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Topical Analgesic (TRPV1 Agonist) Pregnancy: UK SPC section 4.6 (Fertility, pregnancy and lactation), verbatim and complete: 'The safety of Zacin during pregnancy and lactation has not been established, in either humans or animals. However, in the small amounts absorbed transdermally from Zacin Cream, it is considered unlikely that capsaicin will cause any adverse effects in humans.' No separate fertility statement is given. This statement belongs to the 0.025% cream only — it is not a statement about the 0.075% cream or the 8% patch.

Capsaicin 0.025–0.075% Cream

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

This entry covers low-strength topical capsaicin cream applied to the skin for localised musculoskeletal and osteoarthritic joint pain and some neuropathic pain in the orthopaedic setting.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: SCOPE — CAPSAICIN 0.025% CREAM ONLY (Zacin), the lower of the two strengths named in this page's title. Adults and the elderly: 'For topical administration to unbroken skin. Apply only a small amount of cream (pea size) to affected area 4 times daily. These applications should be evenly spaced throughout the waking hours and not more often than every 4 hours. The cream should be gently rubbed in, there should be no residue left on the surface.' ONSET AND DURATION OF BENEFIT: 'Pain relief usually begins within the first week of treatment and increases with continuing regular application for the next two to eight weeks.' NOT COVERED BY THIS SOURCE: the 0.075% cream (Axsain) that forms the upper half of this page's title, and the Qutenza 8% cutaneous patch listed among this page's brands. Neither product's SPC is in this bundle. The 8% patch is applied by a trained clinician on an entirely different schedule, so the four-times-daily instruction above must never be carried across to it. The licensed-indications section of the Zacin SPC was not captured in this bundle, so confirm the licensed indication before prescribing.
Route: Topical, to unbroken skin — 'The cream should be gently rubbed in, there should be no residue left on the surface.' 'Zacin should not be applied near the eyes.'
Frequency: Four times daily, evenly spaced throughout the waking hours and not more often than every 4 hours.
MAXDOSE DELIBERATELY LEFT BLANK. This SPC states no dose ceiling. What it gives is a frequency rule and a minimum interval — 'not more often than every 4 hours' — which is not a maximum dose, so nothing has been entered rather than converting a frequency limit into a dose ceiling. Applying more often than the stated schedule increases burning rather than benefit: 'The burning is observed more frequently when application schedules of more than 4 times daily are used.' HAND WASHING: 'Hands should be washed immediately after application of Zacin unless hands and fingers are being treated' (section 4.2); section 4.4 adds that where the hands are the treated areas 'they should be washed 30 minutes after application'. AVOID: contact with eyes and mucous membranes; 'Patients should avoid taking a hot bath or shower just before or after applying Zacin, as it can enhance the burning sensation'; 'Tight bandages should not be applied on top of Zacin cream'; and 'Patients and carers should avoid inhalation of vapours from the cream, as transient irritation of the mucous membranes of the eyes and respiratory tract (including exacerbation of asthma) has been reported.' The burning 'can be enhanced if too much cream is used and if it is applied just before or after a bath or shower.' REVIEW: 'Medical advice should be sought if the condition worsens, or clears up then recurs.' CHILDREN: 'Not suitable for use in children.'

Paediatric dose

Route: Topical
No paediatric dose exists in this source. Section 4.2, verbatim and final sentence: 'Not suitable for use in children.' No age threshold of any kind is given — the '<12 years (Zacin/Axsain); <18 years (Qutenza patch)' thresholds previously shown on this page are not stated in this SPC and are not carried forward. Nothing is published and the weight-based calculator is disabled.

Dose adjustments

Renal

Not stated, and none is expected to be stated for a topical cutaneous cream. No renal-impairment dosing or caution appears anywhere in the fetched sections 4.2, 4.3, 4.4, 4.6 or 4.8. Do not infer an adjustment.

Hepatic

Not stated, and none is expected to be stated for a topical cutaneous cream. No hepatic-impairment dosing or caution appears anywhere in the fetched sections 4.2, 4.3, 4.4, 4.6 or 4.8. Do not infer an adjustment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Broken or irritated skin — 'Zacin cream is contra-indicated on broken or irritated skin'
  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
  • Children — section 4.2: 'Not suitable for use in children'
  • Precaution rather than contraindication (section 4.4): contact with eyes and mucous membranes should be avoided, and tight bandages should not be applied on top of the cream

Side effects

  • Skin irritation, and transient burning on application — 'Zacin may cause skin irritation or transient burning on application. This burning is observed more frequently when application schedules of more than 4 times daily are utilised. The burning can be enhanced if too much cream is used and if it is applied just before or after a bath or shower'
  • Irritation of the mucous membranes of the eyes and respiratory tract, reported rarely — 'such as nasal and throat irritation ... resulting in symptoms such as coughing, sneezing and runny eyes. These events are usually mild and self-limiting'
  • Dyspnoea, wheezing and exacerbation of asthma — 'There have been a few reports of dyspnoea, wheezing and exacerbation of asthma'
  • Excipients — 'Benzyl alcohol may cause mild local irritation'; 'Cetyl alcohol may cause local skin reactions (e.g. contact dermatitis)'
  • Section 4.8 is complete and not truncated, but it gives no frequency categories (very common / common / uncommon) for any of the above

Monitoring

  • Review if the condition changes — 'Medical advice should be sought if the condition worsens, or clears up then recurs'
  • Expect a lag before judging benefit — 'Pain relief usually begins within the first week of treatment and increases with continuing regular application for the next two to eight weeks'
  • Check application technique if burning is troublesome — burning is worse with more than four applications daily, with too much cream, and with a hot bath or shower just before or after application
  • Watch for respiratory symptoms in asthma — inhalation of vapours has been reported to cause transient respiratory irritation including exacerbation of asthma
  • No laboratory monitoring is specified anywhere in this SPC

Clinical monograph

How it works

Capsaicin is a TRPV1 receptor agonist that initially stimulates and then desensitises cutaneous sensory nerve endings, depleting substance P and reducing transmission of pain signals from the treated area.

Prescribing in practice

  • Apply only to intact skin and wash hands thoroughly after application, avoiding contact with eyes, mucous membranes and broken skin, as capsaicin causes intense burning and irritation.
  • A transient burning sensation at the site is expected and usually settles with regular continued use; do not apply heat or tight dressings over the area.
  • Effect builds with regular application over time rather than providing immediate relief.

Monitoring

Monitor the treated skin for excessive irritation and review analgesic benefit after a period of regular use.

Counselling the patient

  • Wash your hands immediately after applying and keep the cream away from your eyes, nose and mouth.
  • Expect a warm, burning feeling at first that lessens with continued regular use; do not use a heat pad over the treated skin.

Evidence & guidelines

Topical capsaicin is recommended as an option for knee or hand osteoarthritis pain in NICE osteoarthritis guidance.

Reference: NICE NG226 (Osteoarthritis 2022); NICE NG193 (Neuropathic Pain); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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