KnowledgeDose List of Drugs Causing Alopecia

Table of Contents

1. Introduction

2. Drug-induced anagen effluvium

3. Drug-induced telogen effluvium

4. Table: Some drugs that may cause hair loss

Introduction

Some drugs may cause hair loss by interfering with the cycle of hair growth.

Each hair follicle cycles through the following main phases:

Anagen phase (hair is actively growing),
Catagen phase (a transitional phase), and
Telogen phase (the resting phase, followed by shedding of hair).

Diagram of hair growth cycle showing three phases: anagen, catagen and telogen

The two types of hair loss attributable to a drug are anagen effluvium and telogen effluvium. Fortunately, these types of drug-induced alopecias are generally reversible once the offending drug is stopped in the patient.

Drug-induced anagen effluvium

Some drugs may interrupt the anagen phase (when the hair is actively growing) of the cycle of hair growth and thereby cause the loss of hair.
It is most commonly associated with cytotoxic drugs.
Anagen effluvium is a form of non-scarring alopecia.
Hair loss begins soon after the drug is administered.
In most cases, hair loss is reversible once drug treatment is stopped, but it can take a few weeks for regrowth to begin.

Drug-induced telogen effluvium

Some drugs may interfere with the telogen phase (shedding of the hair) of the cycle of hair growth and thus cause more hairs than normal to be shed; this results in thinning of the hair.
Some drugs that have been implicated in drug-induced telogen effluvium are isotretinoin and statins.
Hair loss occurs 2-4 months after initiation of the drug causing alopecia.
Telogen effluvium is a form of non-scarring alopecia with diffuse hair loss.
Telogen effluvium may not be noticed by the patient immediately.
In most cases, hair loss is reversible once drug treatment is stopped and resolves spontaneously.

Table: Drugs causing alopecia

Here is a list of some drugs that may cause drug-induced alopecia.

Table: Some drugs that may cause hair loss

Drugs that may cause hair loss
Antiepileptics e.g. levetiracetam, oxcarbazepine, sodium valproate
Antivirals e.g. didanosine, lamivudine, saquinavir, cidofovir, entecavir
Antiarrhythmics e.g. flecainide
Anticoagulants e.g. warfarin, acenocoumarol, heparin
Antipsychotics e.g. olanzapine, risperidone, lithium
Antidepressants e.g. citalopram, fluoxetine, sertraline
Antifungals e.g. itraconazole, ketoconazole, voriconazole
Antimalarials e.g. mefloquine
Antithyroid drugs e.g. carbimazole, propylthiouracil
Aromatase inhibitors e.g. anastrozole, exemestane
Beta-blockers
Cytotoxic drugs
Disease-modifying anti-rheumatic drugs e.g. leflunomide, hydroxychloroquine sulfate, sodium aurothiomalate
Excess vitamin a
Fibrates e.g. bezafibrate, ciprofibrate
Immunosuppressants e.g. mycophenolate mofetil, tacrolimus
Interferons e.g. interferon beta, peginterferon alfa
Oral contraceptives
Retinoids e.g. acitretin, isotretinoin, alitretinoin
Anti-estrogens e.g. Tamoxifen
Statins e.g. atorvastatin, pravastatin, simvastatin
Betaine
Bicalutamide
Exenatide
Stontium ranelate
Mexiletine
Bromocriptine
Levodopa

Source: References 1-31

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