Document Type

Conference Proceeding

Publication Date


Publication Title

J Gen Intern Med


CASE: 54 year old female with history of hepatic hemangioma, migraines and recently diagnosed alopecia presented to clinic with bilateral upper and lower extremity swelling. She was seen by Dermatology one month prior to presentation and was started on oral Minoxidil 1.25 mg daily for her alopecia. Since then, she has noticed rapid weight gain of 20 pounds over one month, increased peripheral swelling bilaterally with associated leg pain. She has also had intermittent headaches that are different than her usual migraines. She denied chest pain, shortness of breath, palpitations. BNP was mildly elevated. Other lab work including TSH, urinalysis and liver profile was unremarkable. Imaging including CT head, CT PE, lower extremity dopplers, and echocardiogram were also unremarkable. She was trialed with a loop diuretic without improvement in symptoms despite sufficient urine output. Minoxidil was held and her symptoms improved significantly. IMPACT/DISCUSSION: Lower extremity edema is a common complaint that can have profound clinical impact on a patient. A chronic presentation is typically more common in the outpatient setting and is often the result of venous insufficiency. Less common is an acute to subacute presentation of which the most common etiologies typically include acute heart failure exacerbation, acute nephrotic syndrome, and bilateral deep vein thrombosis. Newly initiated medications should always be considered as a cause with dihydropyridine calcium channel blockers being the most commonly seen culprit. Side effects are often seen with a dose dependent relationship. Minoxidil produces vasodilation mediated by cyclic AMP, primarily effecting arteriolar smooth muscle. Although Minoxidil is indicated for use in hypertension, it is more commonly used for dermatological conditions such as androgenetic alopecia. Topical minoxidil is the most frequent formulation but oral minoxidil can also be used. Side effects are minimal but the most common include hypotension, headaches, and hypertrichosis. Peripheral edema is rare, particularly with low doses but is reversible with discontinuation and can be further aided by concurrent diuretic use. CONCLUSION: Rapid onset peripheral edema is often related to acute heart failure, nephrotic syndrome or DVT. Although life-threatening causes should be quickly ruled out, a clinician should also consider medication side effects that could be contributing. Oral minoxidil is less frequently used than topical but significant side effects such as headaches, hypertrichosis, hypotension, and more rarely peripheral edema can occur. Discontinuation reverses the peripheral edema and a low dose loop diuretic can provide additional benefit.




Suppl 3

First Page