Open AccessProlonged hypotension induced by ingesting a topical minoxidil solution: analysis of minoxidil and its metabolites
Author(s) -
Kikuchi Satoshi,
Fujita Yuji,
Onodera Makoto,
Fujino Yasuhisa,
Inoue Yoshihiro
Publication year - 2016
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.196
Subject(s) - minoxidil , medicine , ingestion , urine , anesthesia , pharmacology , chemistry
Case A 47‐year‐old man ingested 60 mL of a topical solution (3,000 mg minoxidil) and presented with prolonged hypotension. Treatment with dopamine hydrochloride and noradrenaline provided blood pressure control. Serum unchanged minoxidil concentrations at 4 and 16 h after ingestion were 4,994 and 33.9 ng/mL, respectively. Urine concentrations of unchanged minoxidil, minoxidil‐ O ‐glucuronide, and minoxidil‐ N ‐ O ‐sulfate at 16 h after ingestion were 360.4, 1,953, and 104.5 ng/mL, respectively. Outcome The serum unchanged minoxidil concentration rapidly decreased over a short interval. However, the patient needed to receive vasopressor support for the first 4 days after being admitted to the hospital. The urine minoxidil‐ O ‐glucuronide concentration was higher than the concentrations of unchanged minoxidil and minoxidil‐ N ‐ O ‐sulfate. Conclusion Although the serum concentration of unchanged minoxidil rapidly decreased, ingesting large amounts of a topical minoxidil solution can have serious and prolonged cardiovascular effects. Analyzing the minoxidil‐ O ‐glucuronide concentration in urine is useful for diagnosing minoxidil poisoning.