Section 06 · Monograph

Capsaicin 0.025-0.1%

Reviewed Nov 2026FDA label

Zostrix (OTC, generic)TRPV1 agonist (topical)

Indications

Temporary relief of minor aches and pains of muscles and joints associated with arthritis, simple backache, strains, and sprains (OTC-labeled indication, e.g. Zostrix Original Strength 0.025% and higher-strength 0.075-0.1% products)FDA-labeled

Adjunctive topical therapy for painful diabetic peripheral neuropathy (off-label; supported by small trials of low-concentration capsaicin cream applied 3-4 times daily)Off-label
Postherpetic neuralgia and other localized peripheral neuropathic pain conditions (off-label)Off-label

Capsaicin, derived from Capsicum (chili pepper) plants, is a TRPV1 receptor agonist on peripheral sensory C-fiber nociceptors in the skin
At low OTC concentrations, repeated application produces initial nociceptor stimulation followed by gradual desensitization and depletion of substance P and other neuropeptides from sensory nerve terminals
With continued regular use over weeks, this leads to reduced transmission of pain signals from the treated area, distinct from the single high-dose, in-office mechanism used by the 8% capsaicin patch
Effect is local/peripheral, with reversal of desensitization typically occurring within days to weeks of discontinuation

OTC topical cream available in low concentrations, typically 0.025% (Zostrix Original Strength) up to 0.075-0.1% (Zostrix HP)
Apply a thin film to the affected, intact skin and rub in gently until absorbed; use 3 to 4 times daily for consistent effect
Consistent, regular (not as-needed) application is required; noticeable benefit for neuropathic pain typically takes 2 to 4 weeks or longer
Wash hands thoroughly with soap and water immediately after application unless treating the hands themselves
Avoid tight bandaging, application of external heat, or use immediately before/after bathing, showering, or strenuous exercise
Do not apply to broken, irritated, or sunburned skin
Discontinue and consult a clinician if symptoms persist beyond 7 days, worsen, or if redness/blistering develops

Known hypersensitivity to capsaicin, chili peppers, or any product component
Not for use on wounds, damaged skin, irritated or broken skin, eyes, or mucous membranes

No clinically significant systemic drug interactions identified, given negligible systemic absorption at low OTC concentrations
Local/additive irritant effect possible if combined with other topical rubefacients, counterirritants, or heat-generating topical products

Application-site burning, stinging, or warmth (very common, expected pharmacologic effect that typically decreases with continued regular use)
Application-site erythema/redness
Cough or sneezing if airborne capsaicin particles are inhaled during application
Eye or mucous membrane irritation with accidental contact
Contact dermatitis or skin irritation, particularly with occlusion, heat exposure, or use on compromised skin
Rarely, blistering or skin injury with excessive/improper use

Monitor adherence, since consistent regular (3-4 times daily) use for several weeks is required for neuropathic pain benefit
Assess application-site skin integrity and tolerability at follow-up
Reassess pain response after an adequate trial period (typically 2-4 weeks or longer)
Counsel on proper application technique to reduce inadvertent irritant exposure

No well-controlled human studies specifically evaluating low-concentration topical capsaicin cream in pregnancy; systemic absorption at OTC concentrations is expected to be minimal
OTC labeling generally advises patients to consult a physician before use if pregnant or breastfeeding
Avoid application to the breast/nipple area during breastfeeding to prevent inadvertent infant mucosal exposure