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Indications:

Traditional claims surrounding the use of capsicum include treatment of bowel disorders, chronic laryngitis, and peripheral vascular disease. Various preparations of capsicum have been applied topically as counterirritants and external analgesics. Topical capsaicin preparations are useful for treating pain associated with diabetic neuropathy, osteoarthritis, postherpetic neuralgia postsurgical pain (including postmastectomy and postamputation pain), rheumatoid arthritis, and other neuropathic pain and complex pain syndromes Capsaicin has been suggested for refractory pruritus and pruritus associated with renal failure. A small study has suggested that nasal inhalation of capsaicin may be beneficial in nonallergic, noninfectious perennial rhinitis. Poor tolerability may be of issue with larger clinical trials. One study has reported capsaicin’s use for urinary urgency. Capsaicin is also increasingly popular as a nonlethal self-defense spray.

Contraindications:

Contraindicated in patients who are hypersensitive to capsicum or chili pepper products. Also contraindicated in pregnant patients to avoid possible uterine stimulant effects.

Adverse reactions:

CNS: neuropathy. EENT: blepharospasm, conjunctival edema, extreme burning pain in eye, hyperemia, lacrimation (ocular complications arc rare and usually result from eye rubbing); burning pain in nose, serous nasal discharge, sneezing. GI: GI discomfort (minimized if seeds are removed from the product before ingestion). GU: renal dysfunction (when used orally on a regular basis). Hematologic: deficient coagulability, RBC hemolysis. Hepatic: hepatic dysfunction (when used orally on a regular basis). Respiratory: transient bronchoconstriction, cough, and retrosternal discomfort. Skin: transient erythema, irritation, itching, and stinging without vesicular eruption (diminishes with repeated use).

Interactions:

ACE inhibitors: Topical application of capsicum may contribute to the cough reflex. Avoid administration with capsicum. Anticoagulant and antiplatelet properties: May increase hypocoagulability when used concurrently with such drugs as warfarin and acetylsalicylic acid. Avoid administration with capsicum. Centrally acting adrenergic agents: May reduce efficacy of antihypertensives such as clonidine and methyldopa. Avoid administration with capsicum. MAO inhibitors: May promote toxicity (hypertensive crisis) when used together because of catecholamine release. Avoid administration with capsicum. Sedatives: Concomitant use may cause additive therapeutic and adverse effects. Use together cautiously.

Warnings:

The intensity of adverse reactions depends on the dose and concentration. Alert topical application of capsicum to open wounds or injured skin, relief can occur in as little as 3 days but may take 14 to 28 days, depending on the condition that requires analgesia. No evidence exists that topical application causes permanent neurologic injury. Dose-related (1 to 100 nM) RBC hemolysis associated with significant changes in erythrocyte membrane lipid components as well as acetylcholinesterase activity can occur. Instruct the patient to avoid contact with eyes, mucous membranes, and nonintact skin. Direct him to flush the exposed area with cool running water for as long as necessary if incidental contact occurs. Caution the patient taking MAO inhibitors or centrally acting adrenergics against using capsicum. Advise women to avoid using capsicum during pregnancy or when breast-feeding. Instruct the patient not to use other heat applications simultaneously with capsicum.

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