Although commercially-available prescription and over-the-counter (OTC) hair loss treatments are effective for many patients, they may not provide optimal results for patients with specific needs, such as those experiencing side effects related to the administration route or the presence of certain excipients or because the commercially-available form uses a non-optimal dosage. Any or all of these factors can increase patient frustration, leading to decreased compliance and ultimately decreasing the effectiveness of the therapy.
Compounded hair loss preparations can address these issues in several ways:
- Removing harsh solvents and irritating excipients
- Altering the administration route
- Altering the dosage
- Combining several drugs into a single customized preparation
In this post, we’ll explore how compounding may help prescribers ensure their patient’s requirements are met for maximizing the efficacy of hair loss and hair regrowth therapies. In addition, it is equally important to mitigate potential side effects.
Let’s review three common treatment options for hair loss prevention and regrowth.
When using oral finasteride, most patients see improvements in hair thickness within months, but several common side effects in male patients, such as gynecomastia and asymmetric breast pain, may decrease patient compliance. To diminish these adverse events, finasteride can be compounded to be administered topically or orally at a lower dosage. Early studies showed that daily doses as low as 0.2 mg of finasteride decreased DHT serum levels by 68.6 percent, which was only slightly lower performance than the 1 mg dose (71.4%).1,2 Although the use of low-dose finasteride for hair loss may provide sub-optimal results, case studies have shown it may also help prevent gynecomastia and allow the libido to return to pre-therapy levels.3
Because they are cheaper due to indication-based pricing, some patients may request 5 mg finasteride tablets (which are indicated for benign prostatic hyperplasia) and then use a pill cutter to decrease the dose. However, it is nearly impossible to obtain accurate dosing using this method. At best, patients will likely only be able to quarter a pill and obtain a 1.25 mg dose. Due to the inaccurate dosing associated with this practice, compounding should be performed when a patient requires a dosage or administration route that is different from the drug’s commercially-available form.
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It’s important to remember that no dosage of finasteride has been shown to completely inhibit DHT production, so it will only slow the hair loss process. Therefore, finasteride is often combined with other medications that promote hair regrowth. Note: Patients should expect some amount of hair loss when beginning any new treatment regimen, but most will see an improvement in hair density during the therapy.
Available as a topical OTC product, minoxidil is used in combination with finasteride and is most commonly available as a topical formulation. However, it can also be administered orally should side effects, like application site irritation or redness, emerge. Similar to finasteride, a common side effect of minoxidil administration is hair shedding during the initial period of treatment.
Combined hair loss therapies often provide superior results to individual treatments. Studies have shown that all-trans retinoic acid improved the efficiency of hair growth using minoxidil compared with minoxidil alone. So, if patients aren’t seeing desired results with OTC versions of minoxidil, consider prescribing a compounded preparation that includes retinoic acid.4
Retinoic acid penetrates and increases the photosensitivity of the skin at the application site and may even cause scalp burns or irritation. Alternatives such as caffeine citrate and a proprietary blend of peptides can be prescribed to avoid skin irritation.
Now, let’s consider some recent research on hair loss treatment options.
Although compounding can help mitigate the side effects of finasteride and minoxidil, these side effects are inherent to the medications themselves, and simply lowering the dose or changing the administration route may not completely eliminate adverse events. As drug development becomes increasingly targeted due to an improved understanding of the underlying molecular mechanisms involved in biological processes, additional hair loss treatments have emerged.
Many studies in the past several years have investigated topical cetirizine as an alternative to more commonly-used medications.5 One study showed that cetirizine regrew hair without noticeable side effects, potentially increasing patient compliance.6 Another study showed that, while both minoxidil and cetirizine provided statistically significant amounts of hair regrowth, minoxidil did outperform cetirizine.7
Initially developed for glaucoma and ocular hypertension, researchers observed thicker and longer eyelashes and hypertrichosis during latanoprost treatment. One study showed that latanoprost significantly increased hair density after only 24 weeks.8 While latanoprost has shown slightly inferior results to minoxidil in the peer-reviewed literature, much lower concentrations (0.005 percent) were needed than minoxidil (5 percent).9
For female patients suffering from androgenetic alopecia, there are several options available, including minoxidil, but the results may be unsatisfactory. Studies around the world have shown that 17α-estradiol (alfatradiol) is effective at treating hair loss in women, albeit less effectively than minoxidil.10,11 However, it can be combined with minoxidil to obtain results better than what is achievable using either individual therapy, as shown by the photo below.
Combining several drugs into a single compounded preparation makes patients’ lives simpler while also retaining or even increasing the effectiveness of the hair loss medication.
As shown above, several studies have reported improved hair regrowth by combining minoxidil and finasteride with other drugs such as retinoic acid and latanoprost. Rather than taking multiple individual medications, they can be combined into a single preparation.
Why should patients choose VLS Pharmacy and New Drug Loft for hair loss compounding?
Prescribers should ultimately rely on their clinical expertise to determine which dosage and administration route is correct for their hair loss patients. If a commercially-available hair loss or hair regrowth treatments aren’t providing desired results, reach out to us to learn more about our compounded hair loss preparations. We offer a variety of administration routes and can combine several drugs into a single preparation to maximize the effectiveness of individual therapies, as backed by peer-reviewed literature.
As a 503A pharmacy specializing in sterile and non-sterile compounding, we will support you and your patients by creating safe, individualized, and effective pharmaceutical therapies. All formulations are compounded with high-quality pharmaceutical-grade APIs sourced directly from PCCA, the leader in superior-quality APIs.
For men and women at any age, feeling healthy, conﬁdent, and comfortable is of the utmost importance. Your patients’ needs will change with each life stage. As such, they require an adaptive and personalized treatment plan. By working with a trusted compounding pharmacy like VLS Pharmacy and New Drug Loft, you are expanding the possibilities for successful and sustainable care.
Reach out to our team to learn about best practices and to partner with our experts on custom compounded medications for your patients. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.
- Drake L, Hordinsky M, Fiedler V, et al. The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia. J Am Acad Dermatol. 1999;41(4):550-554.
- Roberts JL, Fiedler V, Imperato-McGinley J, et al. Clinical dose ranging studies with finasteride, a type 2 5α-reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol. 1999;41(4):555-563. doi:10.1016/S0190-9622(99)80052-8
- Liu JM, Chiang YJ, Chi CL, Lo YF, Chou CY. Male breast cancer after finasteride therapy for benign prostate hyperplasia. Urol Sci. 2013;24(4):127-128. doi:10.1016/j.urols.2012.06.001
- Kwon OS, Pyo HK, Oh YJ, et al. Promotive Effect of Minoxidil Combined with All-trans Retinoic Acid (tretinoin) on Human Hair Growth in Vitro. J Korean Med Sci. 2007;22(2):283-289. doi:10.3346/jkms.2007.22.2.283
- Zaky MS, Abo Khodeir H, Ahmed HA, Elsaie ML. Therapeutic implications of topical cetirizine 1% in treatment of male androgenetic alopecia: A case-controlled study. J Cosmet Dermatol. 2021;20(4):1154-1159. doi:10.1111/jocd.13940
- Rossi A, Campo D, Fortuna MC, et al. A preliminary study on topical cetirizine in the therapeutic management of androgenetic alopecia. J Dermatol Treat. 2018;29(2):149-151. doi:10.1080/09546634.2017.1341610
- Mostafa DH, Samadi A, Niknam S, Nasrollahi SA, Guishard A, Firooz A. Efficacy of Cetirizine 1% Versus Minoxidil 5% Topical Solution in the Treatment of Male Alopecia: A Randomized, Single-blind Controlled Study. J Pharm Pharm Sci. 2021;24:191-199. doi:10.18433/jpps31456
- Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2012;66(5):794-800. doi:10.1016/j.jaad.2011.05.026
- Bloch LD, Escudeiro CC, Sarruf FD, Valente NYS. Latanoprosta e minoxidil: Estudo duplocego comparativo, placebo-controlado no tratamento da queda de cabelos. Surg Cosmet Dermatol. 2018;10(1):41-45. doi:10.5935/scd1984-8773.20181011015
- Blume-Peytavi U, Kunte C, Krisp A, Garcia Bartels N, Ellwanger U, Hoffmann R. Comparison of the efficacy and safety of topical minoxidil and topical alfatradiol in the treatment of androgenetic alopecia in women. J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG. 2007;5(5):391-395. doi:10.1111/j.1610-0387.2007.06295.x
- The Efficacy and Safety of 17α-Estradiol (Ell-Cranell® alpha 0.025%) Solution on Female Pattern Hair Loss: Single Center, Open-Label, Non-Comparative, Phase IV Study – PMC. Accessed April 13, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412238/
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