Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

• PO: Dyspepsia
• Topical: Arthritis, lower back pain, and neuralgias
• Intranasal: Headache, perennial rhinitis

Contraindicated in:

• Hypersensitivity or allergy
• Injured skin or open wounds (topical)
• Infectious or inflammatory GI conditions (oral)
• OB: Pregnancy and lactation (oral).

Use Cautiously in:

• OB: Pregnancy and lactation (topical)
• Pedi: Safety and efficacy has not been shown in children
• Kidney and/or liver disease (long-term, high doses)
• Surgery (discontinue use 2 wk prior to procedure).

Derm: burning (topical), erythema (topical), urticaria (topical), flushing, sweating.

EENT: cough, rhinorrhea, lacrimation,.

GI: GI irritation, diarrhea.

Hemat: bleeding.

Natural-Drug Products:

• May ↑ bleeding risk with antiplatelet agents or anticoagulants.
• May ↑ absorption of theophylline.

Natural-Natural Products:

• May ↑ bleeding risk when taken with clove, garlic, ginger, ginseng, and ginkgo.

• Powder: ;
• Capsules: ;
• Tincture: ;
• Topical cream: 0.025% (Zostrix); 0.075% (Zostrix-HP); 0.1% (Capzacin-HP);

• PO (Adults): Powder — 30–120 mg 3 times daily; Tincture — 0.6–2 mL/dose; Oleoresin — 0.6–2 mg/dose.
• Topical (Adults): Apply cream 3 to 4 times daily (may take up to 14 days to see an effect).
• Intranasal (Adults): 0.1 mL of a 10 mM suspension (300mcg/day) applied to nostril.

Capzasin-HP, Zostrix, capsaicin, chili pepper, African bird pepper, Capsicum annuum

• Binds to nociceptors in the skin, causing neuronal excitation, heightened sensitivity and cutaneous vasodilation. Initially, a burning or pricking sensation is produced. With repeated use, a period of desensitization occurs caused by substance P depletion.

• Decreased pain sensation.

Therapeutic Classification: analgesics

Absorption: Well absorbed when applied to skin.

Distribution: Unknown.

Metabolism/Excretion: Metabolized by the cytochrome P450 system to active metabolites.

Half-life: 1.6 hrs (topical).

• Instruct patient on the correct method for application. Rub cream into affected area well so that little or no cream is left on the surface. Gloves should be worn during application or hands should be washed immediately after application. If application is to hands for arthritis, do not wash hands for at least 30 min after application.
• Advise patient to apply missed doses as soon as possible unless almost time for next dose. Pain relief lasts only as long as capsaicin is used regularly.
• Inform patient that transient burning may occur with application, especially if applied less than 3–4 times daily. Burning usually disappears after the first few days but may continue for 2–4 wks or longer. Burning is increased by heat, sweating, bathing in warm water, humidity and clothing. Burning usually decreases in frequency and intensity the longer capsaicin is used. Decreasing number of daily doses will not lessen burning but may decrease amount of pain relief and may prolong period of burning.
• Caution patient to flush area with water if capsaicin gets into eyes and to wash with warm but not hot, soapy water if capsaicin gets on other sensitive areas of the body. A diluted vinegar solution can be used to remove capsicum cream (capsaicin is not water washable).
• Instruct patients with herpes zoster (shingles) not to apply capsaicin cream until lesions have completely healed.
• Advise patient to discontinue use and notify health care professional if pain persists longer than 1 mo, worsens, or if signs of infection occur.

KAP-si-kum