Upjohn 'Cautiously Optimistic' On Minoxidil for Baldness

Upjohn 'Cautiously Optimistic' On Minoxidil for Baldness Upjohn Vice President Lawrence Hoff, speaking at a health care seminar in New York, said that Upjohn is still "cautiously optimistic" about the use of topical minoxidil for male pattern baldness. But the 2% minoxidillotion, now in Phase III trials in 28 centers, seems to work for only one-third of all male subjects in testing. Hoff said that the company is therefore "still looking for that profile of the best candidate" for treatment with the drug. "We have to know whether [the ideal candidate's] a young male aged 25-40 who has started to lose his hair, or some-

one older. My feeling is that we will find a segment cohort where you will have significantly better hair growth." Then there's the interesting question of using minoxidil for the prevention of baldness. Stated Hoff, "What we've seen are individuals who are 25, 30, 32 who are expected to lose their hair. They've been on the drug and they've not lost it." He added that, in his personal opinion, "at some future point there will be a prophylactic use for topical minoxidil." Among the one-third of the patient population under study fortun-

Ciba Halts T andearil Sales In the wake of a petition questioning the safety of the two drugs oxyphenbutazone (Tandearil) and phenylbutazone (Butazolidin) from Ralph Nader's Health Research Group, and lengthy hearings before the Food and Drug Administration on the issue, Ciba-Geigy has announced that it will stop selling Tandearil. Ciba Vice President Roy Ellis admitted that there had been problems with the drug, and acknowledged that other drugs that involve less risk to the patient are available to replace it. The order to discontinue sales

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originated from the parent company in Basel, Switzerland, after it had "reviewed the clinical data ... and consulted with medical experts, regulatory officials, and consumers," said the company. As for Butazolidin, Ciba will recommend its use "only where other therapeutic measures have been tried and found unsatisfactory."

ate enough to see real hair re-growth, what was observed as "cosmetically acceptable, terminal hair," very similar to that "which [once] covered the area we're looking at, which in these cases was the crown." Preliminary data show that minoxidil, given topically, has shown no significant side effects. Studies are underway to find out whether the minoxidil might compromise the effectiveness of any concurrentlytaken oral antihypertensive medication. Up in the air, too, is the issue of dose-response. FDA wants Upjohn to investigate whether a 1.5% or 1% formulation might not work just as well as the 2% preparation. Hoff speculates that 1/1 % will work in some people, but with a lower rate of efficacy, probably 10-15%." When questioned as to whether FDA might hold up the topical minoxidil New Drug Application, Hoff replied that he expects speedy action on the application "because (a) we've already talked about the questions in their minds; and (b) because they don't like the ad hoc prescribing of the tablets for hair."

Steroid Nasal Sprays Can Cause Perforation of Nasal Septum It's still exceedingly rare, but nonetheless the numbers of case reports are on the rise: perforation of the nasal septum associated with use of steroid nasal sprays. While a 1975 report on the incidence of this effect during the first ten years of use of dexamethasone aerosol counted only eight cases, two Boulder, CO, physicians writing in the April 12, 1985, issue of the Journal of the American Medical Association claim that they have seen six patients over the past two years in whom nasal perforation was apparently caused by nasal sprays.

Of these cases, four were using beclomethasone diproprionate nasal spray; one, flunisolide spray; and one, a nasal decongestant spray, for many years. All denied having used cocaine, and none were exposed to wood dust in their jobs. The first symptoms of impending nasal perforation in many patients seem to be nosebleeds or cru~ting of the septal membrane. So pharmacists may want to refer any patients using steroid nasal sprays who report these symptoms to their physicians immediately.

American Pharmacy Vol. NS25, No.7, July 1985/412

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