capsaicin topical (Capzasin P, Zostrix, Capzasin-HP, Axsain, No Pain-HP, Pain Doctor, Pain-X, Rid-A-Pain, Salonpas Gel Patch, Salonpas Hot, Trixaicin, Menthac)

Dosing and uses of Capzasin P, Zostrix (capsaicin topical)

• Adult
• Pediatric

 

Adult dosage forms and strengths

topical cream

• 0.025%
• 0.035%
• 0.075%
• 0.1%

topical geL

• 0.025%

topical patch

• 0.025%
• 0.075%

topical liquid

• 0.025%

 

Skeletomuscular Pain

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

Patch: Apply patch to affected area up to 3-4 times daily for 7 days; patch may remain in place for up to 8 hr

 

Diabetic Neuropathy (Off-label)

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

 

Orphan Indications

Painful 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

Orphan indication sponsors

• NeurogesX, Inc; San Carlos Business Park 981F Industrial Road; San Carols, CA 94070-4117
• Vallinex Incorporated; 2400 Boston Street, Suite 330; Baltimore, MD 21224
• TheraQuest Biosciences, LLC; 146 Medinah Drive; Blue Bell, PA 19422-3212

 

Pediatric dosage forms and strengths

Safety & efficacy not established

 

Capzasin P, Zostrix (capsaicin topical) adverse (side) effects

>10%

Transient increased pain at application site (dissipates w/ continued use)

Application site erythema (63%)

Pain (42%)

 

1-10%

Nausea (5%)

Vomiting (3%)

Hypertension (2%)

Dryness (2%)

Swelling (2%)

Pruritus (6%)

Papules (6%)

Edema (4%)

Sinusitis (3%)

Bronchitis (2%)

 

<1%

Exfoliation

Dizziness

Cough

Skin odor

Headache

Dysguesia

 

Warnings

Contraindications

Hypersensitivity

 

Cautions

For external use only

Do not apply to broken skin

Do not apply to face or scalp to avoid exposure to eyes or mucous membranes

Treated area may be sensitive to heat for several days (eg, hot water, direct sunlight, vigorous exercise)

Use caution in patients with uncontrolled hypertension, history of cerebrovascular events

 

Pregnancy and lactation

Pregnancy category: B

Lactation: Unknown whether distributed in breast milk; do not apply to nipple or areola

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Capzasin P, Zostrix (capsaicin topical)

Mechanism of action

Transient receptor potential vanilloid-1 (TRPV1) agonist; topical application causes initial TRPV1 stimulation that may cause pain, followed by pain relief by reduction in TRPV1-expressing nociceptive nerve endings