capsaicin topical

Capsaicin topical is a pain-relieving (analgesic) medication used for the temporary relief of minor joint and muscle pains due to muscle strains, sprains, or cramps, bruises, arthritis, and backache.

Capsaicin topical is available over the counter (OTC) as topical creams, gels, and liquids. Capsaicin is also used off-label to relieve nerve pain (neuralgia) caused by certain nerve conditions (neuropathies). 

Capsaicin is an oleoresin, the active compound in chili peppers that causes a burning sensation when it comes into contact with any tissue. Capsaicin works on the counter-irritation principle, initially irritating nerve endings under the skin where it is applied, but continued exposure desensitizes the nerve cells (neurons), providing relief from pain. Capsaicin only provides temporary analgesia and does not treat the underlying condition.

Capsaicin desensitizes transient receptor potential vanilloid-1 (TRPV1), also known as capsaicin receptors. TRPV1 are ion channels on nerve cell membranes and desensitizing them prevents transmission of pain. In addition, capsaicin also locally depletes substance P, a natural chemical involved in neurotransmission of pain.

In addition to muscle and joint pain, other uses of capsaicin topical include:

Off-label

• Diabetic neuropathy (off-label)
• Burning mouth syndrome
• Pain and itching associated with psoriasis

Orphan designation

• Painful human immunodeficiency virus (HIV)-associated neuropathy
• Treatment of intermetatarsal neuroma (Morton's neuroma) that does not respond to conservative treatment and requires either neurectomy or neurolysis
• Postherpetic neuralgia
• Erythromelalgia, a condition with burning pain and redness

• Do not use if you are hypersensitive to capsaicin.
• You may experience a transient burning sensation which generally resolves after a few days of use.
• Do not apply on wounds, broken, irritated or damaged skin or skin folds.
• Do not apply within one hour after a bath, hot tub, sauna or shower.
• Do not cover with a bandage.
• Do not apply external heat, including heat pad, after topical application.
• Do not use capsaicin immediately before or after activities such as swimming, showering, bathing, strenuous exercise, sunbathing, sauna, steam bath, or other types of heat. Avoid exposure of treated areas to sunlight.
• If you develop chemical burns from capsaicin, discontinue use. Contact your physician if you have pain, blistering, or swelling from the burn injury.
• Contact your physician if:
  • You develop excessive redness, blistering, burning or irritation
  • Your symptoms persist for longer than 7 days
  • Symptoms get worse, or resolve and then recur
  • You have difficulty breathing or swallowing
• Use capsaicin with caution if you have high blood pressure (hypertension) or a history of cardiovascular events.

Common side effects of capsaicin topical include:

• Application site reactions including:
  • Redness (erythema)
  • Pain
• Transient increased pain at the application site
• Raised bumps in the skin (papules)
• Itching (pruritus)
• Nausea
• Vomiting
• Swelling (edema)
• Dryness
• High blood pressure (hypertension)
• Bronchial inflammation (bronchitis)
• Sinus inflammation (sinusitis)
• Skin odor
• Skin peeling (exfoliation)
• Headache
• Dizziness
• Taste perversion (dysgeusia)
• Cough

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Topical Cream

• 0.025%
• 0.035%
• 0.075%
• 0.1%

Topical Gel

• 0.025%

Topical Liquid

• 0.025%

Adult:

Skeletomuscular Pain

• Apply to affected area three or four times daily for 3-4 consecutive weeks and evaluate efficacy; efficacy decreased if used less than 3 times daily; not to exceed 4 applications/day; wash hands with soap and water after applying

Diabetic Neuropathy (Off-label)

• Cream: Apply to affected area three or four times daily for 3-4 consecutive weeks and evaluate efficacy; not to exceed 4 applications/day; wash hands with soap and water after applying

Pediatric:

• Safety and efficacy not established

• Systemic absorption from topical capsaicin is unlikely, hence topical application is not expected to cause serious adverse effects. Oral ingestion of topical capsaicin can cause irritation and burning sensation in the gastrointestinal tract. Exposure to mucous membranes can cause severe irritation, pain, and burning. If capsaicin gets in the eye, it can cause prolonged burning pain and tearing.
• Sips of cold milk or water may help with burning sensation in the mouth and esophagus. Rinsing with a lot of water can help relieve burning in the eyes and any capsaicin on the skin should be washed off with soap and water thoroughly.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Capsaicin topical has no listed severe, serious, moderate, or mild interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• Systemic absorption of topical capsaicin is limited and maternal use during pregnancy is unlikely to cause any adverse effects in the fetus.
• Significant systemic absorption of capsaicin topical application to appear in breast milk is unlikely. Avoid applying on the nipples and surrounding region.

• Use capsaicin topical exactly as per label instructions.
• Capsaicin topical is for external use only.
• Do not apply to face or scalp and avoid exposure to eyes and mucous membranes.
• Wash hands thoroughly after a topical application of capsaicin.
• Do not handle contact lenses for at least an hour after handling capsaicin.
• In case of accidental contact with eyes, nose or any sensitive areas, rinse with a lot of water and seek medical help if required, or contact Poison Control.
• Keep out of reach of children.