CAPSAICIN

CAPSAICIN
(cap-say'i-sin)
Axsain, Capsaicin, Capsin, Capsacin-P, Dolorac, Zostrix, Zostrix-HP
Classifications: topical analgesic;
Therapeutic: topical analgesic

Availability

0.025%, 0.075% lotion; 0.025%, 0.075%, 0.25% cream; 0.025%, 0.05% gel

Action

Capsaicin is an alkaloid derived from plants and used as a topical analgesic. Capsaicin depletes and prevents reaccumulation of Substance P, the primary chemical mediator of pain impulses from the periphery to the CNS.

Therapeutic Effect

Renders skin and joints insensitive to pain; therefore, it serves as an effective peripheral analgesic.

Uses

Temporary relief of pain from arthritis, neuralgias, diabetic neuropathy, and herpes zoster.

Unlabeled Uses

Phantom limb pain, psoriasis, intractable pruritus.

Contraindications

Hypersensitivity to capsaicin or any ingredient in the cream.

Cautious Use

Patients on ACE inhibitors. Safety and efficacy in children <2 y have not been established.

Route & Dosage

Analgesia
Adult/Child (>2 y): Topical Apply to affected area not more than 3–4 times/d

Administration

Topical
  • Apply to affected areas only and avoid contact with eyes or broken or irritated skin.
  • If applied with bare hand, wash immediately following application. An applicator or gloved hand may be used to apply cream.
  • Avoid tight bandages over areas of application of the cream.

Adverse Effects (≥1%)

CNS: Concentration >1%: neurotoxicity, hyperalgesia. Skin: Burning, stinging, redness, itching. Other: Cough.

Interactions

Drug: May increase incidence of cough with ace inhibitors.

Pharmacokinetics

Onset: Postherpetic neuralgia: 2–6 wk.

Nursing Implications

Assessment & Drug Effects

  • Monitor for significant pain relief, which may require 4–6 wk of application three or four times daily.
  • Monitor for and report signs of skin breakdown as these generally indicate need for drug discontinuation.

Patient & Family Education

  • Report local discomfort at site of application if discomfort is distressing or persists beyond the first 3–4 d of use.
  • Use caution in handling contact lenses following application of cream. Wash hands thoroughly before touching lenses.
  • Notify physician if symptoms do not improve or condition worsens within 14–28 d.
  • Apply frequently three or four times daily to maximize therapeutic effectiveness.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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