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Hi all....

Just dropping a friendly reminder. Until further evidence/studies arise - no flush does not meet the acetaldehyde is not present. I could just be "masked". Acetaldehyde is very toxic and carcinogenic. Asian's who flush do so because they cannot break down acetaldehyde. So even though you are now able to enjoy the pleasures of drinking, PLEASE keep it moderate. We flushers just cannot get rid of acetaldehyde like regular people can. If you constantly flood your bodies with a toxic cancer-causing agent, you are asking for trouble.

Hi folks,

thought I would clear up something in case anyone has is harbouring any misconceptions. The research does not show that Pepcid causes an elevation of acetaldehyde. So the increase risk of cancer is not from taking H2 blockers per se. The increased risk of cancer comes from increased alcohol consumption and therefore increased acetaldehyde production from the breakdown of the alcohol.  Just thought I would clear that up.

Takezou has hypothesized on some effects of the H2 blockers. Unfortunately, I have to say that is just pure speculation. When scientist test something, there is a basis for that test. If we just speculate, there could be a billion different hypotheses. E.g. 1) maybe the H2 blockers prevent cancer, 2) Maybe the H2 blockers convert acetaldehyde into a harmless substance, 3) Maybe H2 blockers react with alcohol to form harmless substace,etc etc...

My answer the Takezou's suggestions is that there is no evidence to show that H2 blockers would slow alcohol absorption. There is no basis for that suggestion at this time. Further, as I mentioned in my earlier posts, alcohol levels are similar if not slightly elevated with H2 blockers. If the drugs slowed absorption, then you would expect a decreased blood alcohol level. (Dipadova et al found that famotidine, or the beloved pepcid, has no influence on blood alcohol levels. This was also shown by Cassini in 1994. However Ranitidine, i.e. zantac, does slightly elevate blood alcohol). The fact that the H2 blockers work must be caused by something other than decreased alcohol absorption.

As to the 2nd question, as to acetaldehyde being broken down faster. Again, there is no evidence to show that happens. There is no known reaction between acetaldehyde and the H2 blockers per se, and thus no reason to support that hypothesis. Again, and as expected, the research done on H2 blockers show that there is no change in acetaldehyde levels after consumption of ethanol with ranitidine or famotidine. (Tanaka et al, 1988)

Now, the previous favourite hypothesis, as mentioned earlier is that, the H2 blockers inhibit the CONVERSION of alcohol to acetaldehyde. There is at least some basis for this hypothesis because Ranitidine is an inhibitor of alcohol dehydrogenase (the enzyme responsible for the conversion). Dipadova's research found that taking Ranitidine indeed does, to some extent, increase blood alcohol concentration, thus supporting the argument that alcohol breakdown is being slowed. BUT, famotidine, as mentioned above, was found to have no such effect. This is what leads me to believe that there is something else in play which makes Pepcid work. Note that Nemesanszky et al, in a 1996 review of all the evidence, opined that the effect on blood alcohol levels is only very small.

That's why I believe that it is possible that the H2 blockers perhaps work on the release of histamine. The flushing, shortness of breath etc are symptoms of histamine release. And acetaldehyde has been shown to cause histamine release in certain cells. But I state emphatically, the research has shown that neither ranitidine or famotidine decreases serum acetaldehyde. The citation for Tanaka's study is  Br J Clin Pharmacol. 1988 Jul;26(1):96-9.  You should be able to find it on Pubmed. In fact, the Tanaka study showed that Cimetidine, or Tagamet, could actually increase exposure to acetaldehyde (Area under curve for acetaldehyde was slightly elevated). Fortunately, i don't think Tagamet is all that popular here!

So again, please don't take pepcid or zantac as a licence to drink freely.

P.S. It is the result of the Dipadova study, which showed that ranitidine decreased first pass metabolism of alcohol, that makes the Zantac + Claritine combo my favourite. This is because I know that the ranitidine is at least slowing down acetaldehyde production in my blood to some degree. Hopefully giving some protection against it's ill effects. 

pps. the Dipadova citation is JAMA. 1992 Jan 1;267(1):83-6

Redbul:

Yes. All the products mentioned in this forum are available at the pharmacy. However, you have to get it from the registered pharmacists (not all pharmacists have one in attendance). Instead of Pepcid, u may have to ask for the generic Famotidine because they don't carry the brand name "Pepcid" here. And if you are going for the Zantac Claritine combi, note that Zantac is Ranitidine and Claritine is Loartidine. I would not get the Zantac brand Ranitidie as it costs a bomb. Ask for the generic brands, they are much cheaper.

Sweetpea and Jeebus:

Please keep in mind that the meds we are discussing here are not shown to drastically reduce acetaldehyde in our blood. From the research thus far available, my guess is that it merely MASKS the EFFECTS of the acetaldehyde as opposed to cleaning up the acetaldehyde itself. Now there is ample research to show that acetaldehyde is highly toxic and carcinogenic. It's also been linked to cell and blood vessel damage. There is NO evidence to show that the H1/H2 blockers actually help prevent this aspect of acetaldehyde damage. So I am not surprised that sometimes our bodies still react negatively or signal us to stop.

The heartthumping is likely due to vasodilation, I believe. Most likely, so is the warm feeling in the face. When we drink, our vessels dilate and expand. This causes our blood pressure to drop. Our heart therefore has to pump harder to maintain our blood supply. I find that taking the meds helps with my own heart thumping. Perhaps being embarrassed about being bright red causes my heart to beat harder so when I don't turn red, I notice a difference in the thumping!

In any case, I repeat my mantra.... please moderate or minimise your drinking even if the meds are working for you.

Cheers!

The real conclusive way to find out is to have your genes tested. However, as a general rule, homozygotes are MUCH more sensitive. I.e. they will start getting red at just a few sips, and will get very uncomfortable quickly.  For me, if I finish a single beer or a single glass of wine within 20 mins, I would be beet red and have a thumping heart and probably a headache. I would NOT touch another drop.

Heterozygotes tend to have varying ability to keep drinking. They may go red, but can still drink on.  Some of my other friends, whom I suspect to be hetero, will drink, go red, but enjoy the drink to the end. They will easily have a 2nd drink or more, but may remain red.

Sweetpea- personally, I've never tried getting totally drunk while on the combo. But just a wee bit high. Generally, from my experience, the flush did not come back after the 3-4 hour mark, even though I was still a bit "high" from the alcohol.  I think it would be best to experiment yourself as I am not yet that "experienced" in the h1/h2 combo.  I believe Pepcid is easily available over the net. But be cautious about your country's laws as importing controlled substances could well be illegal. Where are you from?

Crimson - No, no drowsiness, or rather, no additional drowsiness that could not be attributed to alcohol. I am also alternating between the zantac/claritine combo and pepcid. I hope that will avert any resistance to either, and it just feels safer not overloading your body with too much of one drug.

Bchin - you sound like a homozygote. (no I am not calling names). Basically, you have a double defective allele in your genes. Some of the flushers here have one good and one bad allele. I am like you. Typically, studies show that we experience 18x the level of acetaldehyde as "normal" people. Heterozygotes (1 good, 1 bad allele), only experience 5 x the acetaldehyde. I find the Zantac Claritine combo works for me very well. So there is hope, even for homozygotes. But pls remember, that the bad stuff acetaldehyde could still be coursing through your veins doing all sorts of damage even though you don't turn red. We need more research in that area.

Crimson is correct about Claritin/Clarintine/Clarityne etc... its sold under diff names in diff countries as well. The ingredient you would look for is Loratadine.

As for the dosage, please look at the pending patent that I posted about on 10 Oct 06. The researchers used and suggested 150mg of Ranitidine (zantac) and 10mg of Loratidine (Clarityne) I think. However, they did suggest a possibility of higher dosages, but THEY HAVE NOT TESTED THAT. So I would not encourage it.

Timing -  the researchers in the said pending patent suggests 30 mins before drinking. apparently the effects last 3 hours. To be safe, I take it about 40 mins before drinking and it works fine. I haven't really taken the time to notice if it works better on an empty or fulll stomach... may look into this.

B Vitamins, Vitamin C, Cysteine (slow release) - Ok, here's something else I would like to bring up. I know there is another thread on this, but I just thought I'd share with you that these are other supplements that I take in conjunction with the H1/H2 inhibitors. These supplements have negligible effect on the flush. However, I take these to somewhat protect against the effects of acetaldehyde. Now, the studies are vague and not conclusive. Cysteine for example can "clear out" acetaldehyde in a test tube, but we don't know how well it works in the blood system. Anyway, it is certainly speculative, but I am hoping that these supplements help protect at least to some degree, my body against acetaldehyde. Experiments on rats have shown some protective effect. Please note that many supplements have shown to help lower blood acetaldehyde levels (like Taurine), but often, they only work on people who are not carrying the defective gene. Again, (nag nag nag), please be very aware of the danger of the highly toxic carcinogen, acetaldehyde, that we expose our bodies too each time we drink.

Thanks for the article Wai. i am not sure how this article helps?

I think we can take it that the cause of acetaldehyde elevation is very well understood by now (the effect of the ADLH2*2 mutated allele is clearly explained in other posts). Nonetheless, it is good that some of you are reading up and learning about the intricacies of our condition.

What would be helpful is if anyone could find recent research to conclusive show how H1/H2 inhibitors affect the flushing syndrome.

I hope I can help clarify this point.

The guilty product of the breakdown of alcohol is not ethanol, but acetaldehyde. That's what makes us go red and gives the rapid pulse. The effect of H2 blockers on blood alcohol has been well studied. Cimetidine (tagamet), Ranitidine (zantac) and our best bud Famotidine (pepcid) were studied. If the blockers slowed the breakdown of alcohol, then you would expect to have elevated alcohol concentrations in your blood after taking H2 blockers. The studies however show that there is only a very mild elevation of blood alcohol for Cimetidine and Ranitidine. Ironically, this forum's favourite H2 blocker Famotidine caused NO elevation in blood alcohol.  Zantac, not Pepcid inhibits alcohol breakdown and the formation of acetaldehyde. The alcohol will be broken down eventually, but at a much slower rate. Slow enough for our defective enzymes to clear out all the acetaldehyde that it produces.

This also basically means that the Pepcid you are popping is stopping the flushing via a different method. This is why I often urge caution against being carried away with one's new found drinking prowess.

ok just an update on my H1/H2 combi (further to my earlier post).

It works. 

I am one of those who turn red on the first coupla sips. The Zantac Claritine combi works for me, and just reduces it to a slight pink.  A friend even commented "wow, u can drink now eh?". This may be good alternative to pepcid for those living in countries where pepcid is prescription only. I don't know if Claritine is prescription too. Zantac should be common OTC in most countries. The active product is loratadine.

Again folks, a warning to all, this combi is still subject to a pending patent. It has not yet been thru any approvals/testing from regulatory bodies.

Also, pls note that the studies showed that these blockers may not work by decreasing Acetaldehyde levels. Just stops the effect of the acetaldehyde. I.e., the toxic stuff is still running through our veins at much higher levels than "normal" people, we just don't feel the usual symptoms as much with these H1/H2 blockers.