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 Arthritis, lower back pain, and neuralgias
Headache, perennial rhinitis

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.

Pharmacokinetics ⬆ ⬇

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).

Time/Action Profile ⬆ ⬇

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

Contraind./Precautions ⬆ ⬇

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).

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 ↑ 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.

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 to 4 times daily (may take up to 14 days to see an effect).
(Adults ): 0.1 mL of a 10 mM suspension (300mcg/day) applied to nostril.

Availability ⬆ ⬇

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

Assessment ⬆ ⬇

Assess pain intensity and location before and periodically during therapy.

Lab Test Considerations:

Monitor: liver and kidney function tests in patients receiving oral therapy. Notes: Capsicum (or cayenne) alters temperature regulation and stimulates circulation.

Implementation ⬆ ⬇

Topical Apply to affected area not more than 3–4 times daily. Avoid getting medication into eyes or on broken or irritated skin. Do not bandage tightly.
- Topical lidocaine may be applied during the first 1–2 wk of treatment to reduce initial discomfort.

Patient/Family Teaching ⬆ ⬇

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.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in discomfort associated with:.
- postherpetic neuralgia.
- disbetic neuropathy.
- rheumatoid arthritis.
- osteiarthritis.
Pain relief usually begins within 1–2 wks with arthritis, 2–4 wks with nauralgia, and 4–6 wks with neuralgias of the head and neck.

US Brand Names ⬆ ⬇

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

Code ⬆

NDC Code

0220- Boiron
- 0220-1138- Capsicum annuum
  - 0220-1138-41- 9 [hp_C] in 1 TUBE (0220-1138-41)

0220- Boiron
- 0220-1139- Capsicum annuum
  - 0220-1139-41- 30 [hp_C] in 1 TUBE (0220-1139-41)

0220- Boiron
- 0220-1142- Capsicum annuum
  - 0220-1142-41- 200 [kp_C] in 1 TUBE (0220-1142-41)

0220- Boiron
- 0220-1147- Capsicum annuum
  - 0220-1147-41- 1 [hp_M] in 1 TUBE (0220-1147-41)

0220- Boiron
- 0220-1150- Capsicum annuum
  - 0220-1150-41- 6 [hp_C] in 1 TUBE (0220-1150-41)

15013- Sinol USA, Inc.
- 15013-004- SinolM Cold and Flu All-Natural
  - 15013-004-47- 15 mL in 1 BOTTLE, SPRAY (15013-004-47)

15013- Sinol USA, Inc.
- 15013-016- SinolD All-Natural Nasal Decongestant
  - 15013-016-06- 15 mL in 1 BOTTLE, SPRAY (15013-016-06)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇