This article highlights the dangers of doing this and discusses the long-term health implications involved.
Antihistamines like Pepcid, Zantac and Zyrtec dangerously mask Asian flush symptoms.
Using antihistamines to reduce symptoms of Asian flush is dangerous. This is because it can mask important symptoms that are telling the body to stop drinking alcohol.
With fewer unpleasant symptoms, the drinker may continue drinking without a similar reduction in blood acetaldehyde.
This practice is dangerous because it allows ALDH2 deficient individuals to consume more alcohol and increases their risk of acetaldehyde toxicity.
Dr Daryl Davies, PhD and director of the Alcohol and Brain Research Laboratory at the University of South Carolina, confirmed this danger in a recent article. He stressed that alcohol flush reaction is the body telling the drinker to slow down and commence hydration:
“Using histamine-2 blockers to reduce the ‘Asian flush’ can escalate alcohol intake and increase the risk of stomach cancers, esophageal cancer and a type of skin cancer called squamous cell carcinoma … the use of H2 blockers may allow someone suffering from Asian glow to drink higher levels of alcohol, but this person shouldn’t do that. It’s just not smart.”
Masking Asian flush with antihistamines may lead to a build-up of dangerous toxins.
Dr Davies is alluding to a series of warnings issued by the National Institutes of Health (NIH) for people with an alcohol flush reaction. In a media release, publicising research from scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and Japan's Kurihama Alcohol Center, they stated that:
“…individuals with one copy of the inactive variant (i.e. Asian flush) are about 6-10 times more likely to develop esophageal cancer than are individuals with the fully active ALDH2 enzyme who drink comparable amounts of alcohol. Notably, these studies showed that individuals with the inactive variant who drink the equivalent of 33 or more U.S. standard drinks per week have a 89-fold increased risk of esophageal cancer compared to non-drinkers.”
In response, the International Agency for Research on Cancer mirrored these sentiments by classifying acetaldehyde from alcohol as a group 1 carcinogen:
“The agent (mixture) is carcinogenic to humans. The exposure circumstance entails exposures that are carcinogenic to humans.”
When taking an antihistamine to reduce Asian flush, drinkers may not realise that they are consuming more alcohol than usual. Doing this results in an over-exposure to toxic acetaldehyde.
Due to the absence of the typical red face, the drinker may think that they can consume more alcohol without any adverse symptoms. If they continue to drink alcohol, acetaldehyde will continue to accumulate in their system and expose them to a Group 1 carcinogen for longer.
Newly discovered risks of using Ranitidine (Zantac) for Asian flush
Users of Zantac for Asian flush should take note that GlaxoSmithKline is recalling their popular heartburn medicine Zantac in all markets. This move comes only days after the FDA discovered what they described as “unacceptable” levels of a probable cancer-causing impurity in the drug.
In response to this, retailers across the United States are suspending the sale of over-the-counter heartburn drugs containing ranitidine (such as Zantac).
"The FDA has clarified that the testing method that found the “extremely high levels” of NDMA applied high heat, at a level much higher than normal body temperature. In other words, the testing did not reflect typical conditions under which the medication would be stored or taken."
Therefore, at the time of writing, the extent of the risk remains unclear. That said, generally speaking, combining these kinds antihistamines with alcohol is still questionable.
Do Pepcid AC, Zantac and Zyrtec help with Asian flush?
Discussed below are clinical trials linking the action of antihistamines to one or more symptoms of alcohol flush reaction. As mentioned above, antihistamines were not created to treat Asian Glow symptoms.
Erythema (skin flushing)
A 1988 study headed by N.S Miller, author of “The Pharmacology of Alcohol and Drugs of Abuse and Addiction”, examined the role of histamine in the expression of alcohol sensitivity in oriental subjects.
One-half of the test subjects in the study got 50 mg of an H1 receptor antagonist similar to Zyrtec and 300 mg of an H2 receptor antagonist identical to Pepcid AC and Zantac. The second half was the placebo group.
The most apparent difference between the antihistamine group and the placebo group was in their degree of flushing. The antihistamine group showed a reduction in skin redness.
Restricted breathing and alcohol
A subsequent 2004 study aimed to look at why Japanese asthmatics experience worsening of asthma symptoms after alcohol consumption. They found that the alcohol by-product acetaldehyde increased airway muscle tone and made it harder for subjects to breathe. This effect was associated with an increase in the release of histamine. An H1 receptor antagonist similar to Zyrtec was able to reverse this effect.
Antihistamine medications commonly abused to treat Asian flush.
There are various types of antihistamines on the market today, but none are created explicitly for Asian flush. However, many ALDH2 deficient people misuse antihistamines to help with their Asian flush symptoms.
Of the many antihistamines on the market, the four most commonly abused varieties for alcohol flush reaction listed below:
- Famotidine - Commonly sold under the trade name Pepcid, Pepcid AC or Pepcid Complete.
- Ranitidine - Found by the trade name Zantac.
- Cetirizine - Sold under the trade name Zyrtec.
- Fexofenadine - Sold under the trade name Allegra.
Side-effects when taking Pepcid AC, Zantac or Zyrtec for alcohol flushing.
As with all medications, antihistamines come with side effects that the user should be aware of, including when using them to combat alcohol flushing symptoms.
When used for their designed use, a lot of the antihistamines mentioned have similar side effects. Of course, medications impact everyone differently.
Pepcid AC side effects include:
- muscle pain or cramps
- dry mouth
Zantac side effects, like other antihistamines, are uncommon and are usually mild. Some side effects you may experience with Zantac are things like stomach pains, constipation and nausea.
Like Pepcid, Zyrtec carries a lot of the same side effects, like fatigue, dizziness, headache, nausea, dry mouth, among others.
Allegra side effects include things like:
- feeling sleepy
- dry mouth
- feeling dizzy
A significant side effect to keep in mind for all of these antihistamines is fatigue or drowsiness, especially if you intend to drive.
This problem can compound when consuming alcohol and taking one of these antihistamines for use against alcohol flushing. Mixing things like Zantac and alcohol means that both the alcohol and the antihistamine can cause fatigue simultaneously.
Alternatives to Pepcid AC, Zantac and Zyrtec for Asian flush
Are there possible alternatives to Pepcid AC, Zantac and Zyrtec for the attenuation of Asian flush symptoms?
When researching how to prevent alcohol flush reactions, a potential alternative to antacids and other antihistamine medications is an amino acid called N-acetyl cysteine or "NAC". Unlike Pepcid & Zantac, NAC does not reduce alcohol flush reaction by controlling histamine release. It does so by reducing blood acetaldehyde levels.
A 1995 study aimed to examine the role of N-acetyl cysteine in attenuating alcohol-related hypertension in rats. The scientists found that N-acetyl cysteine, an analogue of the dietary amino acid cysteine, binds acetaldehyde and works to prevent its damaging effect on physiological proteins.
In conclusion, the scientists stated that:
“Increase in blood acetaldehyde with ethanol treatment was significantly attenuated with N-acetyl cysteine treatment.”
This method addresses the problem of acetaldehyde exposure, rather than merely masking symptoms.
A final word on the use of antihistamines for Asian flush
We discussed the effect of Pepcid, Zyrtec and Zantac on Asian flush in light of evidence linking "off label" antihistamine use to symptomatic relief.
A small number of clinical trials have shown that antihistamines similar to Pepcid AC and Zyrtec may alleviate symptoms such as a red face and restricted breathing.
Despite this, it seems clear that the overarching health concerns of using antacids and other antihistamines with alcohol outweigh the slight improvements seen in symptoms.
Miller NS1, Goodwin DW, Jones FC, Gabrielli WF, Pardo MP, Anand MM, Hall TB (1988). "Antihistamine Blockade of Alcohol-Induced Flushing in Orientals". J Stud Alcohol. 1988 Jan;49(1):16-20.
Kawano T1, Matsuse H, Kondo Y, Machida I, Saeki S, Tomari S, Mitsuta K, Obase Y, Fukushima C, Shimoda T, Kohno S (2004). "Acetaldehyde Induces Histamine Release From Human Airway Mast Cells to Cause Bronchoconstriction". Int Arch Allergy Immunol. 2004 Jul;134(3):233-9. Epub 2004 Jun 1.
Brooks PJ, Enoch M-A, Goldman D, Li T-K, and Yokoyama A. (2009). "The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption". PLoS Medicine. Vol. 6 No. 3: e1000050.
World Health Organization International Agency For Research On Cancer Lyon, France (2009). "IARC Strengthens Its Findings On Several Carcinogenic Personal Habits and Household Exposures". Press Release. No. 196.
Vasdev S1, Mian T, Longerich L, Prabhakaran V, Parai S (1995). "N-Acetyl Cysteine Attenuates Ethanol-Induced Hypertension in Rats". Artery. 1995;21(6):312-6.