Hair loss and heart meds

by Carolyn Thomas      @HeartSisters

Did you know that most of us normally shed 50 to 100 hairs a day from our heads? According to Mayo Clinic experts, this usually doesn’t cause noticeable thinning of our scalp hair, however, because new hair is growing in at the same time. Hair loss actually occurs when this cycle of hair growth and shedding is disrupted for some reason. It’s thought to be related to one or more factors like family history, hormonal changes, medical conditions, or medications.

It was this last factor that caught my attention.  I read recently about a list of medications commonly prescribed to heart patients that may also be linked to the distressing side effect of hair loss – especially since I’ve been noticing with some alarm that my own hair seems to be thinning at a scary rate!

In general, any drugs we take can affect hair loss by interfering with the normal 3-phase cycle of hair growth:

  • during the anagen phase (lasts for around three to four years), the hair grows.
  • during the catagen (transitional) phase (lasts two to three weeks), the hair prepares for the telogen phase.
  • during the telogen phase (lasts about three months), the hair rests and older hairs are shed and replaced by newer hairs.

The reason that some meds may cause us to lose our hair is that they are toxic to hair follicles – the cells responsible for hair growth, says Dr. Sharon Orrange, a Clinical Associate Professor of Medicine at the University of Southern California, who listed a number of the drugs commonly associated with hair loss as a potential side effect. As she wrote in GoodRx:

“When hair follicles become damaged, the normal cycle of hair growth is disrupted, which eventually leads to hair loss. Hair loss typically begins after about 12 weeks of taking the new medication.”

Dr. Orrange calls the following heart medications the “common culprits” associated with hair loss:

1. Beta blockers: These are medications that reduce the workload of your heart and help to lower blood pressure. One of the side effects of taking beta blockers is hair loss, including these named drugs:

  • Atenolol (Tenormin)
  • Metoprolol (Lopressor)
  • Nadolol (Corgord)
  • Propranolol (Inderal, Inderal LA)
  • Timolol (Blocadren)

2. Statins for lowering cholesterol: Both atorvastatin (Lipitor) and simvastatin (Zocor) have reported hair loss as an adverse effect. The newer statin Crestor (rosuvastatin) has not.

3. Anticoagulants: Warfarin or Coumadin are commonly used blood thinners and may cause hair loss.

4. ACE Inhibitors:  Captopril and lisinopril are the two meds in this category that have reported hair loss in about 1% of people taking them.

5. Amiodarone: (Cordarone or Pacerone) are often prescribed to heart patients with arrhythmias like atrial fibrillation; it has a rare but reported side effect of hair loss.

6. Antidepressants: If you’ve been prescribed antidepressants to treat the commonly experienced situational depression associated with heart disease, you should be aware that certain medications used to treat depression and/or anxiety are also known to cause telogen effluvium, a hair loss condition that can affect the entire scalp, rather than just a specific area. These include Prozac, Haldol, Paxil, Zoloft, Elavil, for example.

And remember that many of us heart patients are taking more than one of the drugs on this list.

One of the other important conditions associated with hair loss is stress.

In telogen effluvium, for example, significant stress can push large numbers of our hair follicles into that resting phase.Within just a few months, affected hairs fall out suddenly when simply combing or washing our hair. 

So while we may be quick to blame our meds for thinning hair, we might also examine our recent levels of significant emotional stress, particularly during the past six weeks to three months before hair loss began.

My own first experience worrying that my hair might be thinning happened when I was only in my 30s.

My longtime friend, business partner and co-author Jill Stewart Bowen and I were on a road trip doing a book tour to launch the first of our two books together. After two radio interviews, two bookstore signings, and finally an evening reading event scheduled by our publisher for the first day, we checked into our hotel, happy but exhausted, to rest up for the next day featuring more of the same.

The next morning, I was in our hotel bathroom blow drying my freshly-showered hair when I noticed in the mirror something gleaming back at me.

It appeared to be my scalp!

“JILL!” I screamed. “Come here and look at this!” She rushed in to find me clawing through what remained of my once-normally full head of hair. Perhaps it was the much brighter lighting than I was used to in my own bathroom at home, but somehow I’d never noticed my white scalp before now. And so much of it! Trying to choke down my rising panic, I asked Jill:

“Do you think I’m losing my hair!?!”

Jill paused while carefully examining the cue ball that used to be my head.

“Well. It’s not thaaaat bad. . . ”

I instantly knew what that meant. It was bag-over-the-head time. How could I possibly show up for our scheduled television interview that morning with the studio lights bouncing off my shiny white scalp? How could I go out in public at all?

But this hadn’t just happened overnight. As I thought more about this upsetting turn of events, it struck me that I had been noticing more hair on my pillow lately, more hair caught in my hairbrush, and more hair circling the drain in the shower each morning for quite some time.

When we finished our book tour and returned home, I was referred by my GP to see a dermatologist, who reassured me that this was actually not serious, and quite likely mercifully temporary. This kind of hair loss, he added, is sometimes seen after significant stressors like childbirth, major surgery, or iron deficiency (the latter typically affects women far more than men due to menstruation, the most common cause of iron deficiency in women).  Temporary hair loss, he added, can also often be stress-related.

I had in fact been undergoing all kinds of stress during the past few months (a divorce, packing and moving to a new house, becoming a single parent – all coinciding with the recent publication of this new book which, although a happy event, involved an additional kind of new-to-us stress).

“Within three months, I’m guessing that you’ll feel better when you notice new hair growth!” the dermatologist predicted confidently. 

It turns out he was correct (although I suspected at the time that, since few things in life are more stressful for women than their hair falling out, the stress of hair loss now – albeit temporary – could begin another whole new phase of hair loss later!) 

No matter what the cause, it’s important that physicians must not dismiss or minimize the emotional impact of hair loss side effects on women.

Dr. Shani Francis is a fellow of the American Academy of Dermatology and director of the Hair Disorders Center of Excellence at Northshore University Health System near Chicago. She cites research that suggests hair loss can have a significant negative impact on a woman’s self-esteem, body image and self-confidence.

“Known psychosocial complications include depression, altered self-image and less frequent and enjoyable social engagement.”

“Hair loss in a woman is so emotionally devastating that it can trigger a wide range of social and emotional issues that can negatively impact healthy daily living and overall quality of life. I have heard of women who retreat from social situations, have diminished work performance, and even alter their healthy living – avoiding exercise, overeating, not treating other medical illnesses – all due to their hair loss.”

For older women, hair loss is perceived as accelerated aging, and women have to deal with a sense of lost sexual attraction to their mate as well. Due to societal perception differences, it is much more emotional for women, as there is limited cosmetic acceptance of a balding woman and increased societal pressure on a woman to be attractive.

“The negative quality of life is likely worse in women.”

.

A wee note to my male readers:  Yes, I’m aware, of course, that men too are often alarmed and upset when they start to lose their hair (typically seen as commonly-experienced male pattern baldness). The difference is that, as my girlfriends and I have often observed, there are few male heads out there that cannot actually be improved by going totally bald. As Dr. Francis observes, hair loss is emotionally devastating for women.

NOTE FROM CAROLYN:  My book “A Woman’s Guide to Living with Heart Disease” reads like a “best of Heart Sisters” blog collection. You can ask for it at your local bookshop or public library, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 20% off the list price).

Q: Have you ever experienced temporary hair loss as a side effect of medications?

25 thoughts on “Hair loss and heart meds

  1. Hello, I have had high blood pressure since I was in my 30’s. I tried for years to control it with diet and exercise. When this did not help my doctor put me on Bystolic which is a beta blocker. My hair would shed more than normal but just thought it was age. Now that I am in my 40’s I was told that the shedding was due to my hormones. I was started on HRT using pellets then changing to compounding hormones. This lasted a year and my hair was still falling out. So, the doctor told me it could be the blood pressure meds because the Bystolic is a beta blocker.

    About a month ago the doctor upped my HRT and changed my blood pressure meds to Amlodipine which is a calcium channel blocker. My head started to tingle and itch so bad and my hair starting to not just shed but fall out in clumps. I stopped the hormones because I thought were causing my hair to fall out. Well my head continued to tingle and itch so I figured out it had to be the new blood pressure medication. I have stopped it and no longer feel the tingling in my scalp.

    My hair is still shedding but not like it was. I have lost about half of the thickness of my hair. It falls out at the follicle and I can see the bulb on the end. It is so scary, depressing, and frustrating. Now I need to find something that works for my blood pressure. I am worried that my hair will never grow back.

    I believe the hair falling out has been a side effect to the blood pressure medications but the doctor does not want to believe me. Do you have any advice for me?

    Liked by 1 person

    1. Hello Misty – your story is a good example of how “emotionally devastating” hair loss can be, as Dr. Francis has written about. I’m not a physician so cannot comment specifically on your situation, but I can tell you generally that it seems you’ve already done some personal research (stop this drug, no difference; stop that drug, observe a difference…)

      My only concern is this: I’d like to see your own doctor in on these decisions to monitor these changes to ensure they are not hurting you longterm. There are some meds that can be dangerous to suddenly stop, for example. And as this post explains, there seems to be a 3-month lag time between the start of hair loss and the first sign of hair regrowth so it might also be that you’re in the earlier phase right now where the new hair has not yet grown in. If you haven’t already been referred to a dermatologist, you might want to ask your doc for a referral to discuss hair loss with a medical expert.

      Meanwhile, as you say, you DO need to find something that works for your blood pressure. This may be a good time to revisit the diet/exercise method. Even though you didn’t find it successful last time, it might work now. The DASH Diet, for instance, has been widely researched and consistently shows a remarkable drop in blood pressure even without any meds, particularly in the DASH low-sodium option. And losing ever 10% of your body weight has been shown to reduce BP in those who have that much weight to lose.

      My point: this distressing hair loss may be a unique motivator that you have never had quite like this before to look into non-drug BP-lowering meds. Good luck to you…

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  2. I noticed my hair loss last year. Am on 2 anti arrhythmias and Xarelto. I feel I will be bald next year. is there anything I can do to stop the hair loss?

    Liked by 1 person

    1. So upsetting, Nancy! If I were you, I’d see my doctor first to discuss possible alternatives to the meds you’re now taking (as the lists above suggest, some drugs carry the hair loss side effect, some don’t). And then I’d request a referral to a dermatologist to find out how you can stop (or at least slow down) the hair loss. Good luck to you…

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  3. Very informative information on drugs that cause hair loss. I am taking two of them and my hair is falling out since I’ve been on them. I’ve only taken them for 6 months and I will ask for different drugs that do not cause this.

    Liked by 1 person

    1. Hi Fran – have a talk with your physician about possible alternatives. In some cases, if there is no appropriate substitute, you may have to weigh pros and cons and make a difficult decision based on your cardiac risk factors.

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  4. Thank you for this article. Mine I believe is heart meds. But ive quit going anywhere. I’ve gained weight
    I hope there’s other medications I can take.

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    1. Hello Harriet – check with your doctor about possible meds alternatives. But isolation and weight gain can be just as serious a side effect as distressing hair loss, so talk to your doc about getting support for those issues too.

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  5. I had open heart surgery last fall. In early February, I experienced extreme hair loss. Talked to my doctor about it and he sent me to my cardiologist. She only answered my question about it when I refused to leave without an answer. She said no medication or surgery could affect my hair.

    But with insistence that something be done, she took me off metoprolol (beta blocker) and water pills. That’s been almost a month. Hair is still thin and any body or curls I had are gone. It’s super greasy all the time.

    Waiting for an appointment with dermatologist. I shouldn’t have had to insist on help. The rate of loss has dramatically slowed. Can’t style my hair yet as it won’t take.

    Liked by 1 person

    1. That is SO distressing, Joan! And also distressing that your cardiologist was so insistent that “no medication could affect your hair” (when even the drug manufacturers include that side effect on packaging). And it sounds like your hair is responding to the meds change.

      I really hope that you’ll soon regain your hair’s body and curls, but we know that sometimes sudden dramatic hair changes (for example, very common during pregnancy) don’t always go away completely. Hope your dermatologist’s appointment brings you some relief. Best of luck…

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  6. I remembered when I gave birth, they say I may experience hair loss. After a few months, here it comes. My hair keeps falling and I don’t know what should I feel. I’m worried that it might be serious. I do consultation from a doctor and she explained why I am experiencing it, and should not worry cause my hair is in the phase of shedding.

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  7. I suffered a heart attack six weeks ago and am recovering well. Unfortunately I have been noticing loads of hair loss when brushing and washing my hair, and even when I run my hands through my hair lightly. I am on several medications, as the ones mentioned in the article. I am desperate to know whether this is a temporary or permanent condition, especially as I shall be on some meds for the rest of my life? Or will this gradually slow down?

    Liked by 1 person

    1. Hello Gill – I’m not a physician so can’t comment on your specific situation, but I can tell you some very general info that I’ve learned.

      There appears to be a difference between hair loss caused by pattern (hereditary) baldness and hair loss caused by an external factor like a prescription drug reaction. Most sources say that the latter is usually temporary, and hair loss slows or ends over time, or when the drug is stopped/reduced in dosage. In drug-related hair loss (think of chemotherapy for example) hair loss is almost always considered a temporarary side effect).

      What does that mean for those of us who may be taking these drugs for a longer time – maybe forever? Tell your doctor about your distressing hair loss symptoms, and ask if there’s a possibility to reduce the dosage of some of your meds if they’re on this culprit list. This may NOT be possible in some cases (if you’ve had a stent, for example, it’s very important in preventing another serious blockage to stay on your anti-platelet drug eg Plavix for about one year). At the end of that period, you can revisit this issue if you’re still noticing hair loss.

      But with statins, it might be possible to switch types (from atorvastatin (Lipitor) which is linked to hair loss over to Crestor (rosuvastatin) which is not.

      You are in very early days yet at just six weeks post-heart attack so this seems particularly stressful right now. Many of the temporary hair loss issues seem to fade at around the 3-month mark. If your hair loss persists, ask your physician for a referral to a dermatologist for possible hair loss treatment options. Best of luck to you…

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  8. Has anyone noticed that their hair changed texture — from curly to straight, or straight to curly?

    For almost all of my life, I had very thick, frizzy curly hair that would go into little ringlets when it was wet. After the heart attack, and all the medication I began taking, I began seeing that the new growth at the roots was less curly. The new growth became increasingly straight, and as I had the curly ends trimmed off, my hair just became straighter and straighter. It does not curl at all anymore; it isn’t even wavy. Just straight and frizzy, impossible to style.

    I think I’ve lost a little hair, but it’s hard to tell. When I would blow my hair out straight in the past, it always looked like I had less of it because curls add a lot of volume. So having straighter hair, it’s going to look like less.

    When my hair was curly, I always seemed to lose a lot of hairs while shampooing and styling. I never worried because my hair was always big and bushy anyway, despite the hairs that came out. I don’t see any bare spots. It’s just the change from really curly to straight — it’s so strange!

    I’ve asked my doctors and they insist that no, the medication did not change my hair. Their attitudes seemed to be, “Why are you bothering me with something so trivial anyway? I’ve got patients with real problems.”

    They had no explanation as to why my hair would suddenly and dramatically change in my late fifties. My hairdresser had no explanation either, other than, “Well, people’s hair changes throughout their lives.”

    My sister had very straight, silky hair all her life, and it suddenly became frizzier and wavy after she gave birth. I have heard that puberty, having a baby, and menopause can change the texture and curliness of a woman’s hair. I never heard of medication doing that, but it makes sense that it could. I suppose it is a small problem in the scheme of things…I just wonder why.

    Liked by 1 person

    1. Hi Lynn – I too have often heard of hair that changes curliness or texture during or after pregnancy (which would fall under the “hormones” category that we know affects our hair). Sometimes, we just don’t know for sure what causes these changes…

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  9. Doesn’t the Hair-Skin-Nails have too much biotin in it? it was recently said on the news women are taking too much biotin and it interferes with heart attack tests and other tests in them?

    Liked by 1 person

    1. Hi Cheryl – YES you are right! In fact, the FDA issued an alert in November 2017 saying just that: “Biotin can cause falsely high or falsely low results, depending on the test. Incorrect test results may lead to inappropriate patient management or misdiagnosis. For example, a falsely low result for troponin, a clinically important biomarker to aid in the diagnosis of heart attacks, may lead to a missed diagnosis and potentially serious clinical implications.”

      The daily maximum allowance for biotin is 0.03 mg and these biotin levels do not typically cause significant interference, according to the FDA warning. Some supplements, however, contain significantly higher biotin levels (including those marketed for hair, skin, and nail benefits) of 5 mg of biotin – and some contain up to 20 mg. And there’s no scientific evidence to suggest that this much actually has any effect on thinning hair, but good studies suggesting evidence of potential harm, especially when undergoing cardiac enzyme testing.

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  10. My hair has been thinning since I’ve been on clopidogrel. It’s been since 2010. A slow process but I see a big difference. I used to have such thick hair.

    Liked by 1 person

  11. So odd I should read this post today as I have just been noticing, once again, that my hair seems to be thinning.

    Recently I have had a bad bout of angina which has enhanced my stress level. Now my doctors are making a medication increase so I guess I must prepare for more hair loss?! Oh well, I think to myself, “What is the alternative?” Another adjustment to make in the challenge of heart disease.

    Liked by 1 person

  12. In case this can be of any help to some one, next month it will be three years since my first heart attack. Five months later the second heart attack. One year and a half later, two strokes. A LOT of medicines. I take Hair-Skin-Nails with MSM. I have the most beautiful thick hair. I get compliments on my hair all the time. Both my sisters have thin hair and are on heart meds. I believe this supplement works. Thanks for listening…
    Lu

    Liked by 1 person

    1. Hello Lu Ann – I don’t endorse or recommend any supplements here, but I am curious about why your own two sisters (with thin hair and also on heart meds) aren’t following your example and taking the same supplements? Also, see my comment responding to Cheryl (above) for a link to an FDA warning for heart patients taking biotin.

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      1. Thank you for the heads up on biotin. First I’ve ever heard of it, and my cardiologist knows I take it but never said anything. I deal with A LOT of angina, but my blood work always comes back normal range and they say…oh it’s just angina. This is kinda scary….My sisters are not into supplements, and wouldn’t take anything without a prescription. I will definitely be researching this…
        Lu

        Liked by 1 person

        1. Hi again Lu – it’s quite possible that even your cardiologist was not aware of the recent cautionary alerts about biotin. As the FDA warning explained, both patients and physicians may be unaware of biotin interference in diagnostic laboratory tests, e.g. “Even physicians who are aware of this interference are likely unaware of how much biotin patients are taking.”

          I’m wondering if you are taking nitroglycerin for your angina? No patient should ever hear that this is “just angina” without also hearing a proposed remedy to address angina pain.

          Like

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