capsicum

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.

REMS

PO: Dyspepsia
Topical Treatment of the following conditions:
- Arthritis,
- Lower back pain,
- Neuralgias.
Intranasal: Treatment of the following conditions:
- Headache,
- Perennial rhinitis.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Injured skin or open wounds (topical);
Infectious or inflammatory GI conditions (oral);
OB: Pregnancy (oral);
Lactation: Lactation (oral).

Use Cautiously in:

Renal or hepatic impairment (long-term, high doses);
Surgery (discontinue use ≥2 wk prior to procedure).
OB: Pregnancy;
Lactation: Lactation (topical);
Pedi: Safety and effectiveness not established in children;

Adv. Reactions/Side Effects ⬆ ⬇

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

EENT: cough, lacrimation, rhinorrhea

GI: GI irritation, diarrhea

Hemat: bleeding

Interactions ⬆ ⬇

Natural-Drug Products:

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

Natural-Natural Products:

May ↑ risk of bleeding with clove, garlic, ginger, ginseng, and ginkgo.

Availability ⬆ ⬇

Powder: OTC
Capsules: OTC
Tincture: OTC
Topical cream: OTC

Route/Dosage ⬆ ⬇

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

US Brand Names ⬆ ⬇

capsaicin, chili pepper, African bird pepper, Capsicum annuum

Action ⬆ ⬇

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.

Therapeutic effects:

Decreased pain sensation.

Classifications ⬆ ⬇

Therapeutic Classification: analgesics

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed when applied to skin.

Distribution: Unknown.

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

Half-Life: Topical: 1.6 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	Unknown	Unknown	Unknown
Topical	Unknown	Unknown	Unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication.
Instruct patient to wear gloves for application of topical preparation or hands should be washed immediately after application. Do not wash treated area for ≥30 min after topical application.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Inform patient that transient burning may occur. Burning sensations usually disappear after the 1st few days but may continue for ≥2–4 wk. Burning is ↑ by heat, sweat, bathing in warm water, humidity and clothing. Burning usually ↓ in frequency and intensity the longer capsaicin is used.
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. A diluted vinegar solution can be used to remove capsicum cream.
Instruct patient 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 >1 mo, worsens, or if signs of infection occur.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. If breastfeeding, advise not to apply to breasts.

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Indications ⬇