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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)

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.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

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. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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