Annals of Clinical Case Reports

Clinical Case
Published: 26 Aug, 2021

Type 2 Myocardial Infarction due to Severe Hypotension
Secondary to Oral Minoxidil OverdoseÓscar Fabregat Andrés1,2*, Lucía Gámez-Pérez3, Arantxa Blasco Serra2 and Alfonso ValverdeNavarro2
1

Department of Cardiology, Hospital IMED Valencia, Spain

2

Department of Anatomy, University at de Valencia, Spain

3

Department of Dermatology, Clinica Alejandría Valencia, Spain

Clinical Case
Low-Dose Oral Minoxidil (LDOM) has been proven effective and safe in treatment of womenwith Female Pattern Hair Loss (FPHL) in last year’s [1-3]. It could be an alternative to topicalminoxidil, which is the only approved therapy by the Food and Drug Administration and EuropeanMedicine Agency [4], especially in patients who complain altered hair texture or produce them
contact dermatitis. Postural hypotension and heart rate alterations occurred in <2% of patients, but
serious cardiovascular complications are rare [3].

OPEN ACCESS*Correspondence:Óscar Fabregat Andrés, Departmentof Cardiology, Hospital IMED Valencia,
Avenida de la Ilustración, 1.46100,
Burjassot, Valencia, Spain, Tel: +34963003000;
E-mail: ofabregat@imedhospitales.com
Received Date: 28 Jul 2021
Accepted Date: 16 Aug 2021
Published Date: 26 Aug 2021
Citation:
Andrés ÓF, Gámez-Pérez L, Serra AB,
Valverde-Navarro A. Type 2 Myocardial
Infarction due to Severe Hypotension
Secondary to Oral Minoxidil Overdose.
Ann Clin Case Rep. 2021; 6: 1974.
ISSN: 2474-1655
Copyright © 2021 Óscar Fabregat
Andrés. This is an open accessarticle distributed under the Creative
Commons Attribution License, which
permits unrestricted use, distribution,and reproduction in any medium,provided the original work is properly
cited.

A 43-year-old woman without relevant medical history and treated with LDOM (0.5 mgdaily) since 2 months ago was admitted to our hospital with a presyncopal episode in the context
of sustained severe hypotension. She complained dizziness, blurred vision and chest discomfort.
Physical examination at emergency department showed arterial hypotension (76/37 mmHg),
tachycardia with 120 beats per minute, and ECG with abnormal repolarization suggestive of
subendocardial ischemia (1-mm ST segment depression in leads I-II and V4-V6, and 0.5 mm in
III-aVL and aVF) (Figure 1, panel A). Initial creatinine was 1.60 mg/dL (normal if <1.00) andtroponin I 0.067 ng/mL (normal if <0.056). With the diagnosis of suspected type 2 acute myocardial
infarction and prerenal renal failure, the patient was transferred intensive care unit for volume
replacement and hemodynamic monitoring. The patient was hemodynamically stabilized in a few
hours and was asymptomatic. Subsequent high-sensitivity troponin I determinations demonstrated
ischemic curve (0.085-0.100-0.055-0.012 ng/mL) (Figure 1, panel B) and coronary angiography wasindicated. Given the low cardiovascular risk of the patient, a coronary CT was finally performed
showing arteries without lesions (Figure 1, panel C). The patient was discharged with a normal
echocardiogram and a negative exercise test for ischemia in outpatient control at two weeks.

Figure 1: (A) ECG at admission. (B) Determinations of troponin I during admission. (C) Coronary computed
tomography showing no coronary artery stenosis. (D) Mass chromatography of minoxidil capsules.

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Annals of Clinical Case Reports - CardiologyÓscar Fabregat Andrés, et al.,A more thorough history at this medical consultation revealed
that the patient started a new bottle of capsules on event day. Since
medication was prescribed as magistral formula, drug evaluation
was therefore decided. Analysis by mass chromatography (Acquity®
TQD system) confirmed an overdose of minoxidil with a preparation
range between 300 and 400 mg per capsule (Figure 1, panel D). This
amounts from 700 to 800 more doses than the one prescribed by thedermatologist.

References

To our knowledge, we present the first clinical case of myocardial
infarction due to oral minoxidil overdose. Previously, few clinical cases
had reported in the literature ECG changes (ST: segment depression
and T: wave inversion) and symptoms related to myocardial ischemia
in context of minoxidil intoxication [5]. Based on the risk ofserious cardiovascular disorders, such as chest pain, tachycardia, orcongestive heart failure, and since benefits have not been sufficiently
verified, oral minoxidil is not approved as a treatment drug for maleor FPHL in any country [6]. If future randomized trials clearly define
the efficacy and safety of LDOM in this context, this case illustrates
the need of a pharmaceutical formulation for this indication and thus
avoids preparation errors such as those described.

3. Jimenez-Cauhe J, Saceda-Corralo D, Rodriguez-Barata R, Moreno-Arrones
OM, Ortega-Quijano D, Fernandez-Nieto D, et al. Safety of low-dose oral
minoxidil treatment for hair loss. A systematic review and pooled-analysis
of individual patient data. Dermatol Ther. 2020;33(6):e14106.

1. Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus
minoxidil 5% topical solution for the treatment of female pattern hair loss:
A randomized clinical trial. J Am Acad Dermatol. 2020;82(1):252-3.
2. Rodrigues-Barata R, Moreno-Arrones OM, Saceda-Corralo D, JimenezCauhé J, Ortega-Quijano D, Fernandez-Nieto D, et al. Low-dose oral
minoxidil for female pattern hair loss: A unicenter descriptive study of 148women. Skin Appendage Disord. 2020;6(3):175-6.

4. Dinh QQ, Sinclair R. Female pattern hair loss: Current treatment concepts.
Clin Interv Aging. 2007;2(2):189-99.
5. Gheshlaghi F, Zoofaghari S, Dorooshi G. Unstable angina: A rare
presentation of minoxidil intoxication: A case report and literature review.
J Res Pharm Pract. 2018;7(4):210-2.
6. Manabe M, Tsuboi R, Itami S, Osada SI, Amoh Y, Ito T, et al. Guidelines
for the diagnosis and treatment of male-pattern and female-pattern hairloss, 2017 version. J Dermatol. 2018;45(9):1031-43.

Keywords: Oral minoxidil; Female pattern hair loss; Myocardial
infarction; Overdose.

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