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Thread: Flushing in the evening medication

  1. #1
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    Unhappy Flushing in the evening medication

    Hi all


    can anyone recommend medication (or other treatment) for facial flushing that occurs mainly in the afternoon/evening, particularly after food or when lying down?

    I'm generally fine in the mornings, and early afternoon. But in the evening I can literally feel my face waiting for a minor trigger to set it off.


    I have found something that helps; aspirin. I'm now pretty convinced that 300-600mg of aspirin taken before I'd usually trigger has a massive effect. There have been many evenings when I haven't flushed at all in the evening after taking aspirin. However, it's not 100% effective, and it doesn't work when I go to bed and lie down.

    I've tried propranolol without any success.

    I am considering an SSRI, as the GP says they are happy for me to try that. They seemed less keen on more serious drugs like clonidine, but they might be more willing to let me once I've exhausted other options.
    What ssri should I try? Is it worth trying others if one doesn't work? I'm thinking of mirtazapine or certraline first.

    One thing I should note, I don't think this is social blushing. This happens when I'm home alone or with other people. all the flushing medication seems to be based on decreasing anxiety and I don't think that's the cause for me.

    Thanks for any suggestions,

    G

  2. #2
    Senior Member Brady Barrows's Avatar
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    Using Aspirin for flushing has been around a while. Red Clover is another. Here is a list of everything mentioned to avoid flushing.
    Brady Barrows
    Join the RRDi

  3. #3
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    Quote Originally Posted by Brady Barrows View Post
    Using Aspirin for flushing has been around a while. Red Clover is another. Here is a list of everything mentioned to avoid flushing.
    thanks

    I saw that thread before. I was hoping that someone would recommend which one of the many to try next, based on having similar issues.

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    Quote Originally Posted by Geoff1 View Post
    Hi all


    can anyone recommend medication (or other treatment) for facial flushing that occurs mainly in the afternoon/evening, particularly after food or when lying down?

    I'm generally fine in the mornings, and early afternoon. But in the evening I can literally feel my face waiting for a minor trigger to set it off.


    I have found something that helps; aspirin. I'm now pretty convinced that 300-600mg of aspirin taken before I'd usually trigger has a massive effect. There have been many evenings when I haven't flushed at all in the evening after taking aspirin. However, it's not 100% effective, and it doesn't work when I go to bed and lie down.

    I've tried propranolol without any success.

    I am considering an SSRI, as the GP says they are happy for me to try that. They seemed less keen on more serious drugs like clonidine, but they might be more willing to let me once I've exhausted other options.
    What ssri should I try? Is it worth trying others if one doesn't work? I'm thinking of mirtazapine or certraline first.

    One thing I should note, I don't think this is social blushing. This happens when I'm home alone or with other people. all the flushing medication seems to be based on decreasing anxiety and I don't think that's the cause for me.

    Thanks for any suggestions,

    G
    I had/have the same thing. I would try mirtazapine - that helped me massively with lying down. Lying down at night + sleeping with 22.5 mg mirtazapine at night, isn't really a problem at all anymore.

    Clonidine, propranolol etc - never helped me. It seems like it should work, to help constrict the blood vessels, but I feel at least for me, the dilation is coming from a different mechanism (neurogenic inflammation) and not the norepinephrine, alpha 1 receptors, etc pathway (I guess the lack of constriction that would happen in that pathway) that propranolol, clonidine etc target.

    If aspirin helps you - I would try the supplement palmitoylethanolamide. Can help inflammation and to desensitize the TRPV1 channels on sensory nerves (that otherwise sense acid / heat). Sometimes these channels get upregulated in inflammation, TMJ, neuropathies. I take it, and while it is not everything, it does help. It's safe, I take 800 mg x3. "Heavier" things that also desensitize these channels like THC -- even though it is an otherwise vasodilatory drug -- actually help me a lot. Synthetic THC (dronabinol) is rx'ed for neuropathic itch, which is when the sensory nerves are misfiring creating itch instead of burning/dilation/flushing, perhaps a different manifestation of a similar underlying process.

    The 2 major dilators coming from neurogenic inflammation are substance P and CGRP. Aprepitant is a drug that blocks substance P and also rx'ed for itch. Emgality is an anti-CGRP migraine med (new in US) that also might help. Although I have not tried these 2 things (awaiting insurance approval). Insurance would only cover under "amended" diagnoses (not flushing) because they are $.

    Something that isn't easy to try - is botox, which can help with neurogenic inflammation. 100 units in my cheeks helps with my night flushing but I had to have 2 consecutive rounds to notice benefit, and the day of injections I'm a bloody mess.

    I believe my flushing is independent of anxiety also, but clonazepam does help me a bit. Not enough to even take on a daily basis (bc side effects outweigh benefits), but it might be something easy to try and get an rx.

    Good luck

    PS - I think an SSRI or SNRI is worth a try, just because there are anecdotal reports of it helping people on the forum. They have never helped me with the evening issue though. I wouldn't waste my time trying a different one if something, say celexa doesn't work. Although I might try an NDRI like wellbutrin or SNRI like effexor if an SSRI doesn't work.
    Last edited by laser_cat; 17th January 2019 at 10:46 PM.

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    Quote Originally Posted by laser_cat View Post
    I had/have the same thing. I would try mirtazapine - that helped me massively with lying down. Lying down at night + sleeping with 22.5 mg mirtazapine at night, isn't really a problem at all anymore.

    Clonidine, propranolol etc - never helped me. It seems like it should work, to help constrict the blood vessels, but I feel at least for me, the dilation is coming from a different mechanism (neurogenic inflammation) and not the norepinephrine, alpha 1 receptors, etc pathway (I guess the lack of constriction that would happen in that pathway) that propranolol, clonidine etc target.

    If aspirin helps you - I would try the supplement palmitoylethanolamide. Can help inflammation and to desensitize the TRPV1 channels on sensory nerves (that otherwise sense acid / heat). Sometimes these channels get upregulated in inflammation, TMJ, neuropathies. I take it, and while it is not everything, it does help. It's safe, I take 800 mg x3. "Heavier" things that also desensitize these channels like THC -- even though it is an otherwise vasodilatory drug -- actually help me a lot. Synthetic THC (dronabinol) is rx'ed for neuropathic itch, which is when the sensory nerves are misfiring creating itch instead of burning/dilation/flushing, perhaps a different manifestation of a similar underlying process.

    The 2 major dilators coming from neurogenic inflammation are substance P and CGRP. Aprepitant is a drug that blocks substance P and also rx'ed for itch. Emgality is an anti-CGRP migraine med (new in US) that also might help. Although I have not tried these 2 things (awaiting insurance approval). Insurance would only cover under "amended" diagnoses (not flushing) because they are $.

    Something that isn't easy to try - is botox, which can help with neurogenic inflammation. 100 units in my cheeks helps with my night flushing but I had to have 2 consecutive rounds to notice benefit, and the day of injections I'm a bloody mess.

    I believe my flushing is independent of anxiety also, but clonazepam does help me a bit. Not enough to even take on a daily basis (bc side effects outweigh benefits), but it might be something easy to try and get an rx.

    Good luck

    PS - I think an SSRI or SNRI is worth a try, just because there are anecdotal reports of it helping people on the forum. They have never helped me with the evening issue though. I wouldn't waste my time trying a different one if something, say celexa doesn't work. Although I might try an NDRI like wellbutrin or SNRI like effexor if an SSRI doesn't work.
    Hi Laser_Cat, may I ask how does Palmitoylethanolamide help you, does it help at all with sensitivity to heat?

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    Sounds like typical type 1 Rosacea, try taking an antihistamine every morning, citropram at night and propranolol for social occasions. Oh and sunscreen if your skin can tolerate it.

  7. #7
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    Quote Originally Posted by laser_cat View Post
    I had/have the same thing. I would try mirtazapine - that helped me massively with lying down. Lying down at night + sleeping with 22.5 mg mirtazapine at night, isn't really a problem at all anymore.

    Clonidine, propranolol etc - never helped me. It seems like it should work, to help constrict the blood vessels, but I feel at least for me, the dilation is coming from a different mechanism (neurogenic inflammation) and not the norepinephrine, alpha 1 receptors, etc pathway (I guess the lack of constriction that would happen in that pathway) that propranolol, clonidine etc target.

    If aspirin helps you - I would try the supplement palmitoylethanolamide. Can help inflammation and to desensitize the TRPV1 channels on sensory nerves (that otherwise sense acid / heat). Sometimes these channels get upregulated in inflammation, TMJ, neuropathies. I take it, and while it is not everything, it does help. It's safe, I take 800 mg x3. "Heavier" things that also desensitize these channels like THC -- even though it is an otherwise vasodilatory drug -- actually help me a lot. Synthetic THC (dronabinol) is rx'ed for neuropathic itch, which is when the sensory nerves are misfiring creating itch instead of burning/dilation/flushing, perhaps a different manifestation of a similar underlying process.

    The 2 major dilators coming from neurogenic inflammation are substance P and CGRP. Aprepitant is a drug that blocks substance P and also rx'ed for itch. Emgality is an anti-CGRP migraine med (new in US) that also might help. Although I have not tried these 2 things (awaiting insurance approval). Insurance would only cover under "amended" diagnoses (not flushing) because they are $.

    Something that isn't easy to try - is botox, which can help with neurogenic inflammation. 100 units in my cheeks helps with my night flushing but I had to have 2 consecutive rounds to notice benefit, and the day of injections I'm a bloody mess.

    I believe my flushing is independent of anxiety also, but clonazepam does help me a bit. Not enough to even take on a daily basis (bc side effects outweigh benefits), but it might be something easy to try and get an rx.

    Good luck

    PS - I think an SSRI or SNRI is worth a try, just because there are anecdotal reports of it helping people on the forum. They have never helped me with the evening issue though. I wouldn't waste my time trying a different one if something, say celexa doesn't work. Although I might try an NDRI like wellbutrin or SNRI like effexor if an SSRI doesn't work.

    thanks, this a brilliant reply, just what I'd hoped for.

    As of last night, I've started on Mirtazapine. Do you know if I'm likely to see results immediately? I know that as an anti-depressant it takes a few weeks to work, is it the same for its flushing relief properties?

    You mention it for stopping the night time flushing, is it likely to aid with daytime too? The evening one is the worst; that's the one I'd like to control. The night time one is annoying but at least I'm in bed then so it's not socially awkward!

  8. #8
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    Quote Originally Posted by laser_cat View Post
    I had/have the same thing. I would try mirtazapine - that helped me massively with lying down. Lying down at night + sleeping with 22.5 mg mirtazapine at night, isn't really a problem at all anymore.

    Clonidine, propranolol etc - never helped me. It seems like it should work, to help constrict the blood vessels, but I feel at least for me, the dilation is coming from a different mechanism (neurogenic inflammation) and not the norepinephrine, alpha 1 receptors, etc pathway (I guess the lack of constriction that would happen in that pathway) that propranolol, clonidine etc target.

    If aspirin helps you - I would try the supplement palmitoylethanolamide. Can help inflammation and to desensitize the TRPV1 channels on sensory nerves (that otherwise sense acid / heat). Sometimes these channels get upregulated in inflammation, TMJ, neuropathies. I take it, and while it is not everything, it does help. It's safe, I take 800 mg x3. "Heavier" things that also desensitize these channels like THC -- even though it is an otherwise vasodilatory drug -- actually help me a lot. Synthetic THC (dronabinol) is rx'ed for neuropathic itch, which is when the sensory nerves are misfiring creating itch instead of burning/dilation/flushing, perhaps a different manifestation of a similar underlying process.

    The 2 major dilators coming from neurogenic inflammation are substance P and CGRP. Aprepitant is a drug that blocks substance P and also rx'ed for itch. Emgality is an anti-CGRP migraine med (new in US) that also might help. Although I have not tried these 2 things (awaiting insurance approval). Insurance would only cover under "amended" diagnoses (not flushing) because they are $.

    Something that isn't easy to try - is botox, which can help with neurogenic inflammation. 100 units in my cheeks helps with my night flushing but I had to have 2 consecutive rounds to notice benefit, and the day of injections I'm a bloody mess.

    I believe my flushing is independent of anxiety also, but clonazepam does help me a bit. Not enough to even take on a daily basis (bc side effects outweigh benefits), but it might be something easy to try and get an rx.

    Good luck

    PS - I think an SSRI or SNRI is worth a try, just because there are anecdotal reports of it helping people on the forum. They have never helped me with the evening issue though. I wouldn't waste my time trying a different one if something, say celexa doesn't work. Although I might try an NDRI like wellbutrin or SNRI like effexor if an SSRI doesn't work.
    Hi Laser Cat:

    The Palmitoylethanolamide supplement sounds interesting. Can you provide a little more detail on exactly how it helped you? Did it help relieve flushing? LDN has helped with pain but not flushing for me.

    Thanks!

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    Quote Originally Posted by Geoff1 View Post
    thanks, this a brilliant reply, just what I'd hoped for.

    As of last night, I've started on Mirtazapine. Do you know if I'm likely to see results immediately? I know that as an anti-depressant it takes a few weeks to work, is it the same for its flushing relief properties?

    You mention it for stopping the night time flushing, is it likely to aid with daytime too? The evening one is the worst; that's the one I'd like to control. The night time one is annoying but at least I'm in bed then so it's not socially awkward!
    Any updates Geoff, is it working for the flushing when laying down? What dose are you on.

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    Quote Originally Posted by Mknlvi View Post
    Any updates Geoff, is it working for the flushing when laying down? What dose are you on.

    Well something has helped, at least a bit.

    I haven't approached things very scientifically, in my desperation I've kind of tried multiple things at once, so I'm not sure which has been the biggest help.

    I had IPL recently, which left me pretty purple for a couple of weeks but has healed now. I've also tried loosely following a diet of low-histamine food. And I still pop an aspirin every evening.

    And of course, I've started on 15mg of Mirtazapine.


    Whatever it is, my evenings have been a lot more bearable recently. Not only have I had a few flush-free evenings, but I've also stopped flushing lying down at bedtime.

    It might be a combination of the above, although my instinct tells me the biggest factor the Mirtazapine. I'm due to go to 30mg in a few days, I don't know if that will help more or if this is the extent of its help. I need to drop the aspirin to prove that is no longer needed, but I am scared of eating evening dinner without it!

    Things aren't perfect, I've had a few afternoon flushes. But things are feeling a bit more positive at the moment.

    I'll report back as things progress.
    Last edited by Geoff1; 28th January 2019 at 07:56 PM.

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