pressure pill for people with hair loss.

The usual oral dose ranges from 5 to 40 milligrams per day for high blood pressure. There can be serious side effects at those doses. Some dermatologists are prescribing amounts that range from 0.25 to 1.25 milligrams (Journal of the American Academy of Dermatology, March 2021). They often add the diuretic spironolactone (25 milligrams) to reduce fluid retention and counteract facial hair growth.

Q. You criticized certified medical assistants for inaccurate blood pressure recordings. It is offensive to single us out.

All medical personnel, including doctors, are guilty of hurrying through this measurement and not positioning the patient properly. Using an outdated or uncalibrated sphygmomanometer is not the CMA’s fault.

Patients would be wise to purchase their own home blood pressure devices or go to their pharmacies for weekly or monthly readings. Most doctors respect a person who can produce a written record of readings. This might make a difference in their treatment protocol.

A. We apologize for criticizing CMAs for improper blood pressure measurement technique. As you have correctly pointed out, many health care professionals may fail to follow the appropriate procedures.

We have described in detail all the correct steps for proper blood pressure monitoring in our eGuide to Blood Pressure Solutions. They include time to relax, a bathroom break, proper positioning, correct cuff size, no talking, multiple measurements and home verification with an accurate device. You can find this online resource under the Health eGuide tab at www.PeoplesPharmacy.com.

There are many personal blood pressure monitors available ranging from about $25 to $150. We list our favorite in the guide.

Q. I am so confused. My husband takes Humira for his arthritis. He is 68 and on my health insurance. I am 67 and still working. He is retired.

I am looking at retirement, but it doesn’t look like Medicare covers Humira. What do people do? It’s so incredibly expensive! Do I have to keep working just to pay for his drugs?

A. Welcome to the Alice-in-Wonderland world of prescription drug insurance. According to GoodRx, a month’s supply of self-injectable Humira could cost over $9,000 without insurance. Even with a coupon, the cost could be over $6,000.

Before you retire, you and your husband will need to sign up with Medicare, including a Part D plan that pays for your prescription drugs. There are many providers offering Part D plans and each covers a different list of drugs on its formulary. Comparison shopping is essential to make sure that the plan you select covers the medicines you take.

There should be a program that will cover “biologics” such as Humira. There are several options including Actemra, Cimzia, Enbrel, Orencia, Remicade or Simponi. Your husband’s doctor will need to determine if any of these would be a suitable substitute in the event that he cannot find a plan that covers Humira.

In their column, Joe and Teresa Graedon answer letters from readers. Email them via their website: www.PeoplesPharmacy.com.