(Capsicum frutescens, Capsicum annuum)
Alternate Names/Related Species:
• Capsicum; Grains of Paradise; African Pepper; Bird Pepper; Chili Pepper
Approach to the Patient
Capsaicin, the “hot” constituent of cayenne, has an established medicinal use in topical pain-relieving creams; and patients interested in natural therapies may be pleased to consider it as an option.
Topical capsaicin may also be helpful for psoriasis. Oral cayenne has shown some promise for dyspepsia.
(Higher numbers indicate stronger evidence; X modifier indicates contradictory results. See the Introduction for details of the rating scale.)
Under the brand name Zostrix, a cream containing concentrated capsaicin has been approved by the FDA for the treatment of post-herpetic neuralgia.
There is also some evidence that capsaicin creams may be helpful for relieving various types of arthritis1,2 as well as other forms of pain, such as fibromyalgia3 and neuropathic pain. 4,14-24 Capsaicin instilled into the nose has shown promise for cluster headache. 25
Actual cayenne rather than capsaicin has been tested for pain as well. A 3-week, double-blind trial of 154 individuals with back pain found that cayenne applied topically as a “plaster” improved discomfort to a greater extent than placebo. 26
A double-blind, placebo-controlled trial of about 200 individuals with psoriasis found that use of topical capsaicin can improve pruritis as well as overall psoriasis severity scores. 27 Benefits were also seen in a smaller double-blind study of topical capsaicin for psoriasis. 28
In a double-blind study, 30 individuals with functional dyspepsia were given either 2.5 grams daily of red pepper powder (divided up and taken prior to meals) or placebo for 5 weeks. 29 By the third week of treatment, individuals taking red pepper were experiencing significant improvements in pain, bloating, and nausea as compared to placebo, and these relative improvements lasted through the end of the study. A much smaller study failed to find benefit. 10 Presumably, the effect of capsaicin in dyspepsia is mediated through its action on substance P.
NSAID-Induced Gastritis +1
Limited preliminary evidence in humans and animals suggests that oral use of cayenne may provide gastric protection against nonsteroidal antiinflammatory medications. 5,6,7
Other Proposed Uses
Topical capsaicin has been tried for various pruritic conditions, such as prurigo nodularis, but double-blind studies are lacking. 8,30
Contrary to some reports, cayenne does not appear to be effective for treatment of Helicobacter pylori infection. 9
Cayenne pepper taken internally has been informally reported as a treatment for heart disease, but there is no scientific support for this use.
Mechanism of Action
Capsaicin depletes substance P, thereby diminishing nocioceptive impulses.
Capsaicin creams are approved over-the-counter drugs and should be used as directed.
For internal use, cayenne is typically taken at a dosage of 1 to 2 standard 00 gelatin capsules one to three times daily.
Cayenne is generally recognized as safe. Contrary to some reports, cayenne does not appear to aggravate stomach ulcers. 11
Maximum safe dosages in individuals with severe hepatic or renal disease are not known.
Safety in Young Children and Pregnant or Lactating Women
Maximum safe dosages for pregnant or lactating women, or young children, have not been established. However, use as a condiment is most likely safe.
Though it has not been proven, spicy foods are traditionally thought to stimulate colicky reactions in breast-feeding infants.
Cayenne may increase absorption of theophylline, possibly leading to toxic levels. 12
Cayenne may provide a gastroprotective effect if taken with NSAIDs.6,7,13
1. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: A double blind trial. Clin Ther. 1991;13:383-395.
2. McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol. 1992;19:604-607.
3. McCarty DJ, Csuka M, McCarthy, et al. Treatment of pain due to fibromyalgia with topical capsaicin: A pilot study. Semin Arthritis Rheum. 1994;23(suppl 3):41-47.
4. McCleane G. Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study. Br J Clin Pharmacol. 2000;49:574-579.
5. Yeoh KG, Kang JY, Yap I, et al. Chili protects against aspirin-induced gastroduodenal mucosal injury in humans. Dig Dis Sci. 1995;40:580-583.
6. Abdel Salam OM, Moszik G, Szolcsanyi J. Studies on the effect of intragastric capsaicin on gastric ulcer and on the prostacyclin-induced cytoprotection in rats. Pharmacol Res. 1995;32:209-215.
7. Holzer P, Pabst MA, Lippe IT. Intragastric capsaicin protects against aspirin-induced lesion formation and bleeding in the rat gastric mucosa. Gastroenterology. 1989;96:1425-1433.
8. Stander S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad Dermatol. 2001;44:471-478.
9. Graham DY, Anderson SY, Lang T. Garlic or jalapeno peppers for treatment of Helicobacter pylori infection. Am J Gastroenterol. 1999;94:1200-1202.
10. Rodriguez-Stanley S, Collings KL, Robinson M, et al. The effects of capsaicin on reflux, gastric emptying and dyspepsia. Aliment Pharmocol Ther. 2000;14:129134.
11. Graham DY, Smith JL, Opekun AR. Spicy food and the stomach. Evaluation by videoendoscopy. JAMA. 1988;260:3473-3475.
12. Bouraoui A, Toumi A, Mustapha HB, et al. Effects of capsicum fruit on theophylline absorption and bioavailability in rabbits. Drug Nutr Interact. 1998;5:345-350.
13. Yeoh KG, Kang JY, Yap I, et al. Chili protects against aspirin-induced gastroduodenal mucosal injury in humans. Dig Dis Sci. 1995;40:580-583.
14. Low PA, Opfer-Gehrking TL, Dyck PJ, et al. Double-blind, placebo-controlled study of the application of capsaicin cream in chronic distal painful polyneuropathy. Pain. 1995;62:163-168.
15. Biesbroeck R, Bril V, Hollander P, et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther. 1995;12:111-120.
16. The Capsaicin Study Group. Effect of treatment with capsaicin on daily activities of patients with painful diabetic neuropathy. Diabetes Care. 1992;15:159-165.
17. Tandan R, Lewis GA, Krusinski PB, Badger GB, Fries TJ. Topical capsaicin in painful diabetic neuropathy. Controlled study with long-term follow-up. Diabetes Care. 1992;15:8-14.
18. The Capsaicin Study Group. Treatment of painful diabetic neuropathy with topical capsaicin. A multicenter, double-blind, vehicle-controlled study. Arch Intern Med. 1991;151:2225-2229.
19. Scheffler NM, Sheitel PL, Lipton MN. Treatment of painful diabetic neuropathy with capsaicin 0.075%. J Am Podiatr Med Assoc. 1991; 81:288-293.
20. Jensen PG, Larson JR. Management of painful diabetic neuropathy. Drugs Aging. 2001;18:737-749.
21. Ellison N, Loprinzi CL, Kugler J, et al. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol. 1997;15:2974-2980.
22. Dini D, Bertelli G, Gozza A, et al. Treatment of the post-mastectomy pain syndrome with topical capsaicin. Pain. 1993;54:223-226.
23. Watson CP, Evans RJ. The postmastectomy pain syndrome and topical capsaicin: a randomized trial. P ain. 1992;51:375-379.
24. Watson CP, Evans RJ, Watt VR, et al. The post-mastectomy pain syndrome and the effect of topical capsaicin. Pain. 1989;38:177-186.
25. Marks DR, Rapoport A, Padla D, et al. A double-blind placebo-controlled trial of intranasal capsaicin for cluster headache. Cephalalgia. 1993;13:114-116.
26. Keitel W, Frerick H, Kuhn U, et al. Capsicum pain plaster in chronic non-specific low back pain. Arzneimittelforschung. 2001;51:896-903.
27. Ellis CN, Berberian B, Sulica VI, et al. A double-blind evaluation of topical capsaicin in pruritic psoriasis. J Am Acad Dermatol. 1993;29:438-442.
28. Bernstein JE, Parish LC, Rapaport M, et al. Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris. J Am Acad Dermatol. 1986;15:504-507.
29. Bortolotti M, Coccia G, Grossi G, et al. The treatment of functional dyspepsia with red pepper. Aliment Pharmacol Ther. 2002;16:1075-1082.
30. Reimann S, Luger T, Metze D. Topical administration of capsaicin in dermatology for treatment of itching and pain. Hautarzt. 2000;51:164-172.
Last reviewed September 2002 by EBSCO CAM Review Board
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