Bird Pepper, African Chillies, African Pepper, Aji, Bird Pepper,
Capsaicin, Capsaïcine, Cayenne, Cayenne Pepper, Chili, Chili
Pepper, Chilli, Chillies, Cis-capsaicin, Civamide, Garden Pepper,
Goat's Pod, Grains of Paradise, Green Chili Pepper, Green Pepper,
Hot Pepper, Hungarian Pepper, Ici Fructus, Katuvira, Lal Mirchi,
Louisiana Long Pepper, Louisiana Sport Pepper, Mexican Chilies,
Mirchi, Oleoresin Capsicum, Paprika, Paprika de Hongrie,
Pili-pili, Piment de Cayenne, Piment Enragé, Piment Fort,
Piment-oiseau, Pimento, Poivre de Cayenne, Poivre de Zanzibar,
Poivre Rouge, Red Pepper, Sweet Pepper, Tabasco Pepper,
Trans-capsaicin, Zanzibar Pepper, Zucapsaicin,
See separate listings for Grains of Paradise and Indian Long
frutescens; Capsicum annuum; Capsicum chinense; Capsicum
baccatum; Capsicum pubescens; Capsicum minimum; and other
Capsicum species. Family:
People Use This For:
capsicum is used for dyspepsia, flatulence, colic, diarrhea,
cramps, toothache, poor circulation, excessive blood clotting,
seasickness, swallowing dysfunction, alcoholism, malaria, fever,
hyperlipidemia, and preventing heart disease. Topically,
capsicum is used for the pain of shingles, osteoarthritis,
rheumatoid arthritis, post-herpetic neuralgia, trigeminal
neuralgia, diabetic neuropathy, back pain, and post-surgical
neuralgias. It is also used topically for prurigo
neuropathy, and fibromyalgia. Capsicum is also used to relieve
muscle spasms, as a gargle for laryngitis, and as a deterrent to
thumb-sucking or nail biting.
capsicum is used for allergic rhinitis, perennial rhinitis,
migraine headache, cluster headache, sinonasal polyposis, and
LIKELY SAFE ...when used orally in amounts typically found in
food. Capsicum has Generally Recognized As Safe (GRAS) status in
the US (5). ...when used topically and appropriately. The active
capsicum constituent capsaicin used in topical preparations is an
FDA-approved over-the-counter product (1).
POSSIBLY SAFE ...when used orally and appropriately,
short-term in medicinal amounts (16,17). ...when used topically
and appropriately (11,12). ...when used intranasally and
appropriately, short-term. Capsicum-containing nasal sprays,
suspensions, and swabs seem to be safe when applied daily or
every other day for up to 14 days (28,30,31 ,32, 33, 34, 35, 38,
39, 40, 41, 42, 43). No serious side effects have been reported
in clinical trials, however, application of capsicum-containing
products intranasally can be very painful.
POSSIBLY UNSAFE ...when used orally, long-term or in high
doses. There is concern that long-term use or use of excessive
doses might be linked to hepatic or renal damage (16).
POSSIBLY UNSAFE ...when used topically in children under 2
years old (1). There is insufficient reliable information
available about the safety of capsicum when used orally in
LIKELY SAFE ...when used topically and appropriately (1).
There is insufficient reliable information available about the
safety of capsicum during pregnancy when used orally in medicinal
LIKELY SAFE ...when used topically and appropriately (1).
POSSIBLY UNSAFE ...when used orally. Dermatitis can sometimes
occur in breast-fed infants when mothers ingest foods heavily
spiced with capsicum peppers (2).
Pain. Several clinical studies show that applying 0.25% to
0.75% capsaicin cream topically temporarily relieves chronic pain
from rheumatoid arthritis, osteoarthritis, psoriasis, and
neuralgias including shingles and diabetic neuropathy (13, 47).
The active capsicum constituent capsaicin, used in topical
preparations, is FDA-approved for these uses (1). For
neuropathic pain, the number needed to treat using capsaicin
0.075% for eight weeks is 5.7 (13). (12401). For
musculoskeletal pain, for every 8.1 patients treated with 0.025%
capsaicin, one would achieve at least a 50% reduction in pain
(13). In a study using 0.05% capsaicin (Finalgon CPD Warmecreme)
applied three times daily for 21 days, there was a 49% reduction
in pain compared to placebo in patients with chronic soft tissue
Back pain. Some evidence shows that applying a
capsicum-containing plaster to back can significantly reduce
low-back pain compared to placebo (44, 45. 46).
Cluster headache. Some evidence shows that using capsaicin
intranasally might reduce the frequency of episodic or chronic
cluster headache attacks (29, 33, 34, 40). Intranasal application
of capsaicin 0.025% (Zostrix, Rodlen Laboratories) might also
decrease symptom severity during an acute cluster headache
attack. Daily treatment for 7 days seems to decrease symptom
severity over the following week (35). Ipsilateral, or same side,
nostril application of capsaicin appears to be more effective
than contralateral application (33).
Fibromyalgia. Applying cream containing 0.025% of the active
capsicum constituent capsaicin 4 times daily to tender points for
4 weeks seems to reduce tenderness in patients with fibromyalgia
Perennial rhinitis. Some evidence suggests that intranasal
treatment with capsaicin solution can significantly decrease
symptoms of non-allergic, non-infectious perennial rhinitis
symptoms ( 34, 39, 43) A decrease of symptoms has been observed
for 6-9 months following intranasal capsaicin treatment (34,
Applying a cream containing 0.025% to 0.3% of the active capsicum
constituent capsaicin 4-6 times daily seems to relieve burning
sensations, erythema, pruritus, and healing of skin lesions over
a period of 2 weeks to 33 months. Symptoms, however, may return
after discontinuation of therapy (48).
Allergic rhinitis. Preliminary research suggests that
intranasal treatment with cotton wads soaked in capsaicin applied
for 15 minutes and repeated over two days might reduce the
severity of experimentally induced allergic rhinitis. Severity of
symptoms seems to be decreased for up to two months after
capsaicin treatment (30). However, contradictory evidence
suggests that patients with allergic rhinitis caused by house
dust mites do not have significantly improved symptoms after
using a capsaicin solution providing 0.15 mg/dose for up to 7
doses over a 14-day period (42).
Dyspepsia. Preliminary evidence suggests that red pepper
powder in capsules taken before meals 3 times daily reduces
symptoms of functional dyspepsia. In some patients, there seems
to be a worsening of symptoms before improvement (22). (12410).
Irritable bowel syndrome (IBS). Preliminary evidence suggests
that capsicum fruit taken orally doesn't help symptoms of IBS
Migraine headache. Anecdotal evidence suggests that
intranasal application of capsaicin 0.075% might help abort a
migraine headache (35).
Peptic ulcers. There is preliminary evidence that suggests
people who eat capsicum fruit (chili) an average of 24 times per
month appear to be less likely to have an ulcer than people who
eat chili an average of 8 times per month. This applies to chili
in the form of chili powder, chili sauce, curry powder, and other
chili-containing foods (12).
Sinonasal polyposis. Preliminary evidence suggests that
intranasal application of capsaicin can cause significant
subjective improvement in symptoms as well as objective
improvement in nose/sinus air volume and endoscopy scores in
patients with severe sinonasal polyposis; however, capsaicin does
not seem to significantly affect eosinophil cationic protein
Swallowing dysfunction. Preliminary evidence suggests that
elderly patients at risk for aspiration pneumonia due to
swallowing dysfunction have improved swallowing reflexes after
dissolving a capsaicin-containing lozenge in their mouth before
each meal (27). More
evidence is needed to rate capsicum for these uses.
applicable part of capsicum is the fruit. Capsicum contains the
constituent capsaicin, which makes it taste hot. Naturally-occurring
capsaicin exists only in the trans-stereoisomer form. However,
the cis-isomer, known as civamide, also has pharmacological
activity. Some evidence suggests that civamide is more potent and
causes less irritation than naturally occurring capsaicin.
used topically, capsaicin binds to nociceptors in the skin,
initially causing neuronal excitation and heightened sensitivity.
This is felt as itching, pricking, or burning. Capsaicin also
causes cutaneous vasodilation. The mechanism for these effects is
thought to be the result of selective stimulation of afferent C
fibers, which act as thermoreceptors and nociceptors, and release
of substance P, a sensory neurotransmitter that mediates pain.
This is followed by a refractory period with reduced sensitivity.
After repeated applications, persistent desensitization occurs,
possibly the result of substance P depletion. Pain relief may
also be caused by degeneration of epidermal nerve fibers (13, 16,
also stimulates the unmyelinated slow C-fibers of the sensory
nervous system, which can induce cough, dyspnea, nasal
congestion, and eye irritation after inhalation (6). Some
research with inhaled capsaicin suggests that severity of ACE
inhibitor cough correlates with sensitivity to inhaled
capsaicin (23, 24, 25,26). In
people with swallowing dysfunction, capsaicin is thought to
provide sensory stimulation that increases the swallowing reflex
allergic and perennial rhinitis, it is not clear how capsaicin
nasal spray might work. Like for pain syndromes, capsaicin likely
depletes substance P, resulting in desensitization of the nasal
mucosa to antigens (30, 36). Some research suggests that
capsaicin does not cause significant changes in nasal neuronal
tissue. Capsaicin is thought to possibly have anti-inflammatory
effects. But some research suggests that capsaicin does not
affect inflammatory cell density in the nasal mucosa (28, 30). Or
concentrations of inflammatory mediators such as leukotrienes or
prostaglandins (34). Other research in animal models of
nasal hypersensitivity suggests that intranasal capsaicin
decreases substance P and tyrosine hydroxylase-like
immunoreactive nerve fibers (37). For
migraine and other headaches, capsaicin is thought to cause a
desensitizing effect by relieving both peripheral and central
pain by decreasing release of neuropeptides, such as substance P,
from nerve terminals. When applied intranasally, capsaicin is
also thought to decrease intranasal and central blood vessel
neurotransmitters, cause vasodilation, and histamine or serotonin
release (29). In animal models, intranasal capsaicin also seems
to deplete nerve fibers that are immunoreactive to the
neuropeptides substance P or calcitonin gene-related peptide
(CGRP) (34). Some
researchers theorize that the capsaicin constituent might also
have gastroprotective effects. Preliminary evidence suggests that
capsicum protects against alcohol and non-steroidal
anti-inflammatory drug (NSAID) damage to the GI mucosa. This has
also led to the hypothesis that capsaicin might decrease the risk
of peptic ulcer disease (12). However, with heavy ingestion,
capsaicin has been associated with necrosis, ulceration, and
carcinogenesis (16). Capsaicin
seems to have antiplatelet effects (18, 19). Some evidence shows
capsicum extract has antibacterial properties (14). Capsaicin
is thought to be metabolized by the cytochrome P450 (CYP450)
system to active metabolites. Whether these substances can cause
cancer or protect
against cancer by altering carcinogen metabolism is an area of
active research (14).
powder has been reported to prevent radiation-induced damage to
bacterial DNA and thereby protect certain bacteria (Escherichia
coli, Bacillus megaterium, and Bacillus pumilus spores) from
gamma irradiation, which is used to preserve some foods
capsicum can cause upper abdominal discomfort including fullness,
gas, bloating, nausea, epigastric pain and burning, diarrhea, and
belching (12, 22). Sweating and flushing of the head and neck,
lacrimation, headache, faintness, and rhinorrhea have also been
reported (8, 22). Excessive amounts of capsaicin can lead to
gastroenteritis and hepatic necrosis (13). There are also reports
of dermatitis in breast-fed infants whose mothers' food is
heavily spiced with capsicum (2). Capsicum can also decrease
blood coagulation (9). Topically,
capsicum can cause burning, stinging, and erythema. About one in
10 patients who use capsaicin topically discontinue treatment
because of adverse effects. Side effects tend to diminish with
continued use (10). Exacerbation of ACE-inhibitor cough has been
reported in patients using topical capsaicin and taking
ACE-inhibitors (26). Skin contact with fresh capsicum fruit can
cause irritation or contact dermatitis (20) Intranasally,
capsaicin can cause nasal burning and pain in most patients. It
also often causes lacrimation, sneezing, and excessive nasal
secretion (29, 35, 40): however, these side effects appear to
diminish with repeat applications. In some cases, the burning
sensation disappears after 5-8 applications (33, 40). In some
cases, patients are pretreated with intranasal lidocaine to
decrease the pain of intranasal capsaicin treatment. However,
even with lidocaine pretreatment, patients seem to experience
significant pain (30). Inhalation
of capsicum can cause cough, dyspnea, nasal congestion, eye
irritation, and allergic alveolitis (6). Capsicum
can be extremely irritating to the eyes and mucous
oleoresin, an oily extract in pepper self-defense sprays, causes
intense eye pain. It can also cause erythema, blepharospasm,
tearing, shortness of breath, and blurred vision. In rare cases,
corneal abrasions have occurred (20, 21).
Interactions with Herbs & Supplements:
HERBS AND SUPPLEMENTS: Concomitant use of herbs and supplements
that affect platelet aggregation could theoretically increase the
risk of bleeding in some people. Some of these herbs include
angelica, clove, danshen, garlic, ginger, ginkgo, Panax ginseng,
and others. COCA:
Theoretically, concomitant use of capsicum (including exposure to
the capsicum in pepper spray) and coca might increase the effects
and risk of adverse effects of the cocaine in coca (3).
is one case report of a topically applied cream containing
capsaicin contributing to the cough reflex in a patient using an
ACE-inhibitor (26). (12414).
But it is unclear if this interaction is clinically
oral administration of capsicum before or at the same time as
theophylline might enhance theophylline absorption (14).
with Lab Tests:
TIME: Capsicum has led to increased fibrinolytic activity and may
lead to prolonged times in coagulation studies (9).
with Diseases or Conditions:
SKIN: Capsicum is contraindicated in situations involving injured
skin. Do not apply capsicum if the skin is open. SURGERY:
Capsicum has antiplatelet effects. Capsicum might cause excessive
bleeding if used perioperatively. Tell patients to discontinue
capsicum at least 2 weeks before elective surgical
ORAL: For swallowing dysfunction in the elderly, 1
lozenge containing 1.5 mcg of capsaicin is dissolved in the mouth
before each meal (27).
TOPICAL: For pain syndromes, including rheumatoid and
osteoarthritis, neuropathy, and fibromyalgia, creams contain the
active capsicum constituent capsaicin and are typically applied
3-4 times daily. It can take up to 14 days for the full analgesic
effect. Most creams contain 0.025% to 0.075% capsaicin
concentrations. Higher potency preparations may be used for
diabetic neuropathy (1, 13). For back pain, capsicum-containing
plasters providing 11 mg capsaicin/plaster or 22 mcg/cm2 of
plaster applied have been used. The plaster is applied once daily
in the morning and left in place for 4-8 hours (44, 45,
For prurigo nodularis, 0.025% to 0.3% of the active capsicum
constituent capsaicin 4-6 times daily has been used (48). Tell
patients to make sure they wash their hands after applying
capsaicin cream. Tell patients they can use a diluted vinegar
solution to remove capsicum cream. The active constituent,
capsaicin is not water washable. Warn against using capsicum
preparations near the eyes or on sensitive skin (21).
INTRANASAL: For cluster headache, 0.1 mL of a 10 mM capsaicin
suspension, providing 300 mcg/day of capsaicin, applied to the
ipsilateral nostril, has been used. Applications of the
suspension continued once daily until a burning sensation was no
longer experienced (23, 43). A capsaicin 0.025% cream (Zostrix,
Rodlen Laboratories) applied daily for 7 days has been used to
treat acute cluster headache attacks (25). For migraine headache,
application of capsaicin 0.075% to the nasal mucosa has been used
For allergic rhinitis, a cotton wad soaked in 30 microM capsaicin
solution applied for 15 minutes and repeated over 2 days has been
For perennial rhinitis, intranasal application of capsaicin
solution providing 0.15 mg/dose for up to 7 doses over a 14-day
period has been used (34). A capsaicin nasal spray 0.0033 mol
once weekly for 5 weeks has also been used (42). A capsaicin
nasal spray containing 15 mcg/mcL, 2 sprays applied 3 times daily
for 3 days has also been used (44).
For sinonasal polyposis, 0.5 mL of a 30 mmol/L capsaicin solution
applied to each nostril for 3 days followed by 0.5 mL of a 100
mmol/L capsaicin solution for 2 days has been used (41).
to severe pain associated with intranasal capsaicin
administration, pretreatment with intranasal local anesthetic is
nature, capsaicin occurs only as a trans-stereoisomer. However,
the cis-isomer called civamide also has activity. Some evidence
suggests that civamide is more potent and causes less irritation
than trans-capsaicin. Civamide is currently an investigational
drug for migraine, osteoarthritis, and other pain-related
conditions (29). Products
labeled capsaicin sometimes include nonivamide which is an
adulterant or pelargonic acid vanillylamide, referred to as
"synthetic capsaicin" (10).
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