Health Care Professional Information
Capsicum frutescens, Capsicum annuum. Family: Solanaceae
Capsicum, red pepper, hot pepper, African chillies, conoids, Tabasco pepper, paprika, pimiento, mexican chilies, longum, Louisiana long pepper
Derived from the fruit of Capsicum, cayenne is among the most widely consumed culinary spice. Traditionally, it is used topically as a rubefacient, as a gargle for laryngitis and orally as a gastrointestinal stimulant. The active component, capsaicin, is an irritant which has been used in scientific studies to evaluate pain sensation.
Phytochemical extracts of capsicum have been shown to exhibit more antioxidant activity than broccoli, carrot or spinach (3). Topical capsaicin cream may be effective against chronic soft tissue pain (22) and low back pain (13). Capsaicin may also increase insulin and decrease blood glucose levels (14). Supplementation with capsicum for burning mouth syndrome is associated with significant side effects (4).
In vitro studies have shown that capsaicin has cytotoxic effects against multidrug resistant lymphoma (5), oral tumor cell lines (6) and inhibits leukemia cell growth (7). Topical capsaicin may alleviate oral mucositis pain associated with chemotherapy and radiation therapy (8). Capsaicin cream has also been shown effective in reducing post-surgical pain in cancer patients (9) and for treating psoriasis (10) (11) and pruritus (12).
Use of gloves is recommended when applying topical capsaicin. An adverse effect of topical administration is burning following contact with moist mucous membranes (1) (2).
Toxicities following overdoses from oral injestion include gastroenteritis and renal damage (15). There are reports of erythematous dermatitis formed in infants subsequent to breast-feeding from mothers who had ingested food flavored with red pepper (16). Administration of even a single dose of capsicum may interfere with theophylline metabolism (17).
Fruits of capsicum pepper.
- Burning mouth syndrome
- Circulatory disorders
- Diabetic neuropathy
- Herpes zoster neuropathy
- High cholesterol
- Motion sickness
- Muscle pain
- Rheumatoid arthritis
- Stomach and intestinal gas
- Capsaicinoids: capsaicin, dihydrocapsaicin, nordihydrocapsaicin, homodihydrocapsaicin, homocapsaicin
- Volatile oils: trace amounts
- Carotenoid pigments: capsanthin, capsorubin, carotene, lutein
- Vitamins including A and C.
Mechanism of Action
The phenolic compound capsaicin is responsible for the irritant effects of capsicum (1). Studies show that 100g of the pepper has equivalent antioxidant activity of 826 mg of vitamin C (3). Lignan glycosides isolated from the capsicum pepper were also shown to be potent antioxidants as demonstrated by a strong scavenging activity against the free radical, DPPH (19). The pain relieving property of capsaicin is thought to be due to its ability to desensitize neurons when applied to the skin surface (8).
The active components in capsicum also have anticancer activities (20).
The active component capsaicin is absorbed through the skin, mucus membrane and in the G.I. tract. Capsaicin produces motor effects on gut motility that may affect the absorption of itself or other drugs. Capsaicin may affect the ability to absorb drugs via an alternate pathway than Cytochrome P450 (17).
Common (oral): GI irritation (4) , sweating, flushing, lacrimation, rhinorrhea.
Common (topical): Burning, urticaria, contact dermatitis (15).
Arterial hypertension has been reported in two men following ingestion of large amounts of chilli peppers (23) (24).
- Theophylline: Concurrent administration may increase absorption (17).
- ACE inhibitors: Oral or topical administration may increase the incidence of cough that is associated with ACE inhibitors.
- Sedatives: May increase sedation.
- Monoamine-oxidase inhibitors: May increase catecholamine secretion.
- Antihypertensives: May increase catecholamine secretion and antagonize hypotensive effects.
- Acetaminophen: May increase the absorption of acetaminophen. (21)
Literature Summary and Critique
Chalyasit K, et al. Pharmacokinetic and the effect of capsaicin in Capsaicum frutescens on decreasing plasma glucose level. J Med Assoc Thai. 2009 Jan;92(1):108-13.
A placebo-controlled, crossover study was conducted to determine the effect of capsaicin on plasma insulin and blood glucose levels. This study enrolled 12 healthy volunteers who received a single dose of either placebo or 5 grams of capsicum. After a 1 week washout period, the subjects were then crossed over to receive the other treatment. Insulin secretion and capsaicin levels in plasma were measuring using an HPLC method. The results of an oral glucose tolerance test demonstrated that plasma glucose levels in the subjects who had received capsicum were significantly lower than those in the placebo group at 30 and 45 minutes (p<0.05). Plasma insulin levels of subjects receiving capsicum were also significantly higher at 60, 75, 105, and 120 minutes (p<0.05) than those receiving placebo. The study also found that capsaicin levels achieved after the ingestion of 5 grams of capsicum were associated with a decrease in plasma glucose levels. The authors concluded that these study results may have clinical implications for the management of type 2 diabetes.
Dosage (Inside MSKCC Only)
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- DerMarderosian A. The Review of Natural Products. St. Louis: Facts and Comparisons, 1999.
- Barnes J, Anderson LA, Phillipson JD. Herbal Medicines. London: Pharmaceutical Press, 2002.
- Chu YF, Sun J, Wu X, Liu RH. Antioxidant and antiproliferative activities of common vegetables. J Agric.Food Chem. 2002;50:6910-6.
- Petruzzi M, Lauritano D, De Benedittis M, Baldoni M, Serpico R. Systemic capsaicin for burning mouth syndrome: short-term results of a pilot study. J Oral Pathol Med. 2004 Feb;33(2):111-4.
- Motohashi N, Kurihara T, Wakabayashi H, Yaji M, Mucsi I, Molnar J et al. Biological activity of a fruit vegetable, “Anastasia green”, a species of sweet pepper. In Vivo 2001;15:437-42.
- Motohashi N, Wakabayashi H, Kurihara T, Takada Y, Maruyama S, Sakagami H et al. Cytotoxic and multidrug resistance reversal activity of a vegetable, 'Anastasia Red', a variety of sweet pepper. Phytother Res 2003;17:348-52.
- Zhang J, Nagasaki M, Tanaka Y, Morikawa S. Capsaicin inhibits growth of adult T-cell leukemia cells. Leukemia Research 2003;27:275-83.
- Berger A, Henderson M, Nadoolman W, Duffy V, Cooper D, Saberski L et al. Oral capsaicin provides temporary relief for oral mucositis pain secondary to chemotherapy/radiation therapy. J Pain Symptom.Manage. 1995;10:243-8.
- Ellison N, Loprinzi CL, Kugler J, Hatfield AK, Miser A, Sloan JA et al. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol 1997;15:2974-80.
- Biesbroeck R, Bril V, Hollander P, Kabadi U, Schwartz S, Singh SP et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv.Ther. 1995;12:111-20.
- Reuter J, Wolfe U, Weckesser S, Schempp C. Which plant for which skin disease? Part 1: atopic dermatitis, psoriasis, acne, condyloma, and herpes simplex. J Dtsch Dermatol Ges. 2010 Oct;8(10):788-96.
- Stander S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad.Dermatol 2001;44:471-8.
- Gagnier JJ, van Tulder MS, Berman B, et al. Herbal medicine for low back pain: a Cochrane review. Spine 2007;32(1):82-92.
- Chalyasit K, Khovidhunkit W, Wittayalertpanya S. Pharmacokinetic and the effect of capsaicin in Capsaicum frutescens on decreasing plasma glucose level. J Med Assoc Thai. 2009 Jan;92(1):108-13.
- Newall CA. Herbal Medicines: A Guide for Health Care Professionals. London: Pharmaceutical Press, 1996.
- Cooper RL,.Cooper MM. Red pepper-induced dermatitis in breast-fed infants. Dermatology 1996;193:61-2.
- Bouraoui A, Brazier JL, Zouaghi H, Rousseau M. Theophylline pharmacokinetics and metabolism in rabbits following single and repeated administration of Capsicum fruit. Eur.J Drug Metab Pharmacokinet. 1995;20:173-8.
- Blumenthal M. Herbal Medicine: Expanded Commission E Monographs. Austin: American Botanical Council, 2000.
- Lee DY, Lee DG, Cho JG, et al. Lignans from the fruits of the red pepper (Capsicum annuum L.) and their antioxidant effects. Arch Pharm Res. 2009;32(10):1345-1349.
- Maoka T, Mochida K, Kozuka M, Ito Y, Fujiwara Y, Hashimoto K et al. Cancer chemopreventive activity of carotenoids in the fruits of red paprika Capsicum annuum L. Cancer Letters 2001;172:103-9.
- Brinker F. Herb Contraindications And Drug Interactions. Sandy, OR: Eclectic Medical Publications, 2001.
- Chrubasik S, Weiser T, Beime B. Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain. Phytother Res. 2010 Dec;24(12):1877-85.
- Patanè S, Marte F, Di Bella G, Cerrito M, Coglitore S. Capsaicin, arterial hypertensive crisis and acute myocardial infarction associated with high levels of thyroid stimulating hormone. Int J Cardiol. 2009 May 1;134(1):130-2.
- Patanè S, Marte F, La Rosa FC, La Rocca R. Capsaicin and arterial hypertensive crisis. Int J Cardiol. 2010 Oct 8;144(2):e26-7.
How It Works
Bottom Line: Oral and topical cayenne may help in alleviating some of the side effects of chemotherapy and radiation therapy such as mucositis pain and neuropathy.
The capsicum pepper contains a chemical called capsaicin that is a powerful irritant. It is thought that this chemical can sensitize nerves that report painful stimuli to the brain. Laboratory tests of capsaicin show that it may be able to kill cancer cells, however, a comparable effect in humans has not been shown. The capsicum pepper has also been shown to display powerful antioxidant activities.
- To relieve colic and stomach/intestinal gas
No scientific evidence supports this use. The capsicum pepper is known to be a gastrointestinal stimulant and irritant.
- To treat diarrhea
This claim is not backed by data.
- To treat headaches
Laboratory data show that capsaicin blocks pain fibers. One trial shows limited effect in treating cluster headaches.
- To lower high cholesterol
No scientific evidence supports this use.
- To manage type 2 diabetes.
- One small study demonstrated that capsaicin may have an effect on increasing insulin and lowering blood glucose levels.
- To improve circulation in the hands and feet
Laboratory studies have found that capsaicin inhibits dilation of blood vessels in the skin, which would not help improve circulation to the extremities. There is no proof from clinical trials that capsaicin improves circulation.
- To relieve nerve pain associated with diseases such as diabetes and herpes zoster (shingles)
Clinical trials show conflicting results regarding the use of capsaicin for neuropathies; cancer patients with post-surgical neuropathies benefited from capsaicin cream, while patients with HIV-related distal symmetrical peripheral neuropathy did not.
- To relieve muscle pain and muscle spasms
Laboratory data show that capsaicin blocks pain fibers, but there is no proof from clinical trials that capsaicin can be used to treat muscle pain or spasms.
- To treat joint pain
Several clinical trials support this use, with the results more positive for osteoarthritis than rheumatoid arthritis.
- To treat toothaches
No scientific evidence supports this use.
- To treat chronic skin diseases
One clinical trial supports this use for psoriasis.
- To treat burning mouth syndrome
A pilot study showed benefit, however, significant side effects were also noted.
Oral capsaicin was administered via capsaicin-laced taffy to eleven patients with oral mucositis pain from cancer therapy. Limited, temporary relief was provided by the therapy. Further study is warranted.
- Use of gloves is recommended when applying topically.
- This product is regulated by the F.D.A. as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
Do Not Take If
- You are taking ACE inhibitors (Can increase the incidence of cough that is associated with ACE inhibitors).
- You are taking sedative medication (May increase sedation).
- You are taking theophylline (May increase its absorption).
- You are taking a monoamine-oxidase inhibitor (MAOI) (May interfere with its effects).
- You are taking medication to lower your blood pressure (May lessen its effects).
- You are breast feeding (May cause dermatitis in nursing babies).
- Gastrointestinal irritation
- When taken orally in large doses, capsicum can cause irritation of the gastrointestinal tract, kidney damage, and liver damage.
- Burning and inflammation are possible when applied topically.
Arterial hypertension has been reported in two men following ingestion of large amounts of chilli peppers.
- Capsaicin, when used topically to treat pain, usually takes about four weeks of application to have the maximum benefit.
- Capsicum peppers should not be confused with the black and white pepper spices commonly used alongside salt on the table.
Last updated: July 27, 2011