Ingestion of minoxidil associated with elevated transaminases in the absence of ischemic hepatitis

Submitted: 2 June 2023
Accepted: 8 August 2023
Published: 5 September 2023
Abstract Views: 736
PDF: 109
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Minoxidil is a direct-acting vasodilator that induces relaxation of the vascular endothelium, and historically, it has been used as an antihypertensive agent. It caused hypertrichosis, resulting in its typical use today as an alopecia treatment. Toxicity is characterized by hypotension and tachycardia, often requiring treatment with α-adrenergic agonists. A previously healthy 18-year-old woman presented to the emergency department three hours after ingesting 60 mL of 5% W/V topical minoxidil solution. Initial vitals included sinus tachycardia at 117 beats per minute and a blood pressure of 92/44 mmHg. Laboratory analyses performed three hours post-ingestion revealed elevated aspartate and alanine aminotransferases (224 and 384 IU/L, respectively). Acetaminophen and ethanol concentrations were undetectable. Isotonic crystalloid, N-acetylcysteine, phenylephrine, and midodrine were administered. She developed pulmonary edema, requiring diuresis and supplemental oxygen via a nasal cannula. She was discharged 108 hours post-ingestion after a full recovery. Minoxidil toxicity may be an uncommon etiology of abnormal transaminase concentrations.



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Campese VM. Minoxidil: a review of its pharmacological properties and therapeutic use. Drugs 1981;22:257-78. DOI:
Farrell SE, Epstein SK. Overdose of Rogaine extra strength for men topical minoxidil preparation. J Toxicol Clin Toxicol 1999;37:781-3. DOI:
Garrard A, Wood A, Sollee D, Aaronson P. Refractory hypotension due to Rogaine® (minoxidil) ingestion managed with midodrine. Clin Toxicol 2011;49:907-9. DOI:
Chakar B, Salter M, Roberts DM. Minoxidil overdose with hypotension effectively managed with norepinephrine, rather than dopamine. Clin Toxicol 2023;61:133-4. DOI:
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;7:210-2. DOI:
Kikuchi S, Fujita Y, Onodora M, et al. Prolonged hypotension induced by ingesting a topical minoxidil solution: analysis of minoxidil and its metabolites. Acute Med Surg 2016;3:384-7. DOI:
Gibson PR, Dudly FJ. Ischemic hepatitis: clinical features, diagnosis and prognosis. Aust N Z J Med 1984;14:822-5. DOI:
Colamarino R, Dubost JJ, Sauvezie P. Polymyalgia and minoxidil. Ann Intern Med 1990;113:256-7. DOI:
Roblin X, Blais J, Boisson C, et al. Increase of aminotransferase levels during percutaneous minoxidil therapy. Gastroenterol Clin Biol 1994;18:1146-7. [Article in French].
Roberts DW, Lee WM, Hinson JA, et al. An immunoassay to rapidly measure acetaminophen protein adducts accurately identifies patients with acute liver injury or failure. Clin Gastroenterol Hepatol 2017;15:555-62.e.3. DOI:

How to Cite

Shanahan, E., Mitchell, C., Chen, R., & Walsh, S. (2023). Ingestion of minoxidil associated with elevated transaminases in the absence of ischemic hepatitis. Translational Medicine Reports, 6(1).