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Capzasin-HP (High Potency) for pain---Topical analgesic ( by Kaleem Mohammed, Rph, PhD)

Capzasin Hp Arthritis Pain Relief with NDC 41167-75142 is an over the counter drug product 

Active ingredient: Capsaicin 0.1 %





The term "arthritis" refers to several forms of rheumatic diseases (more than 100 conditions). These conditions often affect the joints and the tissues surrounding the joints such as muscles and tendons (swelling and tenderness). 
Some types can affect other parts of the body as well including the skin and internal organs.

One of the challenges for someone with arthritis is finding ways to live as normally as possible and improving the quality of life. Capsaicin ointment is one of the inexpensive medications that I have seen to help patients during my practice as a pharmacist.

 Chemistry:

Capsaicin (8-methyl-N-vanillyl-6-nonenamide),

Biosynthesized through two pathways related to phenylpropanoid and fatty acid metabolism. 

Place in Therapy: Pain/arthritis 

 
Arthritis - Pain
  • TOPICAL, apply thin film to the affected area 3 to 4 times per day (1)
  •  
    Neuropathic pain, associated with postherpetic neuralgia
    • (Topical patch) Apply up to 4 patches as a single 60-minute application; may repeat every 3 months as needed but do not apply more frequently than every 3 months
 
Musculoskeletal pain
  • TOPICAL, apply thin film to the affected area 3 to 4 times per day (1)
 
Neuropathic pain, associated with diabetic peripheral neuropathy of the feet
  • (Topical patch) Apply up to 4 patches on the feet as a single 30-minute application; may repeat every 3 months as needed but do not apply more frequently than every 3 months (3)
  • Prior to application, examine feet to detect skin lesions related to underlying neuropathy of vascular insufficiency (3)
About Patient:

Pt. is a 79 year old male with prolonged hospitalization for necrotizing pancreatitis and small bowel feeding tube and percutaneous drain, who was in IPR then discharged home. Pt. was brought to ER unconscious on ___.
Pt. had recent appointments with PCP for poor sleep, onfusion and agitation, for which he was prescribed seroquel and xanax at bedtime. Patient sleptt well but remained somnolent and confused throughout the day and therefore brought to ER.

Patient additionally had swollen and red right knee which was causing pain. 

Patient was diagnosed with toxic metabolic encephalopathy and a right knee effusion. Upon admission, pt had hyponatremia of 130 and high CRP of 7.3. Patient diagnosed with sepsis and pyogenic bacterial arthritis of right knee which required incision and drainage of knee and removal of intra-articular screw. Pt was started on Ceftriaxone nd will require IV antibiotics   




Capsaicinoids are plant metabolites, capsaicin being the natural product responsible for pungency of chilli peppers.

References: 

1. Product Information: ZOSTRIX(R) topical cream, 0.025% Capsaicin topical cream. Health Care Products, Amityville,
2. Chapa-Oliver AM, Mejía-Teniente L. Capsaicin: From Plants to a Cancer-Suppressing Agent. Molecules. 2016 Jul 27;21(8):931. 
3.  Product Information: QUTENZA(R) topical patch, Averitas Pharma Inc (per FDA), Morristown, NJ, 2020.

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