-IBIS-1.7.0-
rx
herb
Capsicum spp. (Cayenne Pepper, Red Pepper)
Botanicals
definition
botanical name(s): Capsicum frutescens, Capsicum annuum
synonyms: cayenne pepper, guinea pepper, red pepper, chili pepper, Africa pepper, bird pepper, cockspur pepper, goat's pepper, pod pepper, Spanish pepper, Zanzibar pepper, cayennepfeffer, piment de cayenne
part(s) used: fruit
qualities: very pungent, hot, with secondary cooling effect, dry
affinities: arterial circulation, heart, stomach, intestines, lungs, kidneys
actions: carminative, diaphoretic, local irritant, stimulant, tonic, rubefacient.
dosage:
» fruit powder: 30 - 120 mg
» tincture (1:10:) 0.3 - 1 ml.
» strong tincture: (1 : 3) 0.05 - 0.15 ml.
» semi solid preparations (topical): up to 50 mg capsaicin in 100 g neutral base.
(Manufacturer's preparations vary, typically from 0.025-0.075% capsaicin)
appearance:
» reddish-purple face and/or arms (Wood)
pulse:
» sharp under some fingers, atonic and "blobby" under others; beat unequal between arms, does not match (Wood)
specific indications:
» debility and weakness in the elderly, especially with deficient circulation. Topically, neuralgic pain and sore throat (as a gargle).
» Eclectic specific indications: marked depression and debility, with feeble pulse and repressed secretions; pale membranes, with scanty viscous secretion; tongue dry, harsh, mouth and salivary secretions suppressed or scanty; atonic dyspepsia of drunkards; alcoholic delirium of the depressive type; congestive chill; colic, with abdominal distension; debility with faulty gastrointestinal functioning in the aged (Felter, p. 275)
therapy:
» external: topical stimulant, rubefacient, and counter-irritant; used for local pain, neuralgia, pleurodynia, intercostal neuralgia, toothache,chronic rheumatic pains, lumbago, chilblains. Can be used to promote circulation and tissue repair in gum disease, pharyngitis and hoarseness (gargle).
» internal: stimulant to heart and circulation; peripheral circulatory insufficiency, Raynaud's, intermittent claudication. Low vitality, cold, weak, debility syndromes. Stimulant and tonic to the gastro-intestinal tract; warms digestion, poor appetite, atonic conditions; membranes pale, relaxed, or flabby; impaired secretion; chronic gastric catarrh in abasence of inflammation. atonic dyspepsia; gastric flatulence.
constituents:
» Capsaicinoids: (0.05 - 1.5 %) Pungent phenolic amides including mostly capsaicin, dihydrocapsaicin and derivatives.
» Carotenoids: Carotene, capsanthin
» Volatile Oil: trace
» Other: proteins, vitamins A, C, coumarins, steroidal alkaloids incl solanidine, flavonoids.
pharmacology:
Capsaicin inhibits release of neurotransmitter substance P (sensory afferents, including nocioceptors, after an initial stimulation. It stimulates adrenal secretion from the medulla (adrenaline) and cortex (cortisol). It reduces serum triglycerides. Inhibits gastric motility, increases duodenal motility. Increases mucosal blood flow and vascular permeability. Stimulates ñprotectiveî sensitive areas in stomach and duodenum which afford protection against ulcers (also when stimulated by acid). Animal and human studies are conflicting on increase of gastric secretion levels. There is considerable literature on neurotransmitter research using capsaicin as a diagnsotic tool. (Reviewed, Newall, 1996). Early evidence suggested a fibrinolytic and anti-platelet activity, later studies on this are lacking.
clinical trials:
Topical capsaicin based creams have relieved pain symptoms in both rheumatoid and osteoarthritic joint pains compared to controls, as well as diabetic neuropathy, post herpetic neuralgia, migraine and cluster headaches. A problem with all placebo controlled strudies is the lack of a similar "hot" remedy that is inactive. Capsicum extracts cause increase acid secretion and DNA content in duodenal cells of gastric aspirates in ulcer patients, but has been reported to have little effect on gastric secretions in normal patients.(Newall, 1996). A recent review of 33 clinical trials on capsicum/capsaicin concluded Capsaicin is effective for psoriasis, pruritus, and cluster headache; it is often helpful for the itching and pain of postmastectomy pain syndrome, oral mucositis, cutaneous allergy, loin pain/hematuria syndrome, neck pain, amputation stump pain, and skin tumor; and it may be beneficial for neural dysfunction (detrusor hyperreflexia, reflex sympathetic dystrophy, and rhinopathy).(Hautkappe, 1998: see also Fusko, 1997).
AHPA Botanical Safety Rating: 1 (internal use); 2d (external use)
toxicity: 0
Excessive doses may cause gastric irritation in sensitive individuals. Capsaicin and related phenols are strongly irritant to mucous membranes, external contact with injured skin and eyes should be avoided. Inhalation reportedly may cause allergic alveolitis.
contraindications:
» suggestions that Capsicum is contraindicated during pregnancy are speculative; it was found to be a uterine stimulant in animal studies (Brinker, p. 23) but there are no known problems with use of capsicum during pregnancy. (Newall, 1996)
» stomach ulcers or stomach inflammation (Brinker, Brooks) because capsaicin component increases gastric acid production and can cause mucosal exfoliation.(Brinker)
» chronic bowel irritation (Brooks) due to the mucosal irritant and stimulant properties of capsaicin (Brinker).
interactions:
» Capsicum has the ability to normalize both low and high blood pressure and is often used to equalize blood pressure, hence capsaicin may interfere with the blood-pressure regulating functions of ACE inhibitors. Capsaicin may also aggravate cough due to ACE-inhibitor drugs. (Fox, 1996)
footnotes
Brinker F. 1995. Botanical Medicine Research Summaries. (from Eclectic Dispensatory of Botanical Therapeutics, vol.11), Sandy, Oregon: Eclectic Medical Publications.
Brooks S (ed.). 1995. Botanical Toxicology. Protocol J Bot. Med, 1:147-158.
Chandiramani VA, Peterson T, Duthie GS, Fowler CJ. Urodynamic changes during therapeutic intravesical instillations of capsaicin. Br J Urol 1996 Jun;77(6):792-797.
Abstract: OBJECTIVE: To describe the technique for and urodynamic changes during therapeutic instillations of intravesical capsaicin in patients with detrusor hyper-reflexia. PATIENTS AND METHODS: Ninety intravesical instillations of capsaicin were performed as a therapeutic procedure in 30 patients; 21 patients had various causes of non-traumatic spinal cord disease, five patients were very severely neurologically impaired and were bed-bound with an indwelling catheter, and four were neurologically normal. Simultaneous cystometry was performed in 25 patients during the instillation of capsaicin; 100 mL of 1 or 2 mmol/L capsaicin in 30% ethanol/saline was instilled into the bladder for 30 min and two patients received 30% ethanol/saline only. The last 56 capsaicin treatments were preceded by the instillation of 40 mL of 2% lignocaine for 20 min. Detrusor hyper-reflexia was decreased and urinary continence improved for 3-6 months after a single instillation; the instillation was then repeated. Two patients who received only ethanol/saline showed no clinical or urodynamic improvement. RESULTS: The treatment was not abandoned in any patient due to discomfort and there were no short- or medium-term complications. All patients with spinal cord disease and phasic detrusor hyper-reflexia had similar, frequent and repetitive detrusor contractions during the instillation of capsaicin. These acute reactive contractions did not occur in the neurologically normal patients. Similarly, the instillation of intravesical lignocaine only caused no phasic detrusor contractions. Intravesical lignocaine instillation before capsaicin markedly reduced and sometimes abolished the detrusor overactivity and lessened the discomfort for the patients. The instillation of lignocaine before capsaicin did not alter the benefit from each instillation of intravesical capsaicin. CONCLUSION: A method has been developed for administering capsaicin intravesically which diminishes discomfort for the patient and in the short- and medium-term is free of complications. The study also provides functional evidence of the role of capsaicin-sensitive afferents in phasic detrusor hyper-reflexia due to spinal cord disease.
De Smet PAGM et al. (eds.). 1993. Adverse Effects of Herbal Drugs 2, Berlin: Springer-Verlag
Felter, H. W., and Lloyd, J. U. 1983. King's American Dispensatory, Vols. I and II. Portland, OR: Eclectic Medical Publications.
Felter, H.W. & Scudder, John K., 1922. The Eclectic Materia Medica, Pharmacology and Therapeutics. Cincinnati, Ohio. Reprinted in 1985 by Eclectic Medical Publications, Portland, OR.
Fox AJ, Lalloo UG, Belvisi MG, Bernareggi M, Chung KF, Barnes PJ. Bradykinin-evoked sensitization of airway sensory nerves: a mechanism for ACE-inhibitor cough. Nat Med 1996 Jul;2(7):814-817.
Abstract: Cough accompanied by an increased sensitivity of the cough reflex is the most common symptom of inflammatory airway disease. This symptom is also frequently reported in patients receiving angiotensin-converting enzyme (ACE) inhibitors as therapy for heart failure or hypertension, although the underlying mechanism is unknown. We have investigated the possibility that the inflammatory peptide bradykinin, normally degraded by ACE, causes sensitization of airway sensory nerves and an enhancement of the cough reflex in conscious guinea pigs. Treatment of guinea pigs for two weeks with captopril led to an increased cough response to inhaled citric acid, which was prevented by concomitant treatment with the bradykinin receptor antagonist icatibant. A similar icatibant-sensitive enhancement of citric acid-evoked cough was seen in untreated animals after prior inhalation of bradykinin, although cough evoked by hypertonic saline was unaffected. In electrophysiological studies performed in vitro, responses of single vagal C fibers to capsaicin, applied to receptive fields of single-fiber units in the trachea, were also markedly increased after perfusion with bradykinin, whereas A delta fiber responses to hypertonic saline were unaffected. These results indicate that bradykinin-evoked sensitization of airway sensory nerves may underlie the pathogenesis of ACE-inhibitor cough. Bradykinin receptor antagonists may be of benefit in treating chronic cough seen with this and other inflammatory conditions.
Fusco BM; Giacovazzo M 1997, Peppers and pain. The promise of capsaicin. Drugs 1997 Jun;53(6):909-14 ABSTRACT: Capsaicin, the most pungent ingredient in red peppers, has been used for centuries to remedy pain. Recently, its role has come under reinvestigation due to evidence that the drug acts selectively on a subpopulation of primary sensory neurons with a nociceptive function. These neurons, besides generating pain sensations, participate through an antidromic activation in the process known as neurogenic inflammation. The first exposure to capsaicin intensely activates these neurons in both senses (orthodromic: pain sensation; antidromic: local reddening, oedema etc.). After the first exposure, the neurons become insensitive to all further stimulation (including capsaicin itself). This evidence led to the proposal of capsaicin as a prototype of an agent producing selective analgesia. This perspective is radically different from previous 'folk medicine' cures, where the drug was used as a counter-irritating agent (i.e. for muscular pain). The new concept requires that capsaicin be repeatedly applied on the painful area to obtain the desensitisation of the sensory neurons. Following this idea, capsaicin has been used successfully in controlling pain in postherpetic neuralgia, diabetic neuropathy and other conditions of neuropathic pain. Furthermore, evidence indicates that capsaicin could also control the pain of osteoarthritis. Finally, repeated applications of the drug to the nasal mucosa result in the prevention of cluster headache attacks. On the basis of this evidence, capsaicin appears to be a promising prototype for obtaining selective analgesia in localised pain syndromes.
Hautkappe M et al. 1998, Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction. Clin J Pain 1998 Jun;14(2):97-106
Abstract: BACKGROUND: Topical capsaicin is known to be a safe and effective pain management adjunct for rheumatoid arthritis, osteoarthritis, neuralgias, and diabetic neuropathy. However, studies and case reports in the literature have indicated that other conditions may also benefit from capsaicin: painful or itching cutaneous disorders from operations, injuries, or tumors; neural dysfunction; or inflammation of the airways and urinary tract. METHODS: To determine the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction, the authors analyzed data from 33 reports (MEDLINE search of 1966-96) on the efficacy of capsaicin. Outcome measures consisted of the response rate and degree of pain relief. Results from placebo-controlled trials were pooled when possible; effect of treatment was estimated by the method of DerSimonian and Laird. RESULTS: Pain relief for postmastectomy syndrome and cluster headache was greater with capsaicin than with placebo; also, psoriasis and pruritus responded better to capsaicin. Uncontrolled studies and case reports have indicated that pain or dysfunction was less at the end of capsaicin therapy for neck pain, loin pain/hematuria syndrome, oral mucositis, rhinopathy, reflex sympathetic dystrophy syndrome, detrusor hyperreflexia, and cutaneous pain due to tumor of the skin. CONCLUSIONS: Capsaicin is effective for psoriasis, pruritus, and cluster headache; it is often helpful for the itching and pain of postmastectomy pain syndrome, oral mucositis, cutaneous allergy, loin pain/hematuria syndrome, neck pain, amputation stump pain, and skin tumor; and it may be beneficial for neural dysfunction (detrusor hyperreflexia, reflex sympathetic dystrophy, and rhinopathy). A universal problem for many of the studies analyzed was the absence of a "burning placebo" such as camphor.
Newall CA, Anderson LA, Phillipson DJ., Herbal Medicines: A Guide for Healthcare Professionals. The Pharmaceutical Press, London, 1996.
Phillips, C.D. 1879. Materia Medica and Therapeutics: Vegetable Kingdom. New York: William Wood and Company.
Shin HC, Park HJ, Raymond SA. Potentiation by capsaicin of lidocaine's phasic impulse block in isolated rat sciatic nerve. Pharmacol Res 1994 Jul;30(1):73-79.
Abstract: Compound action potentials (CAPs) of A- and C-fibres were recorded from isolated sciatic nerves of the rat to determine whether lidocaine-induced phasic impulse block was affected by low doses of capsaicin. Preceding impulse activity produced phasic reductions of the amplitudes of both A- (5.7 +/- 1.3%) and C-CAPs (20.7 +/- 7.0%) in drug-free solution. Capsaicin alone (50 microM) did not change the activity-induced reductions of the heights of both CAPs (A-CAP: 6.2 +/- 1.7%, C-CAP: 22.3 +/- 8.0%). Lidocaine (100 microM) caused differential phasic blocks between the A-CAP (20.1 +/- 3.7%; n = 7) and the C-CAP (33.8 +/- 4.9% n = 7). Lidocaine's phasic impulse block was potentiated after 30 min of subsequent capsaicin administration (A-CAP: 40.6 +/- 4.7%, n = 7; C-CAP: 48.8 +/- 5.5% n = 9). Capsaicin's phasic potentiating effects were reversed after 30 min of washing. These results suggest that capsaicin may be a useful agent for the reversible potentiation of phasic impulse blockade by lidocaine.
Vickers ER, Cousins MJ, Walker S, Chisholm K. Analysis of 50 patients with atypical odontalgia. A preliminary report on pharmacological procedures for diagnosis and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998 Jan;85(1):24-32.
Abstract: Atypical odontalgia is a distressing and unusual chronic orofacial pain condition. It is often difficult to diagnose because it is associated with a lack of clinical and radiographic abnormalities. The condition is poorly understood on a pathophysiological basis, and patients often undergo repetitive and unnecessary dental procedures in attempts to alleviate pain. In this study, 50 patients diagnosed with odontalgia were evaluated by pharmacological procedures, including topical anesthetic application and phentolamine infusion. Results of these pharmacological procedures suggest that atypical odontalgia is a neuropathic pain of the oral cavity that may have a component of sympathetically maintained pain. Therapeutic trials of topical capsaicin were carried out to assess its efficacy for pain reduction. Topical capsaicin was effective in most patients.
Wallace MS, Laitin S, Licht D, Yaksh TL. Concentration-effect relations for intravenous lidocaine infusions in human volunteers: effects on acute sensory thresholds and capsaicin-evoked hyperpathia. Anesthesiology 1997 Jun;86(6):1262-1272.
Abstract: BACKGROUND: Preclinical studies have emphasized that persistent small afferent input will induce a state of central facilitation that can be regulated by systemically administered lidocaine. The authors extended these preclinical studies to human volunteers by examining the concentration-dependent effects of intravenous lidocaine on acute sensory thresholds and facilitated processing induced by intradermal capsaicin. METHODS: Fifteen healthy persons received a lidocaine or a placebo infusion. A computer-controlled infusion pump targeted sequential stepwise increases in plasma lidocaine concentration steps of 1, 2, and 3 microg/ml. At each plasma concentration, neurosensory testing (thermal and von Frey hair test stimulation) were performed. After completing the tests at the 3 microg/ml plasma lidocaine level, intradermal capsaicin was injected into the volar aspect of the left forearm, and the flare response and hyperalgesia to von Frey hair stimulation, stroking, and heat was assessed. RESULTS: The continuous infusion of lidocaine and placebo had no significant effect on any stimulus threshold. Although intravenous lidocaine resulted in a decrease in all secondary hyperalgesia responses, this was only significant for heat hyperalgesia. Intravenous lidocaine resulted in a significant decrease in the flare response induced by intradermal capsaicin. CONCLUSIONS: These studies suggest that the facilitated state induced by persistent small afferent input human pain models may predict the activity of agents that affect components of nociceptive processing that are different from those associated with the pain state evoked by "acute" thermal or mechanical stimuli. Such insight may be valuable in the efficient development of novel analgesics for both neuropathic and post-tissue-injury pain states.
Yeo WW, Chadwick IG, Kraskiewicz M, Jackson PR, Ramsay LE. Resolution of ACE inhibitor cough: changes in subjective cough and responses to inhaled capsaicin, intradermal bradykinin and substance-P. Br J Clin Pharmacol 1995 Nov;40(5):423-429.
Abstract: 1. In eight hypertensive patients with ACE inhibitor-induced cough the resolution of the cough was examined in a prospective observational study over 4 weeks duration. Resolution of cough was measured by visual analogue scales and questionnaire at baseline and days 3, 7, 14 and 28. In addition changes in cough sensitivity to inhaled capsaicin, and skin responses to bradykinin and substance-P were measured at the same time points. 2. All patients recorded significant subjective improvement in cough questionnaire scores for severity and night time waking, and by visual analogue scales for severity and frequency of cough (all P < 0.0005 for trend from day 0-28). Significant changes in subjective measures were recorded by 3 to 7 days for most measures, but further reductions were observed up to day 28 (all P < 0.01 day 28 vs day 0). 3. The sensitivity to inhaled capsaicin fell over the 28 days of study after stopping enalapril. The potency of capsaicin relative to day 0 was reduced to 0.25 (95% CI 0.07-0.87) by day 14, and to 0.20 (95% CI 0.06-0.67) by 28 days. 4. After stopping enalapril there was a highly significant reduction in wheal area produced by intradermal bradykinin, with the majority of the effect seen by day 3 (P < 0.0005). The wheal area to intradermal substance-P also declined with time after stopping enalapril, but significant changes were not observed until 14 days (P < 0.01). 5. Multiple regression analysis of the rates of decline for the subjective and objective measures of cough showed significant associations between the response to inhaled capsaicin and the VAS scores for severity of cough (P = 0.005) and frequency of cough (P = 0.011). Capsaicin response was not related significantly to the severity of cough measured by self-administered questionnaire. 6. There was a significant association between bradykinin response and VAS scores for frequency of cough (P < 0.04) and severity of cough (P < 0.05), but not with cough by questionnaire or the capsaicin response. The response to substance-P did not relate significantly to any of the measures of cough. 7. Cough caused by enalapril improved markedly by 14 days but took up to 28 days to resolve. It was associated with increased sensitivity to inhaled capsaicin which decreased over 28 days, and which paralleled changes in subjective cough scores.