Indications and Application:

Localized Neuropathic Pain:

• • Cream (0.075% strength): Apply to the affected skin area 3-4 times daily. Applications should be spaced at least 4 hours apart. Use sparingly to avoid excessive skin irritation.

Post-Herpetic Neuralgia:

• • Cream: Apply 3-4 times daily after lesions have healed. Use sparingly and not more often than every 4 hours.

Painful Diabetic Neuropathy (Under Expert Supervision):

• • Cream: Apply 3-4 times daily for 8 weeks, then reassess effectiveness. Use sparingly and ensure at least 4 hours between applications.

Peripheral Neuropathic Pain (Under Physician Supervision):

• • Transdermal Patch: Consult product literature for specific application instructions.

Osteoarthritis:

• • Cream: Apply 4 times daily. Use sparingly and not more frequently than every 4 hours.

Cautions:

• General Precautions:

• • Avoid application on broken or inflamed skin.
  • Do not use under tight bandages.

• Topical Application:

• • Avoid contact with eyes and do not use before or after hot showers or baths to prevent enhanced burning sensations. Avoid inhaling vapors.

• Transdermal Application:

• • Do not apply on the face, scalp, or near mucous membranes.
  • Use caution in patients with diabetes, cardiovascular disease, or uncontrolled hypertension.

Side Effects:

• General:

• • Uncommon: Cough.

• Specific to Transdermal Use:

• • Common: Abnormal sensations.
  • Uncommon: Atrioventricular block, eye irritation, muscle spasms, nausea, palpitations, peripheral edema, skin reactions, tachycardia, altered taste, throat irritation.
  • Rare: Sneezing, watering eye.
  • Not specified: Asthma exacerbation, dyspnea, skin burning, and irritation if applied too frequently or excessively.

Handling and Storage:

• Topical Use: Wash hands immediately after application, or 30 minutes later if treating hands.
• Transdermal Use: Wear nitrile gloves during patch handling and area cleaning; latex gloves are insufficient.

Monitoring:

• Transdermal Use: Blood pressure should be monitored during treatment due to potential significant changes.

Medicinal Forms and Variations

Cutaneous Patch:

• Qutenza (Grunenthal Ltd): Contains capsaicin 179 mg per patch. It may include butylated hydroxyanisole among its excipients.

Creams:

• Axsain (Teva UK Ltd): Contains 750 micrograms of capsaicin per gram. Excipients may include benzyl alcohol and cetostearyl alcohol (comprising both cetyl and stearyl alcohols).
• Zacin (Teva UK Ltd): Contains 250 micrograms of capsaicin per gram, with similar excipients as Axsain.