Drug Topics - December 10, 2007 - (Page 35)

35 reduction in pain sensitivity after persistent desensitization of the neurons and the depletion of substance P. This phenomenon occurs after repeated application of topical capsaicin. Studies have also shown the degeneration of epidermal nerve fibers may be another possible explanation for capsaicin’s reduction of pain sensitivity. A normal therapeutic dose of topical capsaicin is 0.025% applied topically three to four times a day. Most cream preparations contain 0.025% to 0.075% capsaicin concentrations; however; the higher potency formulations are more often used for diabetic neuropathy. It may take up to 14 days for capsaicin to reach its maximum effectiveness. A review by Mason et al. involving the data from six doubleblind, placebo-controlled trials focused on the pain benefits of topically applied 0.025% and 0.075% capsaicin. A 50% reduction in pain was determined as clinical success in these trials. It was concluded that capsaicin was significantly better than placebo for musculoskeletal as well as neuropathic pain. For musculoskeletal conditions, the treatment rate for capsaicin was found to have a mean response of 38% compared with 25% with placebo after four weeks of concurrent administration applied three to four times daily. An additional study established clinical data focusing on the patient’s perspective of treatment options for osteoarthritis in the knee. The patient’s perspective is extremely important because it focuses on effectiveness of the therapy as well as cost and adverse effects. Treatment options for pain include NSAIDs, COX-2 inhibitors, opioid preparations, glucosamine and/or chondroitin sulfate, and capsaicin. Capsaicin 0.025% cream was applied three times daily, and it was found to have an onset of one hour. The percent of patients with perceived benefits included 50% with prescription nonselective NSAIDs, 50% with prescription COX-2 inhibitors, 50% with prescription opioid preparations, 50% with glucosamine and chondroitin supplementation, and 25% for over-the-counter capsaicin. Even though it was found to be less effective than the other treatment alternatives, patients preferred capsaicin because of its relative low cost and few adverse effects. Precautions are needed with the use of capsaicin. The most commonly reported adverse reaction is skin irritation. Burning, stinging, and erythema of the dermis are the primary symptoms experienced by patients. Patients should be advised to wear disposable gloves when applying the topical agent and to especially avoid mucous membranes. Patients may be advised to use a patch or a no-mess roll-on applicator for ease of use. Studies have shown that skin irritation from topical capsaicin decreases or vanishes after repeated applications. A possible drug interaction may be seen after the concurrent administration of capsaicin with anticoagulant medications. Perhaps capsaicin may increase the effects of antiplatelet medications; however, there is a low level of evidence and occurrence supporting these data. Glucosamine: Glucosamine is an amino sugar and a con- utilized for the synthesis of carbohydrate-containing compounds such as glycoproteins, glycolipids, and glycosaminoglycans. These compounds are found within cartilage, synovial fluids, tendons, ligaments, and other areas of the body. Glucosamine is believed to slow disease progression, possess diseasemodifying capabilities, and reduce pain and inflammation in osteoarthritis patients. One beneficial mechanism of the agent is its ability to increase the metabolism of chondrocytes. In the body, chondrocytes are normally responsible for the maintenance of the cartilaginous matrix that is primarily composed of collagen and proteoglycans. Increasing the activity of chondrocytes in cartilage and synovial fluids causes a shift toward the maintenance of cartilage rather than the destruction seen with the natural disease process of osteoarthritis. Glucosamine’s diseasemodifying activity is another mechanism that is thought to Table 2 Selected osteoporosis and osteoarthritis agents* and USP-verified products Calcium: Calcium carbonate 500 mg by Nature Made Calcium carbonate 500 with D by Sunmark Calcium carbonate 600 mg by Nature Made Calcium carbonate 600 with D by Sunmark Calcium citrate 315 mg + D by Sunmark Chewable calcium carbonate 600 mg with vitamin D (fruit flavor) by Nature Made Vitamin D: Longs Wellness Natural Vitamin D 400 IU by Leiner Health Products Vitamin D 400 IU by Nature Made Vitamin D 400 IU by YourLife Ipriflavone: Bone Support by Twin Lab** 600 mg ipriflavone Capsaicin: various Glucosamine hydrochloride and chondroitin sulfate: Kirkland Signature Glucosamine & Chondroitin by Kirkland Signature Glucosamine HCl & MSM by Sunmark Glucosamine Chondroitin by Sunmark Extra Strength Glucosamine HCl 500 mg Chondroitin Sulfate 400 mg by Kirkland Signature SAMe SAMe 400 mg by Natrol *Agents that have been recommended for use by Natural Medicines Comprehensive Database **Also contains calcium carbonate/citrate 1,500 mg, vitamin D 800 IU, magnesium 750 mg, Novasoy Phytoestrogen Extract 100 mg, boron 3 mg Not USP certified stituent of cartilage proteoglycans. In the body, glucosamine is

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Drug Topics - December 10, 2007

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