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TRPV1 Agonist (Nasal Desensitisation Agent) Pregnancy: Avoid — insufficient data; localised nasal absorption is minimal but lack of pregnancy safety data precludes recommendation

Capsaicin Nasal Spray

Brand names: Rhinopasic (0.1 mmol/L)

Adult dose

Dose: One spray (0.1 mmol/L) to each nostril for 3 sessions on 1 day per week over 3 weeks (3 total treatment days)
Route: Intranasal spray
Frequency: Once per treatment day (3 treatment days, 1 week apart)
Max: 3 treatment sessions
Non-allergic rhinitis (idiopathic/vasomotor rhinitis) unresponsive to other treatments; MHRA licensed 2023 as Rhinopasic; initial burning sensation — premedicating with lidocaine spray reduces discomfort; pre-treat with nasal saline

Paediatric dose

Dose: Not established N/A/kg
Route: N/A
Frequency: N/A
Max: N/A
Not licensed in paediatrics

Dose adjustments

Renal

No systemic dose adjustment required

Hepatic

No systemic dose adjustment required

Paediatric weight-based calculator

Not licensed in paediatrics

Clinical pearls

  • Mechanism: capsaicin activates TRPV1 channels on unmyelinated C-fibres in the nasal mucosa → initial neurogenic inflammation → prolonged desensitisation of C-fibres and depletion of substance P; results in reduced neurogenic inflammation and improved non-allergic rhinitis symptoms
  • MHRA 2023 approved as Rhinopasic for idiopathic non-allergic rhinitis — first licensed nasal capsaicin product in UK; previously used off-label as homemade preparations; highly concentrated pharmaceutical formulation provides standardised dose
  • Non-allergic rhinitis (vasomotor rhinitis) affects up to 30% of rhinitis patients — not IgE mediated; symptoms triggered by temperature changes, odours, humidity, exercise; antihistamines ineffective (no allergic component); capsaicin targets the neurogenic pathway
  • Duration of effect: clinical trials show symptom improvement lasting 3-6 months after 3-treatment course; can be repeated; patients typically notice benefit within 2-4 weeks post-treatment
  • Patient counselling key to adherence: the initial burning is alarming but expected and temporary — explaining this before administration dramatically improves completion rates; saline pre-spray and asking patient to breathe through mouth during application helps

Contraindications

  • Allergic rhinitis (not effective — for non-allergic only)
  • Nasal polyps (not studied)
  • Active nasal infection
  • Known capsaicin hypersensitivity (hot chilli allergy)

Side effects

  • Nasal burning/stinging during and shortly after application (expected — subsides within 20-30 minutes)
  • Watery eyes
  • Sneezing
  • Rhinorrhoea immediately post-application
  • Transient cough

Interactions

  • No pharmacological interactions — localised nasal action

Monitoring

  • Symptom response at 4 weeks (TNSS/VAS)
  • Tolerability of burning (first treatment session)
  • No routine laboratory monitoring required

Reference: BNFc; BNF 90; Fokkens et al. EPOS 2020; Bernstein et al. Laryngoscope 2011; MHRA SPC Rhinopasic 2023; Baudoin et al. J Allergy Clin Immunol 2019. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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