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Capsaicin

Pronunciation

Pronunciation: kap-SAY-sin
Class: Counterirritant

Trade Names

Axsain
- Cream 0.25%

Capzaisin HP
- Cream 0.1%

Capzasin-P
- Cream 0.035%

Icy Hot PM
- Patch 0.025%

No Pain-HP
- Roll-On 0.075%

Qutenza
- Patch 8%

Zostrix
- Cream 0.025%

Zostrix Diabetic Foot Pain
- Cream 0.075%

Zostrix Diabetic Joint and Arthritis Pain Relief
- Cream 0.025%

Zostrix-HP
- Cream 0.075%

Capsaicin HP (Canada)

Pharmacology

OTC

May deplete and prevent reaccumulation of substance P, a principal transmitter of pain impulses, from periphery to CNS.

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Prescription

Causes an initial enhanced stimulation of the transient receptor potential vanilloid 1 receptor (TRPV1)–expressing cutaneous nociceptors, which is followed by pain relief thought to be mediated by a reduction in TRPV1-expressing nociceptive nerve endings.

Indications and Usage

OTC

Temporary relief of pain from rheumatoid arthritis, osteoarthritis, muscle strains, sprains, bruises, and backache; relief of neuralgias (eg, pain after shingles, diabetic neuropathy).

Prescription

For the management of neuropathic pain associated with postherpetic neuralgia.

Unlabeled Uses

Temporary relief of pain of psoriasis, vitiligo, intractable pruritus, postmastectomy and postamputation neuroma (phantom limb syndrome), vulvar vestibulitis, apocrine chromidrosis, reflex sympathetic dystrophy.

Contraindications

None well documented.

Dosage and Administration

OTC
Pain Adults

Topical Apply to affected area 3 to 4 times daily or less.

Prescription
Neuropathic pain Adults

Topical Apply a single 60-min application of up to 4 patches. May repeat every 3 mo or as warranted by the return of pain (not more frequently than every 3 mo).

General Advice

  • OTC
  • Wash hands with soap and water immediately after application.
  • Wear gloves during application and avoid contact with eyes and broken or irritated skin.
  • If bandage is needed, apply loosely to application area.
  • Prescription
  • Use only nitrile gloves when handling this product and when cleansing capsaicin from the skin. Do not use latex gloves.
  • Inspect the pouch. Do not use if the pouch has been torn or damaged.
  • The treatment area (painful area including area of hypersensitivity and allodynia) must be identified and marked on the skin.
  • If necessary, clip hair (do not shave) in and around the identified treatment area to promote patch adherence.
  • The patch can be cut to match the size and shape of the treatment area. Cut the patch before removing the protective release liner.
  • Use only on dry, intact (unbroken) skin.
  • Gently wash the treatment area with mild soap and water and dry thoroughly.
  • Pretreat with a topical anesthetic. Apply topical anesthetic to the entire treatment area and surrounding 1 to 2 cm, and keep the local anesthetic in place until the skin is anesthetized prior to the application of the patch. Remove the topical anesthetic with a dry wipe. Gently wash the treatment area with mild soap and water and dry thoroughly.
  • Refer the manufacturer's prescribing information for application, removal, and disposal directions.
  • To ensure capsaicin maintains contact with the treatment area, a dressing, such as rolled gauze, may be used.
  • Do not to touch the patch or treatment area.

Storage/Stability

Store between 59° and 86°F. Keep the patch in the sealed pouch until immediately before use.

Drug Interactions

ACE inhibitors (eg, captopril)

Capsaicin, including topical use, may cause or exacerbate coughing associated with ACE inhibitor treatment and vice versa. If a severe cough develops in patients taking an ACE inhibitor and using capsaicin, 1 or both drugs may need to be discontinued.

Adverse Reactions

Cardiovascular

Hypertension (2%).

CNS

Burning sensation, dizziness, dysgeusia, headache, hyperesthesia, hypoesthesia, peripheral sensory neuropathy.

Dermatologic

Pruritus (2%); abnormal skin odor, burning, erythema, stinging.

GI

Nausea (5%); vomiting (3%).

Local

Erythema (63%); pain (42%); papules, pruritus (6%); edema (4%); dryness, swelling (2%); anesthesia, bruising, dermatitis, excoriation, exfoliation, hyperesthesia, inflammation, paresthesia, peripheral edema, urticaria, warmth.

Respiratory

Nasopharyngitis (4%); sinusitis (3%); bronchitis (2%); cough, respiratory irritation, throat irritation.

Precautions

Monitor

OTC

Assess location and intensity of pain periodically throughout therapy.

Prescription

Monitor BP periodically.


Pregnancy

Category C (OTC); Category B (prescription).

Lactation

Undetermined.

Children

Do not use Icy Hot PM in children younger than 18 y. Safety and effectiveness of capsaicin prescription patches have not been studied in children younger than 18 y. Consult a health care provider before using in children younger than 18 y.

OTC

Note that transient burning may occur during initial course of therapy but will decrease in a few days. Burning is more common when medication is applied more than 3 times daily.

Prescription

Do not apply to the face or scalp. Remove patches gently and slowly to avoid aerosolization of capsaicin. If skin not intended to be treated comes in contact with capsaicin, apply cleansing gel for 1 min, wipe off with dry gauze, and wash the areas with soap and water. Treat acute pain during and following the application procedure with local cooling (ice pack) and/or appropriate analgesics.

Increased BP may occur.

Patient Information

  • OTC
  • Remind patient that this medication is for external use only.
  • Advise patient to wear gloves, avoid contact with eyes and broken or irritated skin, and wash hands with soap and water immediately after application.
  • Caution patient to use care when handling contact lenses after application.
  • Advise patient to keep bandage placed loosely over application area.
  • Emphasize that following prescribed regimen reduces transient burning associated with infrequent administration.
  • Instruct patient to discontinue treatment and notify health care provider if pain persists 7 days or returns a few days after initiation of therapy, or if signs of infection occur.
  • Counsel patient to notify health care provider if persistent cough and difficulty breathing or swallowing accompanies therapy.
  • Advise patient not to use a heating pad when using these products.
  • Prescription
  • Inform patients that transient erythema and burning sensation may occur. Advise patients not to touch the patch and that if they accidently touch the patch, it may burn and/or sting.
  • Advise patients that if irritation of the eyes or airways occurs, or if any of the adverse effects become severe, to notify their health care provider immediately.
  • Inform patients that the treated area may be sensitive to heat for a few days following treatment.
  • Advise patients that small increases in BP may occur during and shortly after treatment.

Copyright © 2009 Wolters Kluwer Health.

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