Prescription and Non Prescription Flushing Avoidance

[Guide]

There are a number of prescription drugs you could ask your physician about that have been reported to help reduce flushing. There are also over the counter drugs [OTC] non prescription treatments used to reduce or avoid flushing as well. This post is dedicated to those of you searching for methods to control or reduce flushing. Post your own method in this thread, please. 

"Flushing can be treated with medications that have provided some success in other studies, including beta-blockers, clonidine (Catapres, Boehringer Ingelheim), naloxone (Narcan, Endo), ondansetron (Zofran, GlaxoSmithKline), and selective serotonin reuptake inhibitors (SSRIs). However, evidence supporting many of these therapies is limited." [1]

The prescription drugs in the list below came from anecdotal reports posted in various online support groups for rosacea that reported that their physician prescribed the drug to reduce flushing or an anecdotal report mentioning the drug. The same is true for the sources listed for the non prescription treatments or over the counter [OTC] which all these sources are listed in the end notes or as links. Lastly, there is a subheading if you scroll below of 'Other Treatments' for flushing avoidance, and find the end notes. 

Prescription Drugs

Amlodipine (very low dose) [28]

Amitriptyline (Elavil) [37]

Antihistimines (also available OTC) [9]

Atenolol [6]

Benadryl

Botulinum Toxin [30]

Brimonidine

Carvedilol [7]

Citalopram (brand names: Celexa, Cipramil and others) 

Clonidine [1]

Cymbalta [2] 

Diclofenac [16]

Duloxetine [2]

Effexor [2]

Epinephrine

Famotidine [24]

Gabapentin (Neurontin)

Hormone Replacement Therapy

Hydroxychloroquine (Plaquenil) [4]

Isotretinoin (2.5 mg generic low dose)

Ketamine 0.5% and Amitriptyline 1%

Lanreotide

Loratadine (Claratin) [5]

Low Dose Isotretinoin

Lyrica [2]

Maxalt [2]

Megestrol acetate

Mepacrine (INN), also called quinacrine (USAN) or by the trade name Atabrine

Metoprolol

Metformin [35]

Mirtazapine (Remeron) [12]

Monoxidine 

Montelukast (Singulair) [5]

MSM [33]

Nadadol

Naloxone [1]

Naltrexone (low dose) [32]

Ondansetron [1]

Pavinetant [25]

Paxil [26}

Propranolol (Inderal) [8]

Pseudoephedrine [3]

Ranitidine (Zantac) [5]

Roxicodone [2]

Sandostatin LAR

Serotonin Reuptake Inhibitors (SSRIs) [1]

Sumatriptan

Treximet [2]

Triptran ( Imitrex or Sumatriptan) [19]

Venlafaxine [17]

Veralipride [18]

Over the Counter (OTC) NON PRESCRIPTION (or other treatments) [9]

Air Purifier [38]

Antihistimines (OTC) [9] 

Aspirin

Before Elixir [13]

Benadryl

Breathing Exercises [29]

Bromelain [10] [23]

Chili (capsaicin) [36]

codeRed [14]

Diamine oxidase (DAO) [34]

Full Face Gel Mask

Gaviscon [21]

Ibuprofen [27]

MSM [22]

Quercetin Bromelain [10] [23]

Red clover

Sepia [15]

Topical ibuprofen [20]

Vitamin C  [10] [23]

Other Treatments 

Tixel followed by topical application of 100 U of abobotulinumtoxin [31]

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End Notes

[1] Rosacea: A Review
Brittney Culp, BA and Noah Scheinfeld, MD
P T. 2009 January; 34(1): 38–45.

realwork says, "SSRI's work the best for me. Luckily I didn't suffer many side effects." post no. 2

Nat007 writes about "Medication that has proved to be helpful for facial flushing, redness and burning"

American Family Physician. 66 (3): 435–441. PMID 12182520.
"Rosacea: A Common, Yet Commonly Overlooked, Condition". 
Blount, BW; Pelletier, AL (2002).

"Clonidine is an oral alpha2 agonist that has been used for flushing." 
Australian Subscriber
An update on the treatment of rosacea
Alexis Lara Rivero, M Whitfeld

[2] Cymbalta [Duloxetine]

Anecdotal report from Meg post #3 on 6/14/11

Momof reports [in post no 11], "I have been taking 60mg Duloxetine in the morning for the past few days ( instead of amitriptyline) and it is proved a magic bullet."

[3] valby - Post #8 6/16/11 at 3:04AM

[4] Post #14 by shantelle 6/20/11 at 04:51 AM

antwantsclear recommends hydroxychloroquine [see post no 4]

[5] Brook - Post #11 6/25/11

[6] Read Judworth's post 28th November 2011 02:13 PM Post #2

[7] Pronounced facial flushing and persistent erythema of rosacea effectively treated by carvedilol, a nonselective b-adrenergic blocker
J AM ACAD DERMATOL VOLUME 67, NUMBER 3, Letters, page 491

jlb2010 Post #1

"Carvedilol, 6.25 mg twice a day, was prescribed for the first week, followed by 3 times a day thereafter. She monitored her blood pressure and pulse rate regularly at home, and no hypotension or bradycardia was noted. A dramatic improvement in the erythema and telangiectasia was noted in 2 weeks."

Carvedilol for the Treatment of Refractory Facial Flushing and Persistent Erythema of Rosacea
Chia-Chi Hsu, MD; J. Yu-Yun Lee, MD; Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
Download pdf

carveArchives_of_Dermatology_2011_147.pdf

J Am Acad Dermatol. 2012 Sep;67(3):491-3.
Pronounced facial flushing and persistent erythema of rosacea effectively treated by carvedilol, a nonselective β-adrenergic blocker.

Hsu CC, Lee JY.

 

"These findings demonstrate facial flushing and persistent erythema can be effectively treated by carvedilol long-term with a fast onset of improvement in a dose well tolerated." 

J Dermatolog Treat. 2017 Jul 27;:1-16
Long term management of distinct facial flushing and persistent erythema of rosacea by treatment with carvedilol.
Pietschke K, Schaller M

Dermatol Ther. 2020 Nov 11;:e14520
Facial Flushing and Erythema of Rosacea Improved by Carvedilol.
Seo BH, Kim DH, Suh HS, Choi YS

[8] Symptomatic treatment of idiopathic and rosacea-associated cutaneous flushing with propranolol.
Craige H, Cohen JB.
J Am Acad Dermatol. 2005 Nov;53(5):881-4.

[9] Over The Counter (non prescription)

[10] DianaLynn's anecdotal report

[12] J Support Oncol. 2004 Jan-Feb;2(1):50-6.
Pilot evaluation of mirtazapine for the treatment of hot flashes.
Perez DG, Loprinzi CL, Barton DL, Pockaj BA, Sloan J, Novotny PJ, Christensen BJ.

The Effect of Mirtazapine for Treatment of Hot Flashes in Depressed Woman with Breast Cancer Receiving Tamoxifen: A Case Report
Lee SH;    Ko YH;    Joe SH.
Korean Journal of Psychopharmacology; 17(1): 101-104, 2006.

Obstet Gynecol. 1990 Oct;76(4):573-8.
Alpha 2-adrenergic mechanism in menopausal hot flushes.
Freedman RR1, Woodward S, Sabharwal SC.

pleasehelp123 reports taking Mirtazapine

nat007 and BlueDog report taking Mirtazapine

Chai reports taking Mirtazapine with a severe rebound of rosacea when withdrawing from it

[13] Before Elixir (no longer available)
PREVENTS ALCOHOL FLUSH: Reduces flushing of face and symptoms of Alcohol Flush
According to Asian Flush Cure Before Elixir is no longer available and has been replaced by three other treatments, Lighten Up, Nightcap, and Morning After. 

[14] codeRed
No longer available at Amazon (Google it)

. 

[15] 'There's also anecdotal evidence that sepia tablets - a homeopathic remedy - can help flushes. I have had many patients who found that it helped.'
Why your 'flushing' could be a red alert to see your doctor
By Caroline Bellamy, Daily Mail

[16] Diclofenac

 Violetsareblue post #13

[17] Venlafaxine

realwork, post #5

DunkWheezy post no 35 says, "Ever since I started taking a 37.5mg Venlafaxine pill daily I haven't had a problem with flushing. Ask your doctor about trying it, it majorly helped me and I'm sure it could help you. I take a super low dose and experience no side effects."

Prim Care Companion J Clin Psychiatry. 2007; 9(1): 70–71.
PMCID: PMC1894834
Alleviation of Hot Flashes With Increase in Venlafaxine Dose
Prasad R. Padala, M.D., Srinivas B. Rapuri, M.D., and Kalpana P. Padala, M.D.

[18] Climacteric. 2010 Apr;13(2):141-6. doi: 10.3109/13697130903219208.
Reduction of serum serotonin precursors after veralipride treatment for postmenopausal hot flushes.
Carretti N, Florio P, Reis FM, Comai S, Bertazzo A, Petraglia F.

[19] Topical Ibuprofen

laser_cat

[20] Eur Neuropsychopharmacol. 2013 Dec;23(12):1747-53. doi: 10.1016/j.euroneuro.2013.07.013. Epub 2013 Aug 6.
Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise in people with a fear of blushing.
Drummond PD, Minosora K, Little G, Keay W.

[21] Giviscon

Boris reports, "taking a slug of giviscon liquid before i head out to the pub stops me from flushing completely."

[22] antwantsclear post no 7 writes, "Helpful supplements for me include Solgar MSM 1000mg (you can take up to six per day but start with one initially). Higher Nutrition for Healthy Veins. Symprove probiotic (this is very helpful). Zinc 15mg twice per day. Vaxa Buffer pH."

[23] WazzyG started a thread on Quercetin Bromalein at post no 1 while BVokey post no 12 says, "Vitamin C, msm, riboflavin (by itself, not in a b-complex vitamin)"

[24] realwork at RF says, "Famotidine massively reduces the alcohol flush. Always consult your doctor first before taking any medication."

[25] Pavinetant (INN, USAN; developmental code names MLE-4901, AZD-4901, AZ-12472520, AZD-2624)
 "In November 2017, development of the medication for hot flashes and PCOS was also terminated after its developer assessed the clinical risks and benefits." Wikipedia

"In 28 healthy women aged 40–62 years, oral administration of a 40 mg dose twice per day for 4 weeks reduced the number of hot flushes during week 4 by 45 percentage points (95% CI 22–67) compared with placebo (intention-to-treat adjusted means: placebo 49·01 [95% CI 40·81–58·56] vs MLE4901 19·35 [15·99–23·42]; adjusted estimate of difference 29·66 [17·39–42·87]; p<0·0001). This finding was also supported by an objective assessment of flushes, using the Bahr sternal skin conductance monitor. Reductions in the number of flushes might be less important to women than measures of quality of life, thus it is of interest that the authors found hot flush severity, bother, and interference to be significantly reduced during treatment with MLE4901."

The Lancet 
Volume 389, No. 10081, p1775–1777, 6 May 2017
New pathways in the treatment for menopausal hot flushes
Jenifer Sassarini, Jenifer Sassarini, Richard A Anderson

[26] antrax1 (Post no 1}says, "My wonder: 5 MG paxil a day. Works GREAT for itching, flushing and blushing. I barely blush and flush now (was VERY severe, even considered ETS surgery)."

[27] Violetsareblue [post no 6] says, "Taking a 200 or 400 mg ibuprofen every now and then (twice per week max) if I know I will be triggered. This has helped me a lot to feel that I can have control over the condition. Its not good to do it on daily basis, but for me it is a great help just mentally knowing that I have 
some sort of control.

[28] laser_cat at RF post no 12 writes, "The amlodipine is helpful for both pain + flushing, I think by evening out blood flow / oxygen tension in my face."

[29] Flugs reports, "If I close my eyes, exhale deeply, and relax for about 10 seconds, then open my eyes again and look in the mirror, my face is completely pale. The effect only lasts a few seconds before the usual pinkness in my cheeks returns… but, sometimes, if I’m heading towards a light flush, I can actually head it off at the pass by doing this."

[30] "Intradermal botulinum toxin injection may be an effective treatment for refractory erythema and rosacea flushing that deserves further study in a larger patient population."

Dermatology
Botulinum Toxin for the Treatment of Refractory Erythema and Flushing of Rosacea
Park K.Y., Hyun M.Y., Jeong S.Y., Kim B.J., Kim M.N., Hong C.K.

[31] Lasers Surg Med. 2018 Oct 12. doi: 10.1002/lsm.23023. [Full text with images]
The toxic edge-A novel treatment for refractory erythema and flushing of rosacea.
Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O

[32] Flugs reports "I need more time to know if it has - or will - help reduce flushing. Perhaps if the face pain / sensitivity goes the tendency to flush may reduce through time. I also think that I will need to continue to zap the caps and redness a bit more, in order to get rid of the excess infrastructure that makes flushing so easy." (There are others in Flug's thread that are trying Naltrexone like Judworth post no 567, "my flushing has been knocked out by about 99%")

[33] "I've been taking 4000mg a day for 3 days and I've flushed maybe 5 times since I started. I was flushing 10-20 times a day. It's really life changing!" RickSaw12, Reddit

[34] Diamine oxidase (DAO), also known as histaminase, is an enzyme (EC 1.4.3.22) involved in the metabolism, oxidation, and inactivation of histamine and other polyamines such as putrescine or spermidine in animals." Wikipedia

mac5400 posts at Reddit, "I now take an OTC supplement called UmbrelluxDAO before i eat or drink. It contain the enzymes responsible for metabolizing histamine. And I barely flush anymore. The chronic rosiness on my cheeks has significantly reduced; more than any cream I've ever tried. In combination with a low histamine diet, i think i finally found the "cure" to my "rosacea." It's such a breakthrough for me. This supplement is life-changing."

[35] Metformin
Brands: Glucophage, Riomet, Fortamet, Glumetza, and Glucophage XR
Markhill8 at RF states, "Four weeks ago I started taking 500mg Metformin once a day (right before my evening meal). By the third day my flushing had decreased and after around 10 days had reduced drastically. Now I do not flush at all to food and interestingly the other triggers like heat and laying down to sleep (always use to flush with head getting warm on the pillow) no longer make me flush. My nose seems to be decreasing in volume also (edema slowly going) because I no longer flush. If I do something that use to bring on a flush like taking a really warm shower, now I just get a slight tingling feeling that used to herald a massive flush but now only lasts for around 1-2 minutes with no redness or swelling. I don't have diabetes and have type 1 Rosacea with flushing/ nose swelling. For the last week I have reduced the dose to 500mg every other day and it is still working. I hope to reduce it to 500mg every 3 days after another two weeks and see if it still works. Food it seems is a massive delayed trigger for me that is driving my Rosacea."

[36] sepi, Rosacea Forum

Capsaicin is the active ingredient in chili peppers that makes them hot. Capsaicin is used in medicated creams and lotions to relieve muscle or joint pain.

Rugby Capsaicin 0.025% Cream
CAPZASIN-HP CREME
Zostrix Maximum Strength Natural Pain Relief Cream, Capsaicin Pain Reliever:

[37] Momof, reports, "...25mgx2 daily ( 50mg) of Amitriptyline has definitely helped the crazy nerves in my face..."

[38] Rtstar [post #9] "Update: about 4 days ago i started flushing at night again. Last night I used an air purifier in my room and i have been leaving it on all night and day. My skin hasn't looked this good in awhile. I have noticed that because I haven't been flushing as much as before my baseline redness is a little better as well. Obviously the redness gets better without flushing but I didn't realize that staying away from a flushing episode helps baseline redness overall. i haven't added any skincare to my routine either. This is simply just from avoiding heat and my indoor allergies."