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Thread: Flushing in the evening medication

  1. #11
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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.
    Mirtazapine paradoxic effect at different doses is a bit confusing. Would 7.5mg be more effective treating Rosacea flushing than 15mg. I am about to start this and don't know whether to try 7.5mg or 15mg. I don't really care about feeling tired, just want to stop intense nose flushing when I sleep at night.

  2. #12
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    Quote Originally Posted by Johndlwdbm View Post
    Mirtazapine paradoxic effect at different doses is a bit confusing. Would 7.5mg be more effective treating Rosacea flushing than 15mg. I am about to start this and don't know whether to try 7.5mg or 15mg. I don't really care about feeling tired, just want to stop intense nose flushing when I sleep at night.
    I started at 15mg and I'm pretty sure it's had a big effect on both the nose flushing at bedtime, and after my evening meal.

    I've just moved up to 30mg but, like you say, I'm not sure whether this will be better or worse. It feels like 15mg was good, so I'm hoping that 30mg will be twice as good, but am well aware that this might not be how it works.


    I think the only thing to do is start experimenting. It seems like there is no one-size-fits-all solution. Personally I think you should go straight to 15mg, but that is based on absolutely no medical knowledge or even much internet research. It just helped me.

    I'd like the afternoon flush to go away too, things have improved a massive amount, but Ima keep trying to improve things all the time.

  3. #13
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    Quote Originally Posted by Johndlwdbm View Post
    Mirtazapine paradoxic effect at different doses is a bit confusing. Would 7.5mg be more effective treating Rosacea flushing than 15mg. I am about to start this and don't know whether to try 7.5mg or 15mg. I don't really care about feeling tired, just want to stop intense nose flushing when I sleep at night.
    Anything lower than 15mg should be 'safe' (even 7.5 could be worth trying.) I've read people taking doses as high as around 20mg and helping with flushes. My impression is 30mg could be a bit high and might risk being counter productive, because after a certain point it starts acting as an alpha 2 blocker which could make your flushing much worse. But everyones threshold is different, 30mg could be helpful, I guess it's down to the individual.
    Last edited by Brooks; 1st February 2019 at 08:14 PM.

  4. #14
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    Quote Originally Posted by Geoff1 View Post
    I started at 15mg and I'm pretty sure it's had a big effect on both the nose flushing at bedtime, and after my evening meal.

    I've just moved up to 30mg but, like you say, I'm not sure whether this will be better or worse. It feels like 15mg was good, so I'm hoping that 30mg will be twice as good, but am well aware that this might not be how it works.


    I think the only thing to do is start experimenting. It seems like there is no one-size-fits-all solution. Personally I think you should go straight to 15mg, but that is based on absolutely no medical knowledge or even much internet research. It just helped me.

    I'd like the afternoon flush to go away too, things have improved a massive amount, but Ima keep trying to improve things all the time.
    I just started on a dose 7.5mg. Did it literally start working straight away for the flushing or take a couple of days. The main problem I want to teat is a huge flush I get every night about 5 minutes after laying in bed.

  5. #15
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    Quote Originally Posted by Johndlwdbm View Post
    I just started on a dose 7.5mg. Did it literally start working straight away for the flushing or take a couple of days. The main problem I want to teat is a huge flush I get every night about 5 minutes after laying in bed.
    if it's the Mirtazapine, and not the laser treatment, then I think it started working within a couple of days.

    my worst flush has always been the evening one, after food usually. It's the most social. The bedtime one is annoying but at least it's dark and there's no embarrassment factor.

    Good luck. Let us know how it goes.

  6. #16
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    It's been 5 days on 7.5mg and I haven't noticed any side effects. From reading other users experiences I though I would be quite sleepy and have a large appetite. So far not helped the flushing. (This dose is supposed to have more antihistamine activity that at 15 mg). Perhaps that is not the part that helps reduce flushing.

    I am going to start taking 15mg from today and will post an update.

  7. #17
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    How's it going?


    My recent experiences have been great. I have had around a month of very minimal flushing. The at-work afternoon flush is still annoying, but the evening and night time ones have either been absent, not very intense, and/or short lived.


    My only issue is I don't know what is responsible! I haven't approached this scientifically at all, and tried a number of things at once. Therefore it could be any of the following:

    1) Mirtizipane. I started this about a month ago, coinciding with the start of my flush free period. It would be great if this was the main reason for it, because it's something I can keep taking and there are minimal side effects. I'm currently on 22.5mg.

    2) Laser. Just over a month ago I had a strong session of laser treatment that left my nose quite bruised and purpled. As the bruises faded my baseline red (Which was already ok) was even better, and as I've mentioned, I've not been flushing much.

    3) Combination of above. This feels quite likely, sometimes I feel like I'm flushing less which could be the pills, and when I do flush it is less intense, which might be the lasering. What I think is the best way to test this is to keep taking the pills and see if the flushing intensity and frequency increases over time.

    4) Diet. Just to confuse things further I also changed my diet to reduce food with histamine. My diet before, although quite healthy, was full of tomatoes, avocados, bananas, and essentially everything that gets listed on the "foods with high histamine" websites. So I've tried to eat much less of these things, and eat more anti-histamine stuff.

    5) None of the above. As I mentioned in previous posts, I'd been having some success (I thought) with aspirin. I stopped taking that every day when I started on mirtizipane. It might be that the flushing was stopping by itself and the aspirin wasn't actually helping at all!


    So, whilst I'm delighted that I have my life back, and I have normal evenings most of the time (I've even been out to the pub a few times which I'd been avoiding for months), I wish I knew what it is I did that helped! I guess time will reveal more information. For now I am just going to keep on the mirtizipane and also keep an eye on how much high histamine food I eat. I hope it's not the laser because that's an expensive route, both in and in the time I had to take off work; it took a good 2 weeks before I was comfortable even leaving the house. But on the other hand, if it turned out to be just the laser, at least that is something in my control. If it's just something that comes and goes randomly then I'm completely at its mercy.

    The learning continues.
    Last edited by Geoff1; 17th February 2019 at 10:51 AM.

  8. #18
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    Which of my doctors should I go to see about trying an anti flushing med? My derm? Or my regular family doctor?

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    Quote Originally Posted by kfranke View Post
    Which of my doctors should I go to see about trying an anti flushing med? My derm? Or my regular family doctor?
    Ideally you would want to see a dermatologist with a specific interest in rosacea - if you can travel to see such a doctor once even if it takes some effort, a helpful local doctor will often continue to prescribe the medications for you. Not many dermatologists or general doctors have an understanding of the full range of medications that can potentially be used for flushing, so a helpful but not expert doctor of either type can be the second best option. Taking an authoritative article to show to a helpful doctor can be useful if the doctor is not very familiar with how to treat rosacea with anti-flushing medications.


    It's certainly helpful to have an idea of the type of medications you might like to try so you can then discuss these with the doctor.

  10. #20
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    Quote Originally Posted by kfranke View Post
    Which of my doctors should I go to see about trying an anti flushing med? My derm? Or my regular family doctor?
    In the US - my experience is that most derms will not be able to offer much more than PCP. I began by asking PCP to trial medications mentioned here or in literature (clonidine, beta blockers). Eventually I landed on 2 derms who have an interest in neurovascular rosacea, but even they realize a large part comes down to trial and error per patient. My therapist had an "in" at my local teaching hospital and asked around for doctors who would specialize in flushing (how I found one of my derms). I found my other derm by looking up authors of rosacea publications. What I am able to get from these 2 derms I am not able to get from PCP or myself - how long to trial a given medication before I give up, why I wouldn't be a candidate for laser, how to titrate medications, medications that aren't typically "thought of" (calcium channel blockers, Xolair, birth control, IVIG, baclofen, ..), pathophysiology behind my symptoms and similar patients. There are derms who are very interested in neurovascular stuff and who realize that flushing conditions can be anywhere from mild to disabling, but these derms are far and few between I think, most derms will try to rx soolantra, antibiotics etc.
    Last edited by laser_cat; 16th April 2019 at 08:16 PM.

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