Qutenza® (capsaicin) 8% patch

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What Is Postherpetic Neuralgia?

The varicella zoster virus is latent in the sensory ganglia (dorsal root ganglia of the spine and trigeminal cranial ganglion for facial involvement) until such time that the patient’s immune system is weakened, and then the virus reactivates.1 This is referred to as herpes zoster (HZ) (Greek: zoster —girdle) or shingles, and is accompanied by pain that is often described as excruciating. 2 The acute phase of herpes zoster usually resolves after 2 to 4 weeks.1 However, when the pain persists after the acute episode of herpes zoster has healed, this pain syndrome is known as postherpetic neuralgia (PHN). PHN can follow a herpes zoster outbreak at any site in the body and can be difficult to treat. It follows a dermatomal distribution and may remit spontaneously. However, the pain tends to persist for prolonged periods if it hasn’t resolved by 6 months.1

Clinical Symptoms

PHN pain may be spontaneous or may be triggered by light cutaneous stimulation (allodynia) (e.g., by clothing). The pain is usually present to some degree, with no pain-free intervals. Scars and pigmentary changes from the acute vesicular eruption are often visible. The involved area may demonstrate hyperesthesia, hypalgesia, paresthesia, and dysesthesia.1

Epidemiology

Incidence of herpes zoster is up to 1,000,000 cases per year in the United States.3 PHN occurs in about 10% to 20% of cases of herpes zoster.4 Both herpes zoster and PHN are more common in older patients (PHN is rare in patients younger than 40 years of age and usually occurs in patients over 60) and those patients who are immunosuppressed. PHN is more likely after ophthalmic herpes zoster than after spinal segmental cases.1

PHN can affect everyday life—disrupting sleep, mood, work, and activities of daily living.3 The prolonged pain of PHN often does not respond well to analgesic therapy and can lead to behavioral complications, including depression.2

References:

  1. Greenberg MS. Postherpetic neuralgia. In: Handbook of Neurosurgery. 6th ed. New York, NY: Thieme; 2006:387-388.

  2. Dworkin RH, Carrington D, Cunningham A, et al. Assessment of pain in herpes zoster: lessons learned from antiviral trials. Antiviral Res. 1997;33(2):73-85.

  3. Dworkin RH, Malone DC, Panarites CJ, Armstrong EP, Pham SV. Impact of postherpetic neuralgia and painful diabetic peripheral neuropathy on health care costs. J Pain. 2010;11(4):360-368.

  4. Gauthier A, Breuer J, Carrington D, Martin M, Rémy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2009;137(1):38-47.

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Indication: Qutenza® (capsaicin) 8% patch is indicated for the management of neuropathic pain associated with postherpetic neuralgia.

IMPORTANT SAFETY INFORMATION

Only physicians or healthcare professionals under the close supervision of a physician are to administer Qutenza®.

Contraindications: None.

Warnings and Precautions:

  • Do not use on face or scalp.
  • Aerosolization of capsaicin can occur and inhalation may result in coughing or sneezing.
  • If skin not intended to be treated comes into contact with Qutenza®, clean area using Cleansing Gel.
  • Patients may experience substantial procedural pain. Prepare to treat pain with local cooling (such as a cold pack) and/or appropriate analgesic medication.
  • Transient increases in blood pressure may occur during and shortly after the Qutenza® treatment. In clinical trials, blood pressure changes were associated with treatment-related increases in pain. Monitor blood pressure and provide adequate support for treatment-related pain. Patients with unstable or poorly controlled hypertension or a recent history of cardiovascular or cerebrovascular events may be at an increased risk of adverse cardiovascular effects. Consider these factors prior to initiating Qutenza® treatment.

Adverse Reactions: In clinical trials, serious adverse reactions included application-associated pain and increase in blood pressure. The most common adverse reactions (≥ 5% and greater than control) were application-site erythema, application-site pain, application-site pruritus, and application-site papules.

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