Alcohol Flush Reaction: Why Your Face Gets Red When You Drink

Drinking alcohol is common all over the world — whether it’s a beer at a football game, a happy-hour cocktail, or a family celebration. In the U.S., it’s estimated that over 60% of adults drink alcohol. And we know that drinking too much alcohol long-term can cause problems with almost every part of the body.

But for some people, the short-term effects of drinking alcohol are just as concerning. That’s because when they drink alcohol, they get a red, flushed face known as an alcohol flush reaction. But what exactly is the alcohol flush reaction? And do antihistamines such as famotidine (Pepcid AC) actually work to prevent it?

What is the alcohol flush reaction?

The alcohol flush reaction happens to some people after they drink alcohol. It usually causes your face and neck to turn hot and red — or flushed. You may also have other symptoms, including: 

• Headache

• Nausea

• Dizziness (vertigo)

• Low blood pressure

• Fast heart rate

• Trouble breathing

An alcohol flush reaction isn’t a true allergy — although people who experience it often describe themselves as “allergic to alcohol.” It’s also easy to confuse it with being sensitive to other things found in alcohol. Common examples are sulfites and histamine. If you’re sensitive to these ingredients, you may have symptoms that appear similar to an alcohol flush reaction.

Why does the alcohol flush reaction happen?

In short, the alcohol flush reaction happens when your body can’t metabolize (break down) alcohol quickly enough.

Alcohol is broken down by the body in multiple steps. An enzyme (protein) called alcohol dehydrogenase (ADH) first turns alcohol into a toxic substance called acetaldehyde. The next step involves an enzyme called alcohol dehydrogenase 2 (ALDH2). It turns the acetaldehyde into acetate, which is less toxic and easier for the body to remove.

But some people have a genetic variation of ALDH2 — ALDH2*2 — that takes longer to break down acetaldehyde. If you have this variation, when you consume alcohol, acetaldehyde ends up sticking around longer than it should. This triggers the release of a chemical called histamine. High levels of histamine can cause your blood vessels to widen, which leads to facial flushing.

The alcohol flush reaction can also happen to you even if you don’t have a variation of ALDH2. Certain medications can stop ALDH2 from working, which leads to the same build-up of acetaldehyde in the body. Some common medications that may cause this include metronidazole (Flagyl) sulfamethoxazole / trimethoprim (Bactrim, Septra).

Another medication, disulfiram, was intentionally designed to block ALDH2 and cause an adverse reaction to alcohol. It’s prescribed to treat alcohol use disorder, since these negative effects help discourage people from drinking alcohol.

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Are certain people more likely to experience the alcohol flush reaction?

Yes. People of East Asian descent are more prone to the alcohol flush reaction — commonly called Asian flush or Asian glow. The ALDH2*2 variation is inherited — meaning it’s passed down from parents to children. It’s found in 8% of the world population. But in East Asian populations, up to 40% of people have the ALDH2*2 version. Research finds both positive and negative health impacts of this variation.

The alcohol flush reaction is also more likely if you drink alcohol while you’re taking a medication that affects how it’s processed in your body. So it’s a good idea to talk with your healthcare provider or pharmacist about how alcohol can interact with any medications you’re taking.

Is the alcohol flush reaction harmful?

It can be. Acetaldehyde is toxic to the body. And studies show that people who experience the alcohol flush reaction have a higher risk of esophageal cancer — but only if they consume alcohol regularly. Limiting alcohol is one way everyone can prevent esophageal cancer. This is important because less than half of people survive more than 5 years after their diagnosis. Studies found that people with the ALDH2*2 variation are up to twice as likely to get esophageal cancer from alcohol than those without the variation.

Keep in mind that choosing to avoid alcohol lowers this risk. So it’s your best bet if you want to prevent long-term issues due to your alcohol flush reaction. If you get the alcohol flush reaction and drink a lot of alcohol, talk to your healthcare provider. They can let you know if screening for esophageal cancer is recommended. They can also help you find ways to cut back on your drinking if you’re interested in doing so.

Good to know: Even if you don't get the alcohol flush reaction, consuming a lot of alcohol puts you at greater risk of getting cancer. So it’s a good idea to be mindful about how much alcohol you consume. And don’t hesitate to reach out for support if you need it.

How do I prevent my face from getting red when I drink?

If you’re having an alcohol flush reaction, there aren’t any FDA-approved medications to treat it. The best way to prevent flushing is to drink less alcohol. Choosing drinks with lower alcohol content and drinking water in between alcoholic drinks are also helpful ways to manage this reaction. Talk to your healthcare provider if you have questions about how to manage your reaction to alcohol.

One small study showed that applying brimonidine gel to the face before drinking alcohol lowered flushing. But it isn’t approved for this use, and it only helps with the red face — it doesn’t affect the build-up of acetaldehyde in the body.

Newer treatments for the alcohol flush reaction include over-the-counter (OTC) patches that contain herbal ingredients, such as glutathione and N-acetyl-cysteine. The manufacturers claim that the patch ingredients can help your body process acetaldehyde, but these claims haven’t been backed up by clinical studies. And these OTC patches aren’t FDA approved to treat an alcohol flush reaction.

Can you use antihistamines or Pepcid to prevent the alcohol flush reaction?

Unfortunately, no. You may have heard that taking allergy or heartburn medications can help prevent the alcohol flush reaction. But neither one is actually effective at treating it.

Antihistamines

Acetaldehyde increases histamine release. This is the main cause of the facial flushing that happens with the reaction. So it makes sense that allergy medications, which block histamine, could help prevent this from happening. But blocking histamine doesn’t stop acetaldehyde from building up — and that’s where the real damage comes from.

And several antihistamines, such as cetirizine (Zyrtec) and diphenhydramine (Benadryl), can raise your risk of dizziness and drowsiness when they’re combined with alcohol. So combining them isn’t recommended.

Heartburn medications 

Cimetidine (Tagamet) is a heartburn medication called an H2 blocker. These medications also block histamine, but that’s not why people use them for alcohol flush syndrome. Cimetidine blocks ADH in the stomach. The idea is that blocking ADH prevents alcohol from being turned into acetaldehyde. If acetaldehyde isn’t formed, the alcohol flush reaction can’t take place. But most alcohol isn’t processed in the stomach — it’s processed in the liver. So blocking ADH in the stomach has little to no effect on the alcohol flush reaction.

Other H2 blockers, such as famotidine (Pepcid AC), are often suggested as alcohol flush reaction treatments, even though they don’t seem to affect ADH the same way as cimetidine. What’s more, H2 blockers can raise blood alcohol concentrations, which is the percent of alcohol in the blood. In severe cases, alcohol overdose can happen when these medications are combined with alcohol.

Keep in mind: The alcohol flush reaction is usually a sign that you should drink less alcohol, or stop drinking altogether. Using medications to hide flushing can lead you to drink more than you normally would. By preventing your body’s natural response to alcohol, you may miss out on a helpful warning sign that your acetaldehyde levels are too high. This can also put you at risk for short- and long-term health risks.  

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

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