Minoxidil / Ketoconazole / Latanoprost / Finasteride Lotion

Available Dosage Strengths

5% / 2% / 0.003% / 0.1%

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Minoxidil Ketoconazole Latanoprost Finasteride Lotion

Product Overview

Description

The drugs below have been combined together into a lotion to treat hair loss.^1-17

Minoxidil Description

Topical minoxidil is a vasodilatory compound originally developed as an oral antihypertensive agent. It was found to stimulate hair growth (from the observation of hypertrichosis (excessive, abnormal hair growth) in patients taking oral minoxidil) and was subsequently FDA approved for androgenetic alopecia (male and female pattern hair loss).³

Ketoconazole Description

Ketoconazole is a synthetic imidazole antifungal agent commonly used in topical and oral formulations. Topical ketoconazole has been used to promote hair growth, particularly in androgenetic alopecia (AGA) and seborrheic dermatitis-related hair loss. It is often compounded into shampoos, foams, or lotions either alone or in combination with minoxidil, finasteride, or other agents to enhance efficacy.

Latanoprost Description

Latanoprost is a prostaglandin F2α (PGF2α) analog primarily indicated for the treatment of open-angle glaucoma and ocular hypertension. There is evidence that the drug promotes hair growth, particularly in androgenetic alopecia (AGA) and eyelash/eyebrow hypotrichosis.^10-12Its role in hair regrowth was first noted due to its adverse effect of increased eyelash growth in glaucoma patients.

Finasteride Description

Finasteride, a 5-alpha reductase inhibitor, has been shown to benefit patients with symptomatic benign prostatic hyperplasia. Benign prostatic hyperplasia affects men over the age of 50 years old. Finasteride has also been shown to benefit androgenetic alopecia (male pattern baldness).

Mechanisms of Action

Mechanisms of Action^1-7,10-17

Minoxidil

The drug has many mechanisms in supporting hair growth:

Potassium channel opening: Minoxidil is a K⁺-ATP channel opener, resulting in vasodilation and enhanced blood flow to hair follicles.
Prolongation of the hair cycle: It extends the growth phase of the hair cycle, leading to increased follicle size and more robust hair shafts.
Activation of prostaglandins: May indirectly affect prostaglandin-mediated signaling to stimulate hair follicle activity.
Upregulation of vascular endothelial growth factor (VEGF): Promotes angiogenesis in dermal papillae, improving follicular nourishment.

Ketoconazole

Mechanism of Action (in Hair Loss)

Antifungal Action:

Inhibits ergosterol synthesis, a critical component of fungal cell membranes, effectively treating Malassezia spp. overgrowth often seen in seborrheic dermatitis, which is linked to scalp inflammation and hair loss.

Anti-Androgenic Activity (indirect):Though not a systemic anti-androgen, ketoconazole may locally inhibit 5α-reductase, reducing dihydrotestosterone (DHT) formation in the scalp—a key factor in androgenetic alopecia.

Anti-Inflammatory Properties:

Reduces local scalp inflammation, which is a contributing factor in various forms of alopecia, including telogen effluvium and AGA.

Cleansing and Scalp Health:

Improves overall scalp environment by reducing sebum, scaling, and microbial overgrowth, thus promoting a more favorable environment for follicular health.

Latanoprost:

Latanoprost binds to the prostaglandin F2α receptor on hair follicle dermal papilla cells, influencing the hair growth cycle as follows:

Prolongation of Anagen Phase (Growth Phase):

Increases the duration of anagen, resulting in longer and thicker hair shafts.

Stimulation of Melanogenesis:

May enhance pigmentation in vellus hairs, making them appear darker and more terminal-like.

Increased Follicular Density:

Some studies suggest latanoprost may increase the number of follicles actively producing hair, particularly in the eyelash and eyebrow regions, and potentially the scalp.

Finasteride

Finasteride is an analog of testosterone that acts as a competitive, specific inhibitor of type II 5-alpha-reductase, an intracellular enzyme that converts testosterone to the potent androgen 5-alpha-dihydrotestosterone. The type II 5-alpha-reductase isozyme is primarily found in prostate, seminal vesicles, epididymides, and hair follicles, as well as liver. Dihydrotestosterone has been shown to increase prostate growth and can lead to hair thinning. Finasteride has been shown to shrink the prostate to improve urinary flow and in the scalp lowers dihydrotestosterone to slow hair loss and promote regrowth.

Adverse Reactions

Adverse Reactions ^1-7,10-17

Minoxidil

Common

Topical minoxidil is generally well tolerated but may cause local effects:

Local side effects (most common):

Scalp irritation, dryness, flaking
Erythema or contact dermatitis (more common with propylene glycol-containing formulations)
Pruritus or burning sensation
Unwanted facial hair growth (esp. in women or if solution drips onto other areas)

Ketoconazole

Common

Local irritation (erythema, stinging, burning)
Dryness or increased oiliness of scalp
Hair texture changes (dryness or stiffness)
Allergic contact dermatitis (rare)

Latanoprost

Common

Local irritation (itching, burning, erythema)
Hyperpigmentation of skin (especially around eyelids or eyebrows)
Increased pigmentation of treated hair
Eyelid darkening (rare with scalp use)
Unwanted hair growth if medication spreads to unintended areas
Eye irritation (if it migrates to eye area)

Finasteride

Adverse Reactions (with systematic absorption)

Decreased libido
Erectile dysfunction
Ejaculatory disorders (e.g., reduced volume)
Breast tenderness or enlargement
Gynecomastia

Contraindications & Precautions

Contraindications & Precautions ^1-7,10-17

Minoxidil

Contraindications:

Known hypersensitivity to minoxidil or excipients (e.g., propylene glycol, alcohol)
Discontinuation advised if signs of hypersensitivity or severe irritation occur

Precautions:

Avoid use on broken or inflamed skin to minimize systemic absorption
Not for use in individuals under 18 years unless directed by a physician
Caution in patients with cardiovascular disease (though systemic absorption is typically minimal with proper use)
Avoid ocular contact — rinse thoroughly if accidental exposure occurs
Should not be used during pregnancy or lactation unless clinically indicated and under supervision

Ketoconazole

Contraindications:

Known hypersensitivity to ketoconazole or any excipients used in the compounded base
Active scalp infections not of fungal origin (e.g., bacterial folliculitis) unless co-treated appropriately

Precautions:

Use with caution in patients with open wounds or compromised skin integrity
Avoid eye exposure
Evaluate for signs of allergic contact dermatitis or worsening inflammation
Not recommended for use in children unless directed by a physician

Latanoprost

Contraindications:

Known hypersensitivity to latanoprost or prostaglandin analogs
Active ocular conditions if near eyes (without ophthalmologic approval)
History of herpetic keratitis (due to prostaglandin-induced reactivation risk)

Precautions:

Avoid application near the eyes unless specifically prescribed
Use gloves or applicator to prevent unintended hair growth on fingers/hands
Avoid contact with mucous membranes
Patients with a history of uveitis, macular edema, or intraocular surgery should be monitored if periorbital application is required

Finasteride

Contraindications & Precautions

Contraindications:

Contraindicated in women who are or may become pregnant due to risk of teratogenicity (can cause abnormalities in the external genitalia of male fetuses)
Hypersensitivity to finasteride or any component of the tablet

Precautions:

Finasteride lowers serum PSA levels by ~50% after 6 months, which can mask early detection of prostate cancer.
Use cautiously in patients with hepatic dysfunction. The drug is metabolized extensively in the liver.

Storage

Store in a cool, dry place, away from direct light and heat; Room temperature (20°C–25°C / 68°F–77°F) is ideal.

References

Clinical Pharmacology [Internet].: Elsevier; accessed May 2025; Minoxidil topical monograph. Available from: ClinicalKey; https://www.clinicalkey.com/pharmacology/monograph/408?n=Minoxidil
Rogaine® (minoxidil topical solution) package insert. Johnson & Johnson Consumer Inc. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=12fd18f0-859c-7b9a-e063-6394a90addbf&type=display Revised March 2024. Accessed June 16, 2025
Goren A, Naccarato T. Minoxidil in the treatment of androgenetic alopecia. Dermatol Ther. 2018 Sep;31(5):e12686.
Gupta, A.K., et al. (2003). The use of ketoconazole shampoo for the treatment and prophylaxis of dandruff and seborrheic dermatitis: A review. Journal of Cutaneous Medicine and Surgery, 7(1), 6–12.
Pierard-Franchimont, C., et al. (1998). Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology, 196(4), 474–477.
Cordero, A., et al. (2021). Update on the use of topical ketoconazole in the management of androgenetic alopecia. Journal of Cosmetic Dermatology, 20(8), 2443–2451.
Clinical Pharmacology Elsevier. Ketoconazole Monograph (Topical). Accessed 2025.
PubChem CID: 3823 – Ketoconazole structure and properties.
FDA Labeling (Nizoral Shampoo 2%) – Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019927s032lbl.pdf.

Revised October 2013, Accessed June 16, 2025

Johnstone, M. A. (1997). Hypertrichosis and increased pigmentation of eyelashes and adjacent hair in latanoprost therapy. American Journal of Ophthalmology, 120(7), 999–1001.
Blume-Peytavi, U., et al. (2012). Latanoprost stimulates human scalp hair growth in vivo. Journal of the American Academy of Dermatology, 66(5), 807–814.
Kwon, O. S., et al. (2007). Prostaglandin analogs as a potential treatment for hair loss: Latanoprost and bimatoprost in the management of alopecia. International Journal of Dermatology, 46(9), 1044–1048.
Clinical Pharmacology. Elsevier. Latanoprost Monograph. Accessed 2025
FDA Drug Label: Xalatan (latanoprost ophthalmic solution)
Finasteride (Proscar) package insert. Issued October 2010. Accessed June 5, 2025. accessdata.fda.gov/drugsatfda_docs/label/2010/020180s037lbl.pdf
Finasteride (Propecia) package insert. Revised March 2012. Accessed June 5, 2025. accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf.
Clinical Pharmacology finasteride clinical monograph 2025 https://www.clinicalkey.com/pharmacology/

Disclaimer

This sheet is a summary. It may not cover all possible drug information about this product. Call your doctor for medical advice and/or about side effects. You may report side effects to the FDA at 1-800-FDA-1088. A Wells Pharmacy Network pharmacist will be happy to answer any questions. For consultation, please call 1-800-622-4510.