Zostrix


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capsaicin

(kap-say-sin) ,

Capzasin-HP

(trade name),

Capzasin-P

(trade name),

DiabetAid Pain and Tingling Relief

(trade name),

Qutenza

(trade name),

Salonpas Hot

(trade name),

Zostrix Diabetic Foot Pain

(trade name),

Zostrix

(trade name),

Zostrix-HP

(trade name)

Classification

Therapeutic: nonopioid analgesics
Pregnancy Category: UK

Indications

Temporary management of pain due to rheumatoid arthritis and osteoarthritis.Treatment of pain associated with postherpetic neuralgia (topical and transdermal) or diabetic neuropathy.Treatment of postmastectomy pain syndrome.Treatment of complex regional pain syndrome.

Action

Topical: May deplete and prevent the reaccumulation of a chemical (substance P) responsible for transmitting painful impulses from peripheral sites to the CNS.
Transdermal: Initially stimulates the transient receptor potential vanilloid 1 (TRPV1) receptors on nociceptive nerve fibers in the skin; this is followed by pain relief thought to be due to a reduction in TRPV1–expressing nociceptive nerve endings.

Therapeutic effects

Relief of discomfort associated with painful peripheral syndromes.

Pharmacokinetics

Absorption: Unknown.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile

ROUTEONSETPEAKDURATION
topical1–2 wk2–4 wk†unknown
transdermalunknownunknownunknown
†May take up to 6 wk for head and neck neuralgias

Contraindications/Precautions

Contraindicated in: Hypersensitivity to capsaicin or hot peppers;Not for use near eyes or on open or broken skin.
Use Cautiously in: Obstetric / Lactation: Safety not established; Pediatric: Safety not established in children <18 yr (transdermal) or <2 yr (topical).

Adverse Reactions/Side Effects

Cardiovascular

    Patch:
  • ↑ BP

Respiratory

  • cough

Dermatologic

  • pain (after application of patch)
  • transient burning

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

Topical (Adults and Children ≥2 yr) Apply to affected areas 3–4 times daily.
Transdermal (Adults) Apply up to 4 patches for 60 min (single use); may be repeated q 3 mo, as needed based on pain (should not be used more frequently than q 3 mo).

Availability (generic available)

Cream: 0.1%OTC, 0.025%OTC, 0.035%OTC, 0.075%OTC
Gel: 0.025%OTC
Lotion: 0.025%OTC
Topical liquid: 0.15%OTC
Transdermal patch (Qutenza): 0.025%/patch, 8% (179 mg)/patch
In combination with: methylsalicylate (ZiksOTC). See combination drugs.

Nursing implications

Nursing assessment

  • Assess pain intensity and location before and periodically throughout therapy.
  • Transdermal: Monitor BP periodically during application.

Potential Nursing Diagnoses

Chronic pain (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • Do not confuse Zostrix with Zovirax.
  • Topical: Apply to affected area not more than 3–4 times daily. Avoid getting medication into eyes or on broken or irritated skin. Do not bandage tightly.
    • Topical lidocaine may be applied during the first 1–2 wk of treatment to reduce initial discomfort.
  • Transdermal: Identify treatment area (painful area including areas of hypersensitivity and allodynia) and mark on the skin. If needed, clip hair (do not shave) in and around treatment area to promote patch adherence. Cut patch to size and shape of treatment area. Gently wash area with mild soap and water and dry thoroughly. Apply topical anesthetic to the entire treatment area and surrounding 1–2 cm and keep the local anesthetic in place until skin is anesthetized prior to the application of patch. Remove the topical anesthetic with a dry wipe. Gently wash treatment area with mild soap and water and dry. Use only nitrile gloves when handling capsaicin and cleaning capsaicin residue from skin; latex gloves do not provide adequate protection. Apply patch to dry, intact skin. Apply patch within 2 hr of opening pouch. Tear pouch open along the three dashed lines and remove patch. Inspect patch and identify the outer surface backing layer with the printing on one side and the capsaicin-containing adhesive on the other side. Adhesive side of the patch is covered by a clear, unprinted, diagonally cut release liner. Cut patch before removing protective release liner. Peel a small section of the release liner back and place adhesive side of patch on treatment area. While slowly peeling back release liner from under patch with one hand, use other hand to smooth the patch down on to skin. Once patch is applied, leave in place for 60 min. To ensure patch maintains contact with treatment area, a dressing, such as rolled gauze, may be used. Instruct the patient not to touch the patch or treatment area.
    • Even following use of a local anesthetic prior to administration of capsaicin, patients may experience substantial procedural pain. Prepare to treat acute pain during and following application with local cooling (such as an ice pack) and/or appropriate analgesic medication (opioids).
    • Remove patches by gently and slowly rolling inward. After removal, generously apply Cleansing Gel to treatment area and leave on for at least 1 min. Remove Cleansing Gel with a dry wipe and gently wash area with mild soap and water and dry thoroughly. Aerosolization of capsaicin can occur upon rapid removal of patches. Remove patches gently and slowly by rolling adhesive side inward. If irritation of eyes or airways occurs, remove affected individual from the vicinity. Flush eyes and mucous membranes with cool water. Inhalation of airborne capsaicin can result in coughing or sneezing. Provide supportive care if shortness of breath develops. If skin not intended to be treated comes in contact with capsaicin, apply Cleansing Gel for 1 min and wipe off with dry gauze. After Cleansing Gel has been wiped off, wash area with soap and water.

Patient/Family Teaching

  • Topical: Instruct patient on the correct method for application of capsaicin. Rub cream into affected area well so that little or no cream is left on the surface. Gloves should be worn during application or hands should be washed immediately after application. If application is to hands for arthritis, do not wash hands for at least 30 min after application.
    • Advise patient to apply missed doses as soon as possible unless almost time for next dose. Pain relief lasts only as long as capsaicin is used regularly.
    • Advise patient that transient burning may occur with application, especially if applied fewer than 3–4 times daily. Burning usually disappears after the first few days but may continue for 2–4 wk or longer. Burning is increased by heat, sweating, bathing in warm water, humidity, and clothing. Burning usually decreases in frequency and intensity the longer capsaicin is used. Decreasing number of daily doses will not lessen burning but may decrease amount of pain relief and may prolong period of burning.
    • Caution patient to flush area with water if capsaicin gets into eyes and to wash with warm, but not hot, soapy water if capsaicin gets on other sensitive areas of the body.
    • Instruct patient with herpes zoster (shingles) not to apply capsaicin cream until lesions have healed completely.
    • Advise patient to discontinue use and notify health care professional if pain persists longer than 1 mo, worsens, or if signs of infection are present.
  • Transdermal: Inform patient that treated area may be sensitive for a few days to heat (e.g., hot showers or baths, direct sunlight, vigorous exercise).
    • Advise patient that exposure of skin to capsaicin may result in transient erythema and burning sensation. Instruct patients not to touch patch and if they accidentally touch patch it may burn and/or sting.
    • Instruct patient to notify health care professional immediately if irritation of eyes or airways occurs, or if any of the side effects become severe.
    • If opioids are used to treat pain from patch, caution patient that opioids may cause drowsiness and to avoid driving or other activities requiring alertness until response to medication is known.
    • May cause transient increases in BP. Instruct patients to inform health care professional if they have experienced any recent cardiovascular event.
    • Instruct patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in discomfort associated with:
    • Postherpetic neuropathy.
    • Diabetic neuropathy.
    • Rheumatoid arthritis.
    • Osteoarthritis. Pain relief usually begins within 1–2 wk with arthritis, 2–4 wk with neuralgias, and 4–6 wk with neuralgias of the head and neck.

capsicum

(kap-si-kum) ,

Capzasin-HP

(trade name),

Zostrix

(trade name),

capsaicin

(trade name),

chili pepper

(trade name),

African bird pepper

(trade name),

Capsicum annuum

(trade name)

Classification

Therapeutic: analgesics
Oral: Dyspepsia Topical: Arthritis, lower back pain, and neuralgias Intranasal: Headache, perennial rhinitis

Action

Binds to nociceptors in the skin, causing neuronal excitation, heightened sensitivity and cutaneous vasodilation. Initially, a burning or pricking sensation is produced. With repeated use, a period of desensitization occurs caused by substance P depletion.

Therapeutic effects

Decreased pain sensation.

Pharmacokinetics

Absorption: Well absorbed when applied to skin.
Distribution: Unknown.
Metabolism and Excretion: Metabolized by the cytochrome P450 system to active metabolites.
Half-life: 1.6 hrs (topical).

Time/action profile

ROUTEONSETPEAKDURATION
POUnknownUnknownUnknown
TopicalUnknownUnknownUnknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity or allergy; Injured skin or open wounds (topical); Infectious or inflammatory GI conditions (oral); Obstetric: Pregnancy and lactation (oral).
Use Cautiously in: Obstetric: Pregnancy and lactation (topical); Pediatric: Safety and efficacy has not been shown in children; Kidney and/or liver disease (long-term, high doses); Surgery (discontinue use 2 wk prior to procedure).

Adverse Reactions/Side Effects

Dermatologic

  • burning (topical)
  • erythema (topical)
  • urticaria (topical)
  • flushing
  • sweating

Ear, Eye, Nose, Throat

  • cough
  • rhinorrhea
  • lacrimation,

Gastrointestinal

  • GI irritation
  • diarrhea

Hematologic

  • bleeding

Interactions

May ↑ bleeding risk with antiplatelet agents or anticoagulants.May ↑ absorption of theophylline.May ↑ bleeding risk when taken with clove, garlic, ginger, ginseng, and ginkgo.
Oral (Adults) Powder—30–120 mg 3 times daily; Tincture—0.6–2 mL/dose; Oleoresin—0.6–2 mg/dose.
Topical (Adults) Apply cream 3 to 4 times daily (may take up to 14 days to see an effect).
Intranasal (Adults) 0.1 mL of a 10 mM suspension (300mcg/day) applied to nostril.

Availability

Powder:
Capsules:
Tincture:
Topical cream: 0.025% (Zostrix®), 0.075% (Zostrix-HP®), 0.1% (Capzacin-HP®)

Nursing implications

Nursing assessment

  • Assess pain intensity and location before and periodically during therapy.
  • Lab Test Considerations: Monitor: liver and kidney function tests in patients receiving oral therapy. Notes: Capsicum (or cayenne) alters temperature regulation and stimulates circulation.

Potential Nursing Diagnoses

Acute pain (Indications)

Implementation

  • Topical: Apply to affected area not more than 3–4 times daily. Avoid getting medication into eyes or on broken or irritated skin. Do not bandage tightly.
    • Topical lidocaine may be applied during the first 1–2 wk of treatment to reduce initial discomfort.

Patient/Family Teaching

  • Instruct patient on the correct method for application. Rub cream into affected area well so that little or no cream is left on the surface. Gloves should be worn during application or hands should be washed immediately after application. If application is to hands for arthritis, do not wash hands for at least 30 min after application.
  • Advise patient to apply missed doses as soon as possible unless almost time for next dose. Pain relief lasts only as long as capsaicin is used regularly.
  • Inform patient that transient burning may occur with application, especially if applied less than 3–4 times daily. Burning usually disappears after the first few days but may continue for 2–4 wks or longer. Burning is increased by heat, sweating, bathing in warm water, humidity and clothing. Burning usually decreases in frequency and intensity the longer capsaicin is used. Decreasing number of daily doses will not lessen burning but may decrease amount of pain relief and may prolong period of burning.
  • Caution patient to flush area with water if capsaicin gets into eyes and to wash with warm but not hot, soapy water if capsaicin gets on other sensitive areas of the body. A diluted vinegar solution can be used to remove capsicum cream (capsaicin is not water washable).
  • Instruct patients with herpes zoster (shingles) not to apply capsaicin cream until lesions have completely healed.
  • Advise patient to discontinue use and notify health care professional if pain persists longer than 1 mo, worsens, or if signs of infection occur.

Evaluation/Desired Outcomes

  • Decrease in discomfort associated with:.
    • postherpetic neuralgia.
    • disbetic neuropathy.
    • rheumatoid arthritis.
    • osteiarthritis.
  • Pain relief usually begins within 1–2 wks with arthritis, 2–4 wks with nauralgia, and 4–6 wks with neuralgias of the head and neck.

Zostrix®

Capsaicin, see there.
References in periodicals archive ?
Zostrix is said to be widely recommended by physicians and pharmacists alike for fast arthritis-pain relief.
April says that Health Care Products' experience with products for people with diabetes will be a tremendous resource when it comes to reinvigorating Zostrix.
Noting that nearly 43 million Americans have been diagnosed with arthritis, Health Care Products president Gary April sees great potential for Zostrix.
We are excited to acquire Zostrix and be part of this expanding category," April says.
Zostrix Neuropathy Cream is made with topical purified natural capsaicin (0.
Consumers and professionals, he adds, have broadened their view of Zostrix from an arthritis/external analgesics brand to a pain management brand that helps with pain of all kinds.
Arthritis sufferers must use Zostrix three or four times a day for at least a week to experience the full benefit, he adds.
Recently, the brand was extended with the rollout of Zostrix neuropathy cream, targeted to the millions of patients who experience diabetic neuropathy.
25%) that the company notes is stronger than any other over-the-counter capsaicin cream on the market, Zostrix neuropathy cream's unique formulation is said to improve the tolerance of high-strength capsaicin because of its patented cream base (which includes lidocaine).
While at GenDerm he helped reposition ZOSTRIX and ZOSTRIX -HP from ethically promoted and positioned products to consumer (OTC) products.
He adds that HCP is pleased to announce the acquisition of Zostrix Arthritis Cream, which is being widely distributed to drug stores throughout the U.
through its recent acquisition of Zostrix, a highly regarded established external analgesic.