Qutenza (Capsaicin Patch) is a transdermal drug delivery system containing 8% capsaicin (640 micrograms per square centimeter), which was first approved in the United States in 2009. As a TRPV1 channel agonist, it exerts an analgesic effect by acting on sensory nerve endings and is currently approved for the treatment of neuropathic pain associated with postherpetic neuralgia (PHN) and diabetic peripheral neuropathy (DPN).
What Are the Precautions for Using Qutenza (Capsaicin Patch)?
Requirements for Administrators and Environment
Qutenza must be administered by a physician or professional healthcare provider; self-administration or handling by patients is prohibited.
Administration must be conducted in a well-ventilated treatment area. Operators must wear nitrile gloves (latex gloves are not allowed), and it is recommended to use masks and goggles to prevent the risk of accidental exposure to capsaicin.
All used materials must be disposed of in accordance with biomedical waste standards.
Dosage and Applicable Conditions
For PHN patients: A maximum of 4 patches can be used each time, with an application duration of 60 minutes.
For DPN patients: A maximum of 4 patches can be used on the feet each time, with an application duration of 30 minutes.
Treatment interval: Repeat treatment once every 3 months, or as determined based on pain recurrence (the minimum interval shall not be less than 3 months).
Skin condition: The patch can only be applied to dry, intact skin and must not be used on damaged skin. Before using the patch, DPN patients need to check their feet for skin lesions related to neuropathy or vascular insufficiency.
Medication Management for Special Populations
Pregnancy: Animal studies have shown no teratogenicity, but human data are limited, so the benefits and risks must be weighed.
Lactation: The amount of capsaicin excreted in breast milk is extremely low, but the patch should not be applied directly to the nipple and areolar areas.
Elderly patients: In clinical studies, patients aged 75 and above accounted for 43% of the total, and there was no significant difference in safety between this group and younger populations, so no dosage adjustment is required.
Medication Monitoring for Qutenza (Capsaicin Patch)
Real-Time Monitoring During Treatment
Dynamic blood pressure monitoring: Blood pressure must be monitored regularly during and after treatment. Clinical studies have shown that some patients may experience transient increases in blood pressure (average increase < 10 mmHg, lasting approximately 2 hours). Special attention should be paid to patients with unstable hypertension or a recent history of cardiovascular and cerebrovascular events.
Acute pain management: Even if a local anesthetic is used in advance, patients may still experience significant pain or a burning sensation during patch application and removal. Preparations should be made for local cold compresses or analgesic intervention.
Neurological Function Assessment
Sensory function (focusing on changes in temperature sensation and sharpness sensation) must be checked before each treatment.
If sensory deterioration or loss occurs, the feasibility of continuing treatment needs to be re-evaluated.
Skin Reaction Monitoring
Common adverse reactions include erythema (63%), pain (42%), and pruritus (6%) at the application site.
Special vigilance must be paid to the risk of severe burns, including full-thickness (third-degree) and deep partial-thickness (second-degree) burns. There have been cases requiring hospitalization and skin grafting.
