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INTRODUCTION

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capsaicin (kap-say-sin)

Axsam, Capsin, Capzasin-P, Dolorac, No Pain-HP, Pain Doctor, Pain-X, R-Gel, Rid a Pain HP, Zostrix, Zostrix-HP

Classification

Therapeutic: nonopioid analgesics (topical)

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Indications
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Temporary management of pain due to rheumatoid arthritis and osteoarthritis. Treatment of pain associated with postherpetic neuralgia or diabetic neuropathy. Unlabeled Use: Treatment of postmastectomy pain syndrome. Treatment of complex regional pain syndrome.

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Action
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May deplete and prevent the reaccumulation of a chemical (substance P) responsible for transmitting painful impulses from peripheral sites to the CNS. Therapeutic Effects: Relief of discomfort associated with painful peripheral syndromes.

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Adverse Reactions/Side Effects
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Resp: cough. Derm: transient burning.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

  • Monitor the application site, and report any prolonged burning sensations or other skin reactions.

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Interventions
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  • Implement appropriate physical agents, therapeutic exercises, and manual techniques to reduce pain and complement the effects of this drug.

  • Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

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Patient/Client-Related Instruction
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  • Check that the patient and family or caregivers understand topical application procedures and adhere to the recommended dosing schedule.

  • Instruct patient to report any troublesome side effects such as severe or prolonged cough.

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Pharmacokinetics
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Absorption: Unknown.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: Unknown.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
topical 1–2 wk 2–4 wk* unknown

*May take up to 6 wk for head and neck neuralgias.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to capsaicin or hot peppers; Not for use near eyes or on open or broken skin.

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Use Cautiously in: OB/Lactation/Pedi: Safety not established for pregnant women, breast-feeding infants, or children <2 yr.

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Interactions
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Drug-Drug: None significant.

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Route/Dosage
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Topical (Adults and Children ≥2 yr): Apply to affected areas 3–4 times daily.

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Availability
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Cream: 0.025% OTC, 0.075% OTC. Gel: 0.05% OTC. Lotion: 0.025% OTC. Roll-on: 0.075% OTC. In combination with: methyl salicylate (Ziks OTC). See Appendix B.

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