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Topical Analgesic (TRPV1 Agonist)

Capsaicin 0.025–0.075% Cream

Brand names: Zacin (0.025%), Axsain (0.075%), Qutenza (8% patch — specialist use)

Adult dose

Dose: 0.025–0.075% cream: apply thin layer to affected area up to four times daily
Route: Topical
Frequency: Three to four times daily
Max: Apply to affected area only; not more than four times daily
For osteoarthritis and neuropathic pain. Burning sensation on application — diminishes after first 1–2 weeks with regular use. Full benefit in 4–8 weeks of regular application. Wash hands after application (avoid eyes, mucous membranes).

Paediatric dose

Route: Topical
Frequency: N/A
Max: Not recommended <12 years (Zacin/Axsain); <18 years (Qutenza patch)
Not established in children for musculoskeletal indications. Specialist use only if ever considered.

Dose adjustments

Renal

No systemic dose adjustment — topical use only

Hepatic

No systemic dose adjustment — topical use only

Clinical pearls

  • Mechanism: initial TRPV1 receptor activation causes burning/stinging; repeated application depletes Substance P from nociceptors → desensitisation and analgesia
  • Compliance is the main challenge — burning sensation deters many patients; warn and persist through first 2 weeks
  • NICE NG226: capsaicin cream recommended as adjunct for knee OA pain management alongside core treatments
  • 0.075% cream (Axsain) is more effective than 0.025% for neuropathic pain — indicated for post-herpetic neuralgia
  • Qutenza 8% patch (specialist use): single application under supervision effective for up to 3 months in peripheral neuropathic pain

Contraindications

  • Broken or inflamed skin
  • Application to face, genitalia, or mucous membranes
  • Known hypersensitivity to capsaicin or chilli
  • Children <12 years (OTC preparations)

Side effects

  • Local burning, stinging, and erythema (common — especially first 1–2 weeks)
  • Cough (if inhaled during application)
  • Urticaria (rare — local)
  • Systemic absorption is minimal with standard concentrations

Interactions

  • No significant systemic drug interactions — minimal absorption at standard concentrations

Monitoring

  • Local skin reaction (tolerable burning vs skin damage)
  • Pain scores at 4–8 weeks (efficacy assessment)

Reference: BNFc; BNF; NICE NG226 (Osteoarthritis 2022); NICE NG193 (Neuropathic Pain). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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