Modern medicine has developed effective treatments for more ailments in the last few decades than the physicians did for centuries prior. We're in the age of great medicine.
Unfortunately, many medications have adverse side effects, hair loss among them. This is typically caused when a medication interrupts the growth cycle of hair follicles.
Telogen effluvium and anagen effluvium are the two most common types of hair loss caused by medications. Telogen effluvium occurs when hair follicles prematurely enter a “resting” phase and is the more frequent kind of hair loss caused by medications. It generally starts within two to three months of a new medication starting.
Anagen effluvium is less likely and often occurs in patients undergoing chemotherapy. When matrix cells are unable to divide as usual, hair growth can’t continue as normal either. It can cause severe hair loss and can include the loss of all hair on the body, including eyelashes and eyebrows. Anagen effluvium hair loss typically begins soon after the introduction of a new medication, sometimes in as little as a few days’ time.
If you've wondered which medications can cause hair loss as a side effect, below is a list of both over-the-counter and prescription medications that have been associated with hair loss, patchiness, and hair thinning.
Antibiotics are typically taken for short periods of time, generally no more than two weeks. Many of these can cause short-term hair loss or thinning while they’re in use though. Commonly used antibiotics such as penicillin and cephalexin have been shown to cause some hair loss in certain people.
Depakote (valproic acid) and Tridione (trimethadione) are both medications prescribed for the prevention of seizures that have been linked to hair loss in some patients.
Some prescription medications used to treat depression and mood disorders may cause hair thinning. These include Vivactil (protriptyline), Prozac (fluoxetine), Elavil (amitriptyline), Zoloft (sertraline) and Paxil (paroxetine hydrochloride). Research shows, though, that bupropion is the most likely antidepressant to cause hair loss. Its brand names include Contrave, Wellbutrin, Forfivo and Zyban.
Medicines used to fight fungal infections have been shown to cause hair loss in some patients. Voriconazole in particular has been linked to alopecia.
Some anticoagulants prescribed to help prevent blood clots have been associated with patterns of hair loss. Heparin and warfarin have both been connected to patients developing alopecia after extended use.
Hair growth occurs in phases. Because of the way that birth control manipulates hormones to prevent pregnancy, hormonal birth control prescriptions can cause hair loss as the hair is put into its resting phase early and stays in it for quite some time. This isn’t limited to birth control pills but also includes other hormone-related medications such as Depo-Provera and hormone injections, Xulane and other skin patches, Nexplanon and other progestin implants, and NuvaRing and other vaginal rings.
Some forms of birth control are low-androgen and may result in less hair loss than high-androgen birth control options. These include:
- Ortho Tri-Cyclen and Ortho-Cyclen (norgestimate-Ethinyl estradiol)
- Ortho Micronor, Lyza, Nor-QD and Aygestin (norethindrone)
- Ortho-Novum 7/7/7, Tri-Norinyl, Modicon, Ovcon-35 and Brevicon (norethindrone-Ethinyl estradiol)
- Desogen and Reclipsen (desogestrel-ethinyl estradiol)
Blood Pressure Medications
Many beta-blockers prescribed to treat high blood pressure and other heart conditions have been shown to result in hair loss for some patients. These include Blocadren (timolol), Inderal and Inderal LA (propranolol), Lopressor (metoprolol), Corgard (nadolol) and Tenormin (atenolol).
ACE inhibitors likewise can cause hair loss. Common prescriptions with this side effect include Zestril and Prinivil (lisinopril), Capoten (captopril) and Vasotec (enalapril).
Chemotherapy has long been linked to hair loss. Studies show that nearly two-thirds of all patients who undergo chemotherapy experience hair loss. This is because the nature of chemotherapy is to disrupt cell growth. Though cancer cells often respond to this in the desired way, healthy cells are also affected, which can result in hair growth ceasing and hair falling out.
Some types of chemotherapy medication are more likely to cause extensive hair loss than others. Examples of these are:
- Alkylating agents – Ifex (ifosfamide), Busulfex or Myleran (busulphan), Neosar or Cytoxan (cyclophosphamide), Thioplex (thiotepa)
- Antimetabolites – Gemzar (gemcitabine), Efudex (fluorouracil)
- Antimicrotubular agents – Alcrest or Navelbine (vinorelbine), Ellence (epirubicin), Ixempra (ixabepilone), Vincasar or Marqibo (vincristine), Taxol (paclitaxel), Taxotere (docetaxel)
- Antitumor antibiotics – Doxin or Adriamycin (doxorubicin), Cosmegen (dactinomycin), Idamycin (idarubicin)
- Topoisomerase inhibitors – Camptosar (irinotecan), VePesid (etoposide)
Other types of chemotherapy may still result in hair loss but to a lesser degree. These include:
- Alkylating agents – Hexalen (altretamine)
- Antimetabolites – Otresxup, Resuvo (methotrexate), Trexall
- Antitumor antibiotics – Mutamicin (mitomycin C), Bloe 15k (bleomycin)
- Oral cyclophosphamide
- Platinums – Eloxatin (oxaliplatin), Paraplatin (carboplatin), Platinol (cisplatin)
- Topoisomerase inhibitors – Potactasol or Hycamtin (topotecan), Novantrone (mitoxantrone)
Non-Chemo Cancer Therapies
Some modern treatments for cancer do not have the same devastating hair loss that many chemotherapy treatments do but still can result in some minor hair loss.
Hormonal therapies that are often used to treat breast cancer have been linked to thinning hair in patients. These include Faslodex (fulvestrant), Octreotide (Sandostatin), Tamoxifen and some aromatase inhibitors, particularly Femara (letrozole) and Arimidex (anastrozole).
Other targeted therapies are associated with hair loss. Examples of these are:
- Bcr/Abl inhibitors – Gleevec (imatinib) and Tasigna (nilotinib)
- BRAF inhibitors – Tafinlar (dabrafenib) and Zelboraf (vemurafenib)
- Cyclin-dependent kinase inhibitors – Kisqali (ribociclib), Ibrance (Palbociclib), and Verzenio (abemaciclib)
- VEGF inhibitors – Nexavar (sorafenib)
Cholesterol-lowering drugs Lipitor (atorvastatin) and Zocor (simvastatin) have led to hair loss in some patients. It’s unclear why exactly this happens, but Harvard reports that it may be due to the role that cholesterol plays in the steroid hormones that are important to hair growth.
Hormone Replacement Therapies
Hormone replacement therapies are often used for women who have had full hysterectomies or are post-menopausal. Women are prescribed hormones to make up for the loss of estrogen to help regulate the body. Like birth control, hormone replacement therapies can cause hair loss in women by disrupting the natural cycle of hair growth.
Testosterone replacement therapies typically used to treat low levels of testosterone have been linked to hair loss, as well. Finally, the use of anabolic steroids for muscle-building likewise can cause hair loss due to the production of dihydrotestosterone at higher levels.
Medications used to treat autoimmune conditions such as rheumatoid arthritis have been shown to have the adverse side effect of hair loss. Some that have been proven include Arava (leflunomide), Enbrel (etanercept) and Cytoxan (cyclophosphamide).
Some prescriptions used to treat gout, such as Zyloprim and Lopurin (allopurinol), have been linked to hair loss in some patients.
Although Vitamin A is important to hair growth, too much of it can have an adverse effect and cause hair to cease growing and fall out.
Accutane (isotretinoin) and Retin-A (tretinoin) are both acne medications that are derived from vitamin A that are used to help reduce the production of sebum. Because sebum is important to maintaining healthy hair and the hair growth cycle, its suppression can sometimes result in hair loss.
It’s important to follow the directions of your physician and take your medications as prescribed or directed.
If you believe your medication is causing hair loss and would like to explore ways to combat that loss, and possibly even regrow hair, Shapiro MD may be able to help. Get started with out free hair quiz tro find the right system for you.