In combination with: methylsalicylate (ZiksOTC). See Appendix [not included in this PDA edition].
Route/Dosage⬆⬇
(Adults and Children ≥2 yr): Apply to affected areas 3–4 times daily.
Transdermal (Adults ): Postherpetic neuralgia: Apply up to 4 patches for 60 min (single use); may be repeated every 3 mo, as needed based on pain (should not be used more frequently than every 3 mo); Diabetic neuropathy of feet: Apply up to 4 patches for 30 min (single use); may be repeated every 3 mo, as needed based on pain (should not be used more frequently than every 3 mo).
US Brand Names⬆⬇
Capzasin-HP, Capzasin-P, DiabetAid Pain and Tingling Relief, Qutenza, Zostrix, Zostrix-HP
Action⬆⬇
TopicalMay deplete and prevent the reaccumulation of a chemical (substance P) responsible for transmitting painful impulses from peripheral sites to the CNS.
TransdermalInitially stimulates the transient receptor potential vanilloid 1 (TRPV1) receptors on nociceptive nerve fibers in the skin; this is followed by pain relief thought to be due to a reduction in TRPV1-expressing nociceptive nerve endings.
Therapeutic effects:
Relief of discomfort associated with painful peripheral syndromes.
‡May take up to 6 wk for head and neck neuralgias.
Patient/Family Teaching⬆⬇
Topical Instruct patient on the correct method for application of capsaicin. 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 ≥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.
Advise patient that transient burning may occur with application, especially if applied fewer than 3–4 times daily. Burning usually disappears after the first few days but may continue for 2–4 wk or longer. Burning is ↑ by heat, sweating, bathing in warm water, humidity, and clothing. Burning usually ↓ in frequency and intensity the longer capsaicin is used. ↓ number of daily doses will not lessen burning but may ↓ 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.
Instruct patient with herpes zoster (shingles) not to apply capsaicin cream until lesions have healed completely.
Advise patient to discontinue use and notify health care professional if pain persists >1 mo, worsens, or if signs of infection are present.
Inform patient that treated area may be sensitive for a few days to heat (e.g., hot showers or baths, direct sunlight, vigorous exercise).
Advise patient that exposure of skin to capsaicin may result in transient erythema and burning sensation. Instruct patients not to touch patch; if they accidentally touch patch, it may burn and/or sting.
Instruct patient to notify health care professional immediately if irritation of eyes or airways occurs or if any side effects become severe.
If opioids are used to treat pain from patch, caution patient that opioids may cause drowsiness and to avoid driving or other activities requiring alertness until response to medication is known.
May cause transient ↑ in BP. Instruct patients to inform health care professional if they have experienced any recent cardiovascular event.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise breastfeeding patient to avoid application to nipple and areola. Capsaicin is negligibly absorbed systemically following topical administration, and fetal exposure is not expected following maternal use.
