Common Medications that Cause Hair Loss – Part 1

How often is hair loss a side effect of common medicines? A numeric value is actually pretty hard to track down. The reason it is so hard to find is that the people who are responsible for tracking side effects of medications usually worry about and record the most life-threatening and severe side effects. Hair loss, while it can be personally devastating and life changing for an individual is not considered a severe enough side effect to warrant an intricate warning system the way heart failure, liver damage or blindness would. While we can all agree that hair loss is not as severe a side effect as these other clinical problems may be it would be ignorant of anyone to say hair loss does not matter. Hair loss is a life altering experience to those who have to live with it and those who must cope with a bald head.

Unfortunately many very common medications have been shown to cause hair loss. And worse news is that some of these medications can be absolutely critical to maintaining good health. Knowing which medications can lead to hair loss is a first step, but do not stop taking your medications without first consulting your doctor. Some of the medications below, like warfarin, are used to prevent serious complications of illnesses like strokes and heart attacks. So be cautious when evaluating your hair loss and seek expert medical opinion before you stop potentially life-saving medicine.

Aspirin

Aspirin is widely known as a blood thinner but it actually makes blood less sticky rather than thinning it out. It directly alters the way platelets stick together making your blood less likely to clot. It is a very good medicine for preventing strokes and heart attacks; it is cheap, and relatively safe. It can cause some life threatening side effects like GI bleeds, but it is also a well-known cause of baldness and hair loss (Blann, 2002). The way this occurs is not clear, but aspirin has been associated with hair loss for many years. The good news is that aspirin is one of many drugs that thin the blood and as such there may be a different medicine you can take if you began suffering from hair loss after starting aspirin. In cases where aspirin is the cause of hair loss, stopping the medicine will actually stop your hair loss.

Allopurinol

This is a very old medication that is very good at treating gout. Gout if a very painful inflammatory arthritis, but luckily it is very responsive to allopurinol. Allopurinol works so well in treating gout that if you have this disease the changes that you are on this medicine is very high. It is a first choice medication for treating gout. Unfortunately allopurinol is also a well-known cause of hair loss. There is a severe reaction to this medication known as allopurinol sensitivity syndrome that causes quick and severe hair loss, very significant rash and renal failure (Singer, 1986). A more mild form of reaction to this medication may just be increasing hair loss and decreased regrowth of hair. This will show up as progressive balding and hair thinning. Allopurinol shouldn’t be stopped without discussing with your doctor, gout is a very painful condition and you do not want to have flair up, but there are other options for gout and if you are experiencing hair loss from allopurinol you should ask your doctor about changing to a different medication to treat the gout.

Carbamazepine

Carbamazepine is sold under the name tegretol. It is a medicine used for epilepsy, headaches, migraines, neuropathies and trigeminal neuralgia. In some places it is also used as a mood stabilizer in psychiatric disorders, although this would be an uncommon use in the United States. Carbamazepine is a very good drug for treating seizures and is a first line drug for treating trigeminal and hypoglossal neuralgia. In many cases of seizure onset after a traumatic head injury or a stroke the patient will be put on carbamazepine as a first attempt at controlling the seizures. As such, carbamazepine is a very commonly used drug. It can also lead to hair loss and the hair loss associated with this medicine can be profound (Ikeda, 1997). As with the other medications it is a bad idea to stop taking carbamazepine without first notifying your doctor. Suddenly topping this medication can cause you to go into status epilepticus a very dangerous and hard to control seizure syndrome. The good news is that the hair loss associated with carbamazepine is reversible if the medication is stopped, and better news is that there are many other good alternatives to carbamazepine if you are having side effects from this medication (Shuper, 1985). If you have begun carbamazepine and began no notice hair loss and baldness, speak to your doctor about other alternative medicines. Many are available and one may be the better choice for you.

Warfarin

Warfarin is a blood thinner but it works much differently that aspirin. While aspirin prevents platelets from sticking to one another and forming clots warfarin interferes with the metabolism and production of certain enzymes and proteins that are important in activating the clotting cascade. Without these proteins your blood has difficulty activating the clotting mechanism. This is a lifesaving medicine and is excellent when used appropriately. Warfarin is used to prevent strokes, to treat blood clots in the legs or lungs, and also to prevent people with genetic predisposition to forming clots from being devastated by their illness. Unfortunately, as the article titles suggests, this medicine also has been associated with hair loss (Umlas, 1988). In the past there were no other suitable options for a blood thinner as potent as warfarin, but in just the last few months a new medication has been approved to prevent blood clots and it is considered safer than warfarin and a good alternative in people who cannot take this medication (Schulman, 2009). This new medication is dabigatran, also known as Pradaxa in the United States. If you are suffering from hair loss that started after starting on warfarin you should speak to your physician about possibly changing your medications to this newer drug. You should be warned though that dabigatran is a brand new medicine and in all likelihood it has side effects we have not fully recognized yet, these side effects may include hair loss. But as of now, it is considered a safe alternative to warfarin and is not recognized as a cause of baldness.

Unfortunately the sheer number of medications that cause hair loss would be too overwhelming to document in a few online articles, but the key points to understand form this article and the ones following it about medications that cause hair loss is that there are often alternative options to the primary medicine. If you believe your hair loss is from your medication do not hesitate to ask your doctor about other options. but also remember never to stop your medicine without first consulting with your doctor, the effects of suddenly stopping an important medicine can be devastating. While it is reasonable to be concerned about your hair you should not forget your health nor should you make rash decisions when it comes to critical medications like those mentioned above.

Medical references:
1. Blann AD , Landray MJ, and Lip G “ABC of antithrombotic therapy: An overview of antithrombotic therapy” BMJ. 2002 October 5; 325(7367): 762–765.

2. Singer, J. Z. and Wallace, S. L. “The allopurinol hypersensitivity syndrome. Unnecessary morbidity and mortality. Arthritis & Rheumatism” (1986), 29: 82–87
3. Ikeda A, Shibasaki H, Hibasaki A Shiozaki A, & Kimura J “Alopecia with carbamazepine in two patients with focal seizures” J Neurol Neurosurg Psychiatry. 1997 October; 63(4): 549–550.

4. Shuper A, Stahl B, Weitz R. “Carbamazepine-induced hair loss.” Drug Intell Clin Pharm. 1985 Dec;19(12):924-5.

5. Umlas J, Harken DE. “Warfarin-induced alopecia.” Cutis. 1988 Jul;42(1):63-4.

6. S Schulman, C Kearon, AK Kakkar et al “Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolis” NEJM 2009; 361:2342-2352