capsaicin
Patient Counselling
Intended benefit: To relieve pain in patients suffering from osteoarthritis
Dosage: 0.025% capsaicin (Zostrix) and 0.075% capsaicin (Zuacta)1
Administration: Patients should be advised to use a concentration of capsaicin that works best for them and apply it in a thin layer over the affected area four times daily.2,3,4,5 Application should be with gloves and not near broken skin or mucous membranes.6 Furthermore, heating devices should not be placed on the skin after application.
Side effects: Pain, tingling, burning, stinging or erythema.1,6,7 Tingling reduces within 72 hours with repeated use; if it continues to bother the patient, options include using a lower concentration, or pre-treating the area with EMLA cream or topical lidocaine.6 Some patients experience coughing while a small portion of patients might experience arthralgia.7 Patients should also be advised of the side effects and encouraged to report any dermatological changes that they may experience.
Drug Interaction: No interactions with other drugs, natural health products, foods or herbal products have been identified.6,7
Special Populations
● Pregnancy: not studied in this population7
● Lactation: recommended to remove the product thoroughly if applied to nipple area.7 Avoid direct contact between infant skin and applied cream on patient’s body.7
● Renal: none7
● Hepatic: none7
● Pediatrics: do not use in persons under the age of 2.7 Safety and efficacy not determined in patients under the age of 18.7 Recommended to use the product on patients 18 years of age and older.7
● Other: hypersensitivity to capsaicin7
References:
1. RxFiles. Pain – chronic non-cancer (CNCP): General considerations. http://www.rxfiles.ca/rxfiles/uploads/documents/members/CHT-Pain-Chronic-NonCa.pdf Updated December 2013. Accessed March 4, 2014.
2. Altman RD, Aven A, Holmburg CE, Pfeifer LM, Sack M, Young GT. Capsaicin cream 0.025% as monotherapy for osteoarthritis: a double-blind study. Semin Arthritis Rheu. 1994; 23(6): 25-33.
3. Zhang WY, Li Wan Po A. The effectiveness of topically applied capsaicin: a meta-analysis. Eur J Clin Pharmacol. 1994; 46: 517-522.
4. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based expert consensus guidelines. Osteoarthr Cartilage. 2008; 16: 137-162.
5. Altman RD, Barthel HR. Topical Therapies for Osteoarthritis. Drugs. 2011; 71(10): 1259-1279.
6. Grindrod K, Marra C. Osteoarthritis. In: The Canadian Pharmacists Association (CPhA), 2nd ed. Patient Self-Care: Helping your patients make therapeutic choices. Ottawa, ON: CPhA; 2010: 456-469.
7. e-Therapeutics. Capsaicin Derivatives (CPhA Monograph). https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=capsaicin&simpleIndex=brand_generic&simpleQuery=capsaicin#m700107n00019. Updated 2014. Accessed March 4, 2014.
Dosage: 0.025% capsaicin (Zostrix) and 0.075% capsaicin (Zuacta)1
Administration: Patients should be advised to use a concentration of capsaicin that works best for them and apply it in a thin layer over the affected area four times daily.2,3,4,5 Application should be with gloves and not near broken skin or mucous membranes.6 Furthermore, heating devices should not be placed on the skin after application.
Side effects: Pain, tingling, burning, stinging or erythema.1,6,7 Tingling reduces within 72 hours with repeated use; if it continues to bother the patient, options include using a lower concentration, or pre-treating the area with EMLA cream or topical lidocaine.6 Some patients experience coughing while a small portion of patients might experience arthralgia.7 Patients should also be advised of the side effects and encouraged to report any dermatological changes that they may experience.
Drug Interaction: No interactions with other drugs, natural health products, foods or herbal products have been identified.6,7
Special Populations
● Pregnancy: not studied in this population7
● Lactation: recommended to remove the product thoroughly if applied to nipple area.7 Avoid direct contact between infant skin and applied cream on patient’s body.7
● Renal: none7
● Hepatic: none7
● Pediatrics: do not use in persons under the age of 2.7 Safety and efficacy not determined in patients under the age of 18.7 Recommended to use the product on patients 18 years of age and older.7
● Other: hypersensitivity to capsaicin7
References:
1. RxFiles. Pain – chronic non-cancer (CNCP): General considerations. http://www.rxfiles.ca/rxfiles/uploads/documents/members/CHT-Pain-Chronic-NonCa.pdf Updated December 2013. Accessed March 4, 2014.
2. Altman RD, Aven A, Holmburg CE, Pfeifer LM, Sack M, Young GT. Capsaicin cream 0.025% as monotherapy for osteoarthritis: a double-blind study. Semin Arthritis Rheu. 1994; 23(6): 25-33.
3. Zhang WY, Li Wan Po A. The effectiveness of topically applied capsaicin: a meta-analysis. Eur J Clin Pharmacol. 1994; 46: 517-522.
4. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based expert consensus guidelines. Osteoarthr Cartilage. 2008; 16: 137-162.
5. Altman RD, Barthel HR. Topical Therapies for Osteoarthritis. Drugs. 2011; 71(10): 1259-1279.
6. Grindrod K, Marra C. Osteoarthritis. In: The Canadian Pharmacists Association (CPhA), 2nd ed. Patient Self-Care: Helping your patients make therapeutic choices. Ottawa, ON: CPhA; 2010: 456-469.
7. e-Therapeutics. Capsaicin Derivatives (CPhA Monograph). https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=capsaicin&simpleIndex=brand_generic&simpleQuery=capsaicin#m700107n00019. Updated 2014. Accessed March 4, 2014.