Minoxidil

Reserve for severe hypertension refractory to other drugs

In patients with severe blood pressure elevation, too rapid control of blood pressure, especially with intravenous agents, can precipitate syncope, cerebrovascular accidents, myocardial infarction and ischemia of special sense organs with resulting decrease or loss of vision or hearing; patients with compromised circulation or cryoglobulinemia may also suffer ischemic episodes of affected organs

Patients with malignant hypertension should have initial treatment with minoxidil carried out in a hospital setting, both to assure that blood pressure is falling and to assure that it is not falling more rapidly than intended

Neonatal hypertrichosis reported following exposure to minoxidil during pregnancy

Although minoxidil does not itself cause orthostatic hypotension, administration to patients already receiving guanethidine can result in profound orthostatic effects; if at all possible, discontinue guanethidine well before minoxidil is begun; if this is not possible, therapy should be started in hospital and patient should remain institutionalized until severe orthostatic effects are no longer present or patient has learned to avoid activities that provoke them

Therapy not used in patients who have had a myocardial infarction within preceding month; it is possible that reduction of arterial pressure with drug might further limit blood flow to myocardium, although this might be compensated by decreased oxygen demand because of lower blood pressure

Patients with renal failure or on dialysis, may require smaller doses and should have close medical supervision to prevent exacerbation of renal failure or precipitation of cardiac failure