Hair is an important factor in preserving body image and self-confidence, so it's no surprise that hair loss is commonly accompanied by psychological distress. Unfortunately, hair loss is a common health concern – age-related hair loss alone affects 53% of men and 37% of women over the age of 65. Because so many factors can contribute to hair loss, effective treatment relies on getting to its root cause.
Besides age, medications are a common reason that individuals may experience hair loss. In this article, we'll discuss five commonly prescribed medications, why they cause hair loss, and what can be done to treat it.
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Understanding Medication-Induced Hair Loss
Before discussing the types of drug-induced hair loss, it's helpful to review the three main stages of the hair growth cycle:
- Anagen: Active growth phase
- Catagen: Transitional phase
- Telogen: Resting (shedding) phase
With this in mind, the two most common types of drug-induced hair loss are:
- Telogen effluvium is a type of temporary, nonscarring hair loss that develops as a response to a stressor, including medication use. Medications can push hair follicles prematurely into the telogen phase of the hair growth cycle, causing diffuse hair shedding approximately three months after starting a new medication.
- Anagen effluvium is another type of temporary hair loss that is most commonly associated with chemotherapy. Anagen effluvium occurs when a medication halts hair follicle growth during the anagen phase, causing hair loss within a few weeks of starting a medication.
5 Medications That Can Cause Hair Loss
There are many reasons for hair loss, including genetics, nutrient deficiencies, aging, and hormonal changes. Medications can also cause hair loss. Let's examine some of the most common medications responsible for hair loss.
1. Chemotherapy Drugs
Chemotherapy agents are used to treat cancer by killing rapidly dividing cells.
How Do They Cause Hair Loss?
As chemotherapy circulates throughout the body, it affects rapidly dividing cells indiscriminately, including cancer cells and healthy cells with high turnover rates (such as those in hair follicles). This damages the hair follicle, leading to hair loss (including facial hair, eyebrows, and eyelashes) in approximately 65% of patients. (28)
How to Manage This Effect
Scalp cooling is FDA-approved for the prevention of chemotherapy-induced hair loss. Scalp-cooling devices reduce blood flow to the hair follicles, thereby reducing these cells' uptake of chemotherapy drugs. Scalp-cooling devices may prevent hair loss by 50-80%. (22)
Hair loss due to chemotherapy is temporary. Once treatment is completed, hair typically begins to grow back, although the regrowth may differ in texture or color (28). Minoxidil and bimatoprost are medications that can be applied topically to the scalp after chemotherapy is complete to encourage hair growth (22).
2. Beta-Blockers
Beta-blockers are medications that block the effects of adrenaline on the heart, reducing heart rate and blood pressure. They are commonly prescribed to patients with high blood pressure, heart failure, chest pain (angina), and irregular heart rhythms (arrhythmias). Beta-blockers are sometimes used to manage symptoms of anxiety. (6)
How Do They Cause Hair Loss?
Beta-blockers are one of the medications linked to telogen effluvium by having a direct toxic effect on the hair follicles.
Commonly prescribed beta-blockers include:
- Propranolol
- Atenolol
- Metoprolol
How to Manage This Effect
When possible, your doctor may lower the dose or prescribe an alternative medication with similar actions, such as calcium channel blockers. You should never modify or discontinue a beta-blocker without the guidance of your doctor.
3. Anticoagulants (Blood Thinners)
Anticoagulants, also called blood thinners, are medications that prevent blood clot formation. They are commonly prescribed to patients at risk of clot-related conditions such as deep vein thrombosis, pulmonary embolism, stroke, and atrial fibrillation or those who have undergone certain surgeries. (4)
How Do They Cause Hair Loss?
Hair loss can appear anywhere from weeks to years after starting an anticoagulant medication. The exact cause for hair loss associated with these medications is unknown. (27)
Anticoagulants associated with hair loss include (27):
- Heparin
- Warfarin
- Apixaban
- Rivaroxaban
- Dabigatran
How to Manage This Effect
Hair loss due to anticoagulants may take time to develop; staying attentive to changes in hair texture, thickness, or shedding can help catch any issues early on.
The duration of anticoagulant therapy depends on the purpose for which it is being used. For patients on a short-term course, hair loss is reversible once active treatment with the blood thinner is discontinued (27).
Patients requiring longer-term anticoagulant therapy can discuss with their doctors the possibility of switching to a different type of blood thinner. Given the risk of blood clots, patients should never modify or discontinue their anticoagulant on their own.
4. Retinoids
Retinoids are a class of medications derived from vitamin A that are used to treat a variety of skin conditions, such as acne and psoriasis.
How Do They Cause Hair Loss?
Excess vitamin A can disrupt the normal functioning of hair follicle stem cells. Consequently, more hair follicles enter the telogen phase of the hair growth cycle prematurely, resulting in increased hair shedding.
Isotretinoin (Accutane) is a common retinoid medication used to treat acne. According to the American Osteopathic College of Dermatology, 10% of people who take oral isotretinoin will experience temporary hair thinning.
How to Manage This Effect
Hair loss associated with oral retinoid use appears to be dose-related, in which higher doses are more likely to cause adverse effects. Therefore, doctors may reduce the dose to minimize hair loss while using retinoids.
Hair loss is usually reversible after the treatment course has been completed. Oral retinoids are often prescribed for 15-20 weeks.
While they can effectively treat various skin disorders, retinoids often do not address the root cause of dermatologic conditions. A holistic approach to dermatology identifies and corrects the root causes of symptoms, including intestinal dysbiosis, hormonal imbalances, nutritional inadequacies, and stress. Such an approach can lead to improved clinical outcomes without the reliance on medications with unwanted side effects.
5. Antidepressants
Antidepressant medications are prescribed to treat depression, anxiety disorders, and other mental health conditions. They work by altering brain chemistry. For example, selective serotonin reuptake inhibitors (SSRIs) increase serotonin levels in the brain. (19)
How Do They Cause Hair Loss?
Psychotropic drugs, including antidepressants, may influence hair growth, structure, and color by affecting the telogen phase of the hair growth cycle. The exact mechanism behind these side effects is poorly understood. Drug-induced hair loss caused by antidepressants usually occurs within the first three months of treatment. (13)
A research review comparing antidepressant-associated hair loss found that bupropion had the highest associated risk of hair loss compared to other antidepressant medications, including:
- SSRIs: fluvoxamine, fluoxetine, paroxetine
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): duloxetine, venlafaxine
How to Manage This Effect
Discontinuation or a dose reduction of an antidepressant usually results in the complete reversal of hair loss and hair growth. Because not all antidepressants have the same risk for hair loss, your doctor may prescribe an alternative medication. Due to the potential for adverse effects, you should never stop or modify the dose of your antidepressant without the guidance of your doctor.
In addition to pharmacotherapy, evidence-based complementary and integrative medicine modalities can effectively treat depression and anxiety disorders. Using adjunctive therapies, such as psychotherapy, botanical medicine, mind-body medicine, and acupuncture, can improve mental health and reduce the need for medications.
Prevention and Treatment of Medication-Induced Hair Loss
Patients should discuss drug-induced hair loss with their doctors, who can recommend safely switching to an alternative treatment option to stop hair loss. Once a person stops taking the medication that caused hair loss, new hair growth usually begins within 3-6 months. (10)
In cases where discontinuing the provoking medication is not an option, your doctor may be able to recommend therapies to support hair growth. Topical minoxidil (Rogaine), laser caps/combs, and scalp microneedling are therapies that can promote hair growth.
Other factors may be at play that increase the risk of hair loss. Addressing these factors can help prevent the risk of drug-induced hair loss. General tips for supporting healthy hair include:
- Eat a healthy diet with foods rich in nutrients for hair health, such as healthy proteins, B vitamins, iron, and zinc.
- Avoid harsh hair treatments (e.g., heating, curling, dying) and tight hairstyles (e.g., ponytails, buns, cornrows) that can damage hair and create excessive tension on the hair follicles (12).
- Manage stress to prevent stress-induced hair loss
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Key Takeaways
- Many medications can cause hair loss, including chemotherapy, beta-blockers, anticoagulants, oral retinoids, and antidepressants.
- Drug-induced hair loss is usually temporary, and hair will regrow once the medication is stopped. However, stopping a medication isn't always an option.
- Patients should always discuss concerns about drug-related hair loss with their doctors. They may be able to recommend a treatment option to mitigate the side effect or change the inciting medication to an alternative that is less likely to cause hair loss.
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