Evolving Roles for Capsaicin Bring New Outreach Opportunities for Compounding Pharmacists

Evolving Roles for Capsaicin Bring New Outreach Opportunities for Compounding Pharmacists

i-bottleEvery morning, about 25 million Americans wake up knowing they face another day of chronic pain, yet they represent not quite one-fourth of the total adults living with persistent, if not daily pain. Many aren’t aware that they can find some relief from topical capsaicin. But capsaicin does more than provide pain relief—recent studies show it may heal liver damage and prevent prostate cancer. In addition to expanding capsaicin’s role, every new study represents an opportunity to build your business. Compounding pharmacists can use the info as a jumping off point to talk with physicians and new patients about treatment options using capsaicin.

Research Sheds Light on Roles for Capsaicin

Capsaicin has been the subject of intense research for a decade. With each new study, experts get closer to defining the molecular dynamics of its interaction with TRPV1, which will eventually lead to developing new pain relief medications. Other researchers have focused on identifying its role in systemic diseases such as liver damage. Capsaicin’s ability to inhibit liver fibrosis was recently confirmed by a team from the Liver Cell Biology Laboratory in Brussels, Belgium. After subjecting mice to three days of bile duct ligation, dietary capsaicin downregulated stellate cells and significantly improved liver fibrosis.1 The researchers concluded that it has potential therapeutic benefits for cholestatic liver fibrosis and hepatotoxic-induced liver injury.

Some of the most promising advances involve capsaicin’s ability to fight prostate cancer, but defining the precise mechanism of action has been elusive. A study released in November 2015 found that capsaicin triggers the production of reactive oxygen species and promotes cell death in androgen insensitive PC-3 cells, as well as androgen-sensitive LNCaP cells.2 Most importantly, healthy prostate cells were resistant to capsaicin-induced toxicity. In the future, capsaicin may become an effective treatment option for prostate cancer without the devastating toxicity caused by chemotherapy with docetaxel.

Topical Capsaicin for Neuropathic Pain

For the first time since it was approved by the FDA, the efficacy of the capsaicin 8 percent patch was compared with an optimized dose of another standard treatment for postherpetic neuralgia—pregabalin. The results published in November 2015 state that 52 percent of patients using the capsaicin patch achieved optimal therapeutic effect for peripheral neuropathic pain, compared with 45 percent of those using pregabalin.3 As you would expect, pain relief was faster with the topical patch. Adverse systemic reactions were 1 percent or less with capsaicin, while they caused 9 percent of pregabalin subjects to leave the study.

Since the capsaicin 8 percent patch is a unique application, with one dose administered under a physician’s supervision, compounding pharmacists in the community setting may not have direct experience with the product. But you will encounter many patients seeking relief from neuropathic pain, so it’s vital to determine whether they’ve been treated with the patch. If they did receive a dose of capsaicin 8 percent and still suffer pain, it’s possible they didn’t get the treatment soon enough. Patients with pre-existing pain lasting less than six months experienced optimal pain relief and improvement in quality of life.4 As duration of pre-existing pain increased, the chances of gaining substantial pain relief from the high-dose patch continued to decrease.

Take a Proactive Role to Talk About Capsaicin

The prescription-strength capsaicin patch may boost physicians’ awareness of—and willingness to use—alternative options, but it’s still a second line treatment and capsaicin isn’t on the radar of many health professionals. Compounding pharmacists can use new research as an opportunity to connect with local physicians and practitioners of alternative medicine. As you discuss the benefits of capsaicin, you’ll open the door to new business not just for capsaicin, but for other compounded pharmaceuticals.

Patient education about capsaicin also deserves time and attention. Many patients with chronic pain, whether caused by nerves, muscles or inflammation, self-manage their condition long before consulting their physician. Then they often head to their local pharmacy when pain returns. Reach out to them to schedule a counseling session, which should include:

Pain Assessment: Ask whether they saw a doctor and received a diagnosis. Lacking a diagnosis, assess their pain to determine whether they should be referred to a physician. Key concerns are whether the pain is acute or chronic, what triggers the pain, and how it impacts daily activities.5

Target the Treatment: Topical capsaicin can be used to treat many types of pain, from basic sore muscles to the chronic pain associated with arthritis. It relieves postherpetic neuralgia, as well as diabetic- and HIV-related neuropathies. It also helps alleviate postmastectomy neuropathic syndromes. The specific cause of the pain is important because neuropathies are treated differently. For neuropathies, capsaicin is usually adjunctive to a multimodal treatment plan that includes tricyclic antidepressants and second-generation anticonvulsants.

Dosage and Use: If your patients use OTC products, catch them at the check-out counter and talk to them about dosage and proper use.  Fifty-seven percent of people with neuropathic conditions experienced significant pain relief with capsaicin 0.075 percent, but efficacy drastically drops with lower doses typically found in OTC products.6 Be sure patients know that they have to use topical capsaicin consistently and it may take several weeks to achieve optimal pain relief.

Compounding Options: In addition to improving the health of your patients, one of the benefits of proactive counseling is the ability to teach them about the options available from compounding topical treatments. In addition to the choice of creams, gels and patches, capsaicin can be mixed with other ingredients to optimize each person’s individualized treatment.

Fill the Gap and Improve the Bottom Line

Compounding pharmacists have an advantage when it comes to natural pharmaceuticals like capsaicin because it’s a standard treatment in their arsenal. Even though the prescription-strength patch edged capsaicin into the mainstream, many physicians don’t routinely consider using alternative medications and may not stay up-to-date with the latest research. This is an opportunity to fill that gap and expand your business.

Pharmaceutica North America offers bulk APIs to treat multiple pain symptoms and a line of over-the-counter analgesics that contain capsaicin. Please contact us today to learn about our quality ingredients and how we can meet your compounding needs.

Show 6 footnotes

  1. “Inhibitory Effect of Dietary Capsaicin on Liver Fibrosis in Mice,” June 2015, http://www.ncbi.nlm.nih.gov/pubmed/25755097
  2. “The Pepper’s Natural Ingredient Capsaicin Induces Autophagy Blockage in Prostate Cancer Cells,” November 2015, http://www.impactjournals.com/oncotarget/index.php?journal=oncotarget&page=article&op=view&path%5B%5D=6415&path%5B%5D=17604
  3. “Capsaicin 8 Percent Patch Versus Oral Pregabalin in Patients With Peripheral Neuropathic Pain,” November 2015, http://www.ncbi.nlm.nih.gov/pubmed/26581442
  4. “Treatment of Peripheral Neuropathic Pain by Topical Capsaicin: Impact of Pre-Existing Pain in the QUEPP Study,” May 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238838/
  5. “Assessment of Pain,” May 2008, http://bja.oxfordjournals.org/content/101/1/17.full
  6. “Topical Preparations for Pain Relief: Efficacy and Patient Adherence,” December 2010,http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048583/

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