To the Editor:
Early and effective treatment for androgenetic alopecia (AGA) is crucial to prevent long-term dermatologic and psychosocial consequences.1-3 With the release of and attention to the New York Times (NYT) article "An Old Medicine Grows New Hair for Pennies a Day, Doctors Say" on August 18, 2022,3 low-dose oral minoxidil (LDOM) drew heightened patient interest for the management of AGA, with 71% of dermatologists surveyed nationwide in one study claiming a sudden rise in medication inquiry, and prescription numbers surpassing 85% total increases since this NYT article was published.3,4 Given the increased demand for this off-label use, a potential for LDOM 2.5 mg shortages in recent months is plausible and could impact continuity of care. We sought to evaluate current inventories of varied dosages of oral minoxidil at mainstream pharmacies in surrounding neighborhoods of Washington, DC, Maryland, and northern Virginia.
Four retail chain pharmacies with approximately even distribution among suburban, urban, and rural towns in the DMV (District of Columbia, Maryland, and Virginia; Table 1) were selected, including CVS, Giant, Walgreens, and Harris Teeter. During the first week of October 2023, a total of 277 pharmacies were contacted by telephone using standardized scripts to assess the availability and quantity of oral minoxidil in stock for both 2.5-mg tablets and 10-mg tablets, with specific inquiry for a 30-day supply and 30 tablets of each dosing. Charting, calculations, and analysis of results were performed using Prism.
Twenty-three percent (33/143) of all northern Virginia pharmacies confirmed the availability of both oral minoxidil 2.5-mg and 10-mg tablets, with adequate inventories for 30-day supplies. Similar findings with limited reserves for both dosages were reported when calling Washington, DC (17.9%, 12/67) and Maryland (14.9%, 10/67) pharmacies. Only 40.1% (111/277) of all contacted pharmacies in the DMV reported availability of LDOM 2.5-mg tablets for a 30-day supply; 29.6% (82/277) of the very same DMV pharmacies reported having oral minoxidil 10-mg tablets to cover the same time frame. When stratified geographically, Maryland showed the greatest deficit in oral minoxidil availability: 28.3% (19/67) of the state’s pharmacies confirmed 30-day supplies of LDOM 2.5-mg tablets in stock and 22.3% (15/67) of the pharmacies noted having 30-day supplies of oral minoxidil 10-mg tablets. Northern Virginia and Washington, DC, pharmacies demonstrated similar inventory distributions of LDOM 2.5-mg tablets, with 44% (63/143) and 43.2% (29/67), respectively, having availability. The volume of oral minoxidil 10-mg tablets also lagged, with 32.2% (46/143) of northern Virginia pharmacies confirming sufficient supply for a 30-day prescription fill and 26.8% (18/67) of Washington, DC, pharmacies with analogous counts (Figure 1).
These data reveal a significant care gap resulting from oral minoxidil 2.5 mg and 10 mg shortages within the DMV, which could potentially translate to the national level. Such paucities pose a challenge for dermatologists managing AGA but also for primary care physicians using this medication on-label. This study underscores the need and opportunity for approaches
