Usage
- This combination medication is primarily prescribed for androgenetic alopecia, also known as male or female pattern baldness. It may also be used for other types of hair loss, like telogen effluvium and traction alopecia, although its efficacy in these conditions is less established.
- Pharmacological classification: This is a combination product containing a vasodilator (minoxidil), a retinoid (tretinoin), and a dicarboxylic acid (azelaic acid) with anti-inflammatory and 5-alpha-reductase inhibiting properties. It is classified as a hair growth promoter and scalp health improver.
- Mechanism of Action: Azelaic acid inhibits 5-alpha-reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT), a hormone implicated in hair follicle miniaturization. Minoxidil is a vasodilator, increasing blood flow to hair follicles, delivering more oxygen and nutrients. Tretinoin, a retinoid, increases cell turnover and promotes hair follicle growth.
Alternate Names
- No widely recognized alternate names exist for this specific combination. It is often referred to simply as a “minoxidil, tretinoin, and azelaic acid combination” or topical solution.
- Brand names: Minokem-N. More brand names may exist regionally.
How It Works
- Pharmacodynamics: The combined action of the three components targets different aspects of hair loss. Azelaic acid reduces DHT levels, which helps to prevent further miniaturization of hair follicles. Minoxidil enhances blood supply to the follicles promoting hair growth. Tretinoin enhances follicular growth and keratinization.
- Pharmacokinetics: Azelaic acid has low percutaneous absorption (1.6% - 3.9%). Absorption may increase with inflammation. Limited data is available on the percutaneous absorption of minoxidil and tretinoin in this combination. Elimination pathways are primarily renal and hepatic. Minoxidil is mainly eliminated via the kidneys, and tretinoin via hepatic metabolism. Data on azelaic acid elimination in combination preparations is limited.
- Mode of Action: Azelaic acid acts by inhibiting 5-alpha-reductase. Minoxidil’s mechanism is not fully understood but is thought to involve potassium channel opening, leading to vasodilation. Tretinoin activates retinoic acid receptors, modulating gene expression and influencing cell growth and differentiation.
- Receptor Binding, Enzyme Inhibition: Azelaic acid inhibits 5-alpha-reductase. Minoxidil interacts with potassium channels. Tretinoin binds to retinoic acid receptors.
Dosage
As this is a compounded medication, dosing varies significantly. Here is the dosage mentioned in one of the sources.
Standard Dosage
Adults:
1ml of Minokem N solution 2% is applied once daily or as prescribed by the physician for androgenetic alopecia.
Children:
This medication is contraindicated in children under 18 years of age.
Special Cases:
- Elderly Patients, Patients with Renal Impairment, Patients with Hepatic Dysfunction, Patients with Comorbid Conditions: Specific dosage recommendations for these populations are not available but caution is advised when using this medication. Consult with the physician before prescribing to these special populations.
Clinical Use Cases
This medicine is used for specific clinical cases of androgenetic alopecia, telogen effluvium and traction alopecia. However, its efficacy in other conditions is less established. Dosage recommendations may vary; consult a physician for individualized plans. It is not indicated for use in situations like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage modifications should be determined by the healthcare provider based on individual patient response and tolerance.
Side Effects
Common Side Effects
- Scalp irritation (burning, stinging, itching, redness).
- Dryness or flaking of the scalp.
- Headache
- Itching.
Rare but Serious Side Effects
- Unwanted facial or body hair growth.
- Dizziness.
- Chest pain.
- Swelling of hands/feet.
- Allergic reactions (rash, itching/swelling, dizziness, trouble breathing).
Long-Term Effects
Long-term effects are not well-established, but potential concerns include persistent skin irritation or changes in hair growth patterns in areas other than the scalp.
Adverse Drug Reactions (ADR)
Severe allergic reactions, significant changes in blood pressure or heart rate.
Contraindications
- Hypersensitivity to minoxidil, tretinoin, azelaic acid, or any component of the formulation.
- Severe skin conditions or open sores on the scalp.
- Pregnancy and breastfeeding (unless deemed absolutely necessary by a physician).
- Children under 18.
Drug Interactions
- Other topical scalp treatments, especially those containing corticosteroids.
- Medications for high blood pressure (e.g., guanethidine).
- Drugs that interact with alcohol (e.g., disulfiram, metronidazole).
- Some OTC medications and herbal products may interact, it’s important to consult with the physician before starting any new medication.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Not classified. Topical tretinoin is typically advised against due to potential risk although limited data is available. Azelaic Acid is considered relatively safe to use topically during pregnancy. Minoxidil is typically advised against during pregnancy. The combination should generally be avoided unless specifically directed by a physician.
- Data regarding excretion in breast milk is limited for each of the individual medications. Azelaic Acid and Minoxidil are thought to be present in low amounts in breast milk; avoidance is generally advised for this combination.
Drug Profile Summary
- Mechanism of Action: Azelaic acid inhibits 5-alpha-reductase, minoxidil vasodilates, and tretinoin promotes cell turnover.
- Side Effects: Scalp irritation, dryness, headache, unwanted hair growth.
- Contraindications: Hypersensitivity, scalp lesions, pregnancy, breastfeeding, children under 18.
- Drug Interactions: Other topical treatments, antihypertensives, medications interacting with alcohol.
- Pregnancy & Breastfeeding: Generally contraindicated.
- Dosage: Variable, consult a healthcare provider.
- Monitoring Parameters: Hair growth, scalp condition, blood pressure, heart rate for certain patients (especially with cardiovascular issues).
Popular Combinations
This particular triple combination itself is considered a popular combination for hair loss when individually these medications are not proving effective.
Precautions
- Evaluate patient history for hypersensitivity, scalp conditions, and other medical conditions.
- Caution advised in patients with heart, kidney, or liver disease.
- Pregnant or breastfeeding women must consult before using this combination.
- Avoid contact with eyes, nose, and mouth.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Azelaic Acid + Minoxidil + Tretinoin?
A: Dosage varies depending on the specific formulation, but Minokem-N 2% solution is typically applied once daily (1ml) or as directed by the physician.
Q2: Can this combination be used during pregnancy or breastfeeding?
A: It is generally contraindicated during pregnancy and breastfeeding.
Q3: What are the most common side effects?
A: Scalp irritation (burning, stinging, itching, redness), dryness, headache.
Q4: Are there any serious side effects I should be aware of?
A: Yes, unwanted facial/body hair growth, allergic reactions, dizziness, chest pain, and swelling of extremities can occur.
Q5: Can I use other hair products while using this combination?
A: It’s best to consult with a doctor before combining with other scalp treatments as this can increase the risk of irritation and absorption related side effects.
Q6: How long does it take to see results?
A: Results can vary, but it often takes several months of consistent use to see noticeable improvement.
Q7: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember. If it’s close to the next dose, skip the missed dose and continue with your regular schedule. Don’t double the dose.
Q8: Can this combination treat all types of hair loss?
A: While primarily indicated for androgenetic alopecia, it may be used for other types of hair loss. Consult with a dermatologist for best treatment strategy.
Q9: What should I do if I experience side effects?
A: Consult your doctor if you experience any persistent or bothersome side effects. Some mild side effects may resolve with continued use. Discontinue immediately if any serious reactions occur.
