Capsaicin
QUTENZA
Pronunciation: kap-SAY-i-sin
What it isTRPV1 agonist causing nociceptor defunctionalization; neuropathic pain.
Why this one8% patch gives months of relief from a single application by depleting nerve terminals.
What limits itIntense burning during application requires pre-treatment and supervised administration. Benefit takes weeks to appear.
Pearls
- Qutenza: 60 minutes for postherpetic neuralgia, 30 minutes on diabetic feet.
- Low-strength creams and patches are OTC.
FDA-approved for
- neuropathic pain (2009)
Principal riskIntense burning during application
Classes and tags
Clinical profile
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Neuropathic pain of postherpetic neuralgia (PHN) | Adults | Single 60-min application of up to 4 systems (HCP-applied) | Repeat every 3 months or as pain returns | 4 systems per application; not more often than every 3 months |
| Neuropathic pain of diabetic peripheral neuropathy (DPN) of the feet | Adults | Single 30-min application on the feet of up to 4 systems (HCP-applied) | Repeat every 3 months or as pain returns | 4 systems per application; not more often than every 3 months |
Renal Undefined
Hepatic Undefined
Safety/effectiveness <18 years not studied; no dose adjustment in geriatric patients
Instructions
- Physician/HCP administration only; do not dispense for self-administration or handling
- Well-ventilated area; nitrile (not latex) gloves; face mask and protective glasses advisable
- Dry, intact skin only; not on face, eyes, mouth, nose or scalp; DPN: examine feet before each application
- Mark treatment area; clip (do not shave) hair; system may be cut to fit; optional topical anesthetic pretreatment
- Remove gently and slowly by rolling inward; apply Cleansing Gel for at least one minute, wipe off, wash with soap and water
- Treated area may be heat-sensitive for a few days
Available strengths
- patch 8 %
- sol 0.1 g/100 g
- sol 0.075 g/100 mL
- sol 0.0015 g/mL
- sol 0.25 mg/mL
- cream 0.025, 0.035, 0.075, 0.1 g/100 g
- cream 0.12 g/120 g
- cream 0.08 g/80 g
- + 10 other marketed forms not shown
Cautions
- Severe irritation with unintended capsaicin exposure (eyes, mucous membranes, respiratory tract, skin)
- Application-associated pain — prepare local cooling/analgesics
- Transient blood pressure increase — monitor during and after treatment
- Reduced sensory function — assess before each application
- Severe application site burns (second-/third-degree)
Adverse reactions
- Application site erythema
- Application site pain
- Application site pruritus
- Application site papules
- Application site edema
- Burning sensation (DPN)
- Pain in extremity (DPN)
- Nausea
- Vomiting
- Nasopharyngitis
- Hypertension
Pregnancy Negligible systemic absorption; fetal exposure not expected; no malformations in animal studies
Lactation Negligible absorption; infant exposure not expected; avoid applying to nipple and areola
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 8 % | patch | per unit | not offered |
Open Capsaicin in the interactive console ↗
Self-check
- What capsaicin concentration patch can give months of relief?
8%. - How quickly does capsaicin benefit appear?
Over weeks.