Q: MY HAIR has been falling out since I had a pacemaker fitted three years ago. I was taking bisoprolol tablets, which I know can cause hair loss, but changing to a different medicine hasn’t helped.
LK
A: I AM deeply sympathetic to your plight. The loss of hair like this is not only distressing, it’s also fraught with worry about how far it will progress and whether anything can be done to halt it. Many female patients with hair loss came to see me during my years as a GP and it pleases me to say that when medication is to blame, there is a solution.
While hair loss is often thought of as a male problem, around 70 per cent of women over 70 experience hair thinning and it is a problem I frequently encountered in my patients.
There are many causes, perhaps the most common being hormonal changes after childbirth and breastfeeding, or the onset of the menopause, but an adverse response to medication comes a close second.
Certain drugs interfere with the normal cycle of hair growth, during which each follicle goes through a phase of growth, followed by one of rest, and a final phase when hair from that follicle is shed.
The hair follicles across your scalp are naturally in different phases, ensuring hair stays thick and full. But certain drugs can synchronise the resting phases – something that leads to widespread hair loss.
The long list of medications that can trigger this includes statins, immunosuppressants, antidepressants, vitamin A-based acne treatments, blood-pressure-lowering drugs including beta-blockers and blood-thinning treatments.
Chemotherapy, is, of course, notorious and affects the follicles in a different manner, causing people to lose all or most of the hair on their head, as well as their eyebrows, eyelashes and other body hair.
Both the bisoprolol and nebivolol you’ve now been prescribed are beta-blockers for regulating the heart. Bisoprolol is reported to be associated with widespread hair loss but so far as I can gather nebivolol is not; however, it does belong to the same group of drugs, so must be regarded with suspicion.
In your longer letter, you explain you also take apixaban. This relatively new blood-thinning medicine prevents dangerous clots forming and is often prescribed when patients have an irregular heartbeat or, indeed, after a pacemaker is fitted to correct an irregular heartbeat.
The older type of anticoagulants, warfarin and heparin, are both associated with hair loss and so, again, although there are no reports as yet incriminating apixaban, it may well be a factor here.
You also said you are being treated for an underactive thyroid. The thyroid gland produces hormones that help regulate metabolism and hair loss can be a sign that levels are too low. I suggest you ask your GP for a blood test to check if your thyroid medication needs to be increased.
When at the surgery, you should enquire whether the drug minoxidil could be used to treat your hair loss. Known also by the brand name Regaine, it is a liquid or foam that is rubbed into the scalp once a day, to increase blood supply to the scalp and stimulate the follicles.
Minoxidil is available without prescription. However, it lowers blood pressure and given your heart condition, it is important you speak to your GP before using it.
If given the go-ahead for minoxidil, I suggest you combine it with a supplement containing vitamins C, B12 and B7 and iron, selenium, and lysine — all key to healthy follicles.
It will take at least three months before you notice a difference but, hearteningly, after six to 12 months, your hair could well be back to its usual thickness. In the meantime, I urge you not to be drawn into buying exotic shampoos which are of little value, despite their expense, and don’t be tempted to stop taking any of your prescribed medications.
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