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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, and the earlier page text that the patch should be avoided in pregnancy is not sourced by this bundle.

Capsaicin

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

Capsaicin is a topical analgesic, derived from chilli peppers, used for neuropathic pain and for symptomatic relief in osteoarthritis.

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 first of the three products this page covers and the one named in its lead indication. 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 — two of the three regimens this page previously carried: first, the 0.075% cream (Axsain) for post-herpetic neuralgia and diabetic neuropathy; second, the Qutenza 8% cutaneous patch for neuropathic pain. Neither product's SPC is in this bundle. The 8% patch is a single timed application performed by a trained clinician, not a self-applied cream, so the four-times-daily instruction above must never be carried across to it, and no patch figure is published on this record. 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.' CROSS-CHECK NOT USED: the US OTC label in this bundle is a 0.1% cream directing 'Apply 3 to 4 times daily' — a different strength from any on this page, with no indication section fetched, so it has not been used to widen or alter the figures above.

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 in the SPC. The US OTC cross-check label states only 'Children under 18 years: Ask a doctor', which is not a dose. 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; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — 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
  • ⚠️ These are the contraindications of the 0.025% cream only. The 0.075% cream and the 8% patch listed among this page's brands are not sourced in this bundle and may carry their own

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, and it describes the 0.025% cream only

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

It is an agonist at the TRPV1 receptor on sensory nerves, initially stimulating then desensitising nociceptive fibres and depleting substance P, reducing pain transmission.

Prescribing in practice

  • Avoid contact with eyes, mucous membranes and broken or inflamed skin, and ensure hands are washed thoroughly after application to prevent spread.
  • A transient local burning sensation is common on application and usually diminishes with continued use.
  • High-concentration cutaneous patches must be applied by a trained healthcare professional in an appropriate setting.

Monitoring

Monitor the application site for local skin reactions and assess analgesic response over time.

Counselling the patient

  • Apply to intact skin only and wash your hands thoroughly afterwards, or use gloves.
  • Expect a burning or stinging sensation at first, which usually eases with regular use.
  • Do not apply heat such as a hot bath or heat pad to the treated area.

Evidence & guidelines

Topical capsaicin is recommended in clinical guidance as an option for localised neuropathic pain and osteoarthritis.

Reference: SmPC Zacin / Axsain / Qutenza; NICE NG226 (Osteoarthritis 2022); NICE CG173 (Neuropathic Pain 2013); BPS Guidelines; 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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