52 Herbal Medicine

CAYENNE PEPPER Latin Name: Capsicum species

Pharmacopeial Names: capsici fructus, capsici fructus acer

Other Names: Capsicum annuum L. var. annuum: bell pepper, chili pepper, red pepper, sweet pepper, paprika; Capsicum annuum var. conoides Irish: Mexi­can chili, pimiento; Capsicum annuum var. glabriusculum (Dunal) Heiser & Pickersgill: bird pepper; Capsicum annuum var. longum Sendtner: Louisiana long pepper or hybridized to the Louisiana sport pepper; Capsicum frutescens L.s.l.: Tabasco pepper, African capsicum, African chili, capsicum, chili pepper, hot pepper.

[Note: This herb was published under the monograph heading "Paprika (Cayenne)" in the original book of Commission E monographs.]

Overview Capsicum annuum is an annu al or biennial plant (Iwu, 1990) , while C. (rutescens is a perenni al shrub. Both species are native to tropical America, now cultivated wo rldwide in tro pical and subtropical zones (Leung and Foster, 1996; Whistler, 1992). The degree of punge ncy, calculated in heat units, of dried Capsicum and/or the o leoresin extrac tive, is what determines its value and end use (Wood, 1987) . The material of commerce comes mainly from tropical Africa, China, and India (BHP, 1996).

Chili is the Aztec name for cayenne pepper. It has been used by Native Ameri cans as food and medicine for at least nine thousand years. Based on archeological evi­dence, its cultivation in M exico is beli eved to have begun around seven thousand years ago . It was first introduced to Europe by Dr. Diego Alvarez Chanca, who accompanied explorer Cristoforo Colombo (ca. 1451-1506 C.E. ) to the West Indies (Lembeck, 1987; Palevitch and Craker, 1995). From Europe, it was then trans­ported to most tropical, subtropical, and temperate zones around the world (Pale­vitch and Craker, 1995).

Cayenne was introduced into traditional Indian Ayurvedic medicine as well as traditional Chinese, Japanese, and Korean medicines, respectively. In Ayurvedic medi cine, a combination of cayenne, garlic, and liquid amber are used externally in paste or plaster form as a rubefacient (agent which reddens the skin) and local stimulant. It is also combined with mustard seed in a paste form used as a coun­terirr itant (Kapoor, 1990; Nadkarni , 1976). The dried fruit and/or tincture are also used internally to treat fla tulent dyspepsia and atony of digestive organs (Karnick, 1994 ; Nadkarni , 1976). In Chinese medicine, cayenne is considered to have diges­tive stimulant action and is sometimes used to cause diaphoresis (Shih-Chen et ai. , 1973 ). Topically, it is used in China in an ointment form to treat mya lgia and fros t­bite. In Japan, the tincture fo rm is used topically to treat the same conditions (But et ai. , 1997).

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Cayenne pepper 53

In Germany, cayenne pepper is official in the German Pharmacopeia an d approved in the Commission E monographs as a topical ointment for the relief of painful muscle spasms in the upper torso (DAB, 1997). In the United States, cap­sicum tincture and o leoresin were former ly official in the United States Pharma ­copeia an d National Formulary. Capsicum USP was used as a carminative, stimulant, and rubefacient (Leung and Foster, 1996; Taber, 1962). Capsa icin, iso­lated from Capsicum, is recognized by th e U.S . FDA as a counterirritant for use in OTC topi cal analgesic drug products (Palevitch and Craker, 1995) . It is used as a component in various counterirritant preparations (Leung and Foster, 1996), including ArthriCare® (Del Pharmaceuticals, Inc.) arthritis pain relieving rub, which contains Capsicum oleoresin (0.025% capsaicin) in combination with men­thol USP and Aloe vera gel (Arky et al., 1999). Capsicum ointments, such as Zostrix® cream (Ge nDerm Corp.) , containing 0.025% or 0.075% capsaicin, are used topically to treat shingles (herpes zoster) and post-herpetic neuralgi a (Bern­stein et aI., 1987; Der Marderosian, 1999; Palevitch and Craker, 1995).

Cayenne preparations have demonstrated significant efficacy in the treatment of shingles, trigeminal neuralgia, and redu ction of pain following surgical amputation (Tyler, 1993). For topical arthritis relief, capsaicin interferes with the pain of inflammatory joint d isease. It may block pain fib ers by destroy ing substance P, which normally would mediate pain signals to the brain (Garrett et al., 1997; Tyler, 1993). It may also interfere with oxygen radical transfers that are intrinsic to pain­producing prostaglandin pathways (Leun g and Foster, 1996). While its exact mech­anisms are not full y understood , capsaicin is regarded as a neuropathic pain reliever, and has recently been the subject of a phase 3 trial that demonstrated sig­nificant redu ctions in the long-term, postsurgical pain of cancer survivors (Ellison et aI., 1997).

Numerous studies on top ical preparations containing isolated capsa icin have been documented. Human trials have investigated its use as a treatment for chronic post-herpetic neuralgia (Bernstein et aI., 1987; Bernstein et al., 1989; Menke and H eins, 1999; Peikert et al., 1991; Watson et aI. , 1988; Watson et aI., 1993), its effects on normal skin and affected dermatomes in herpes zoster (Westerman et aI. , 1988), the somesthetic and electrophysiologic effects of top ical capsaicin (Walker and Lewis, 1990), its use in the treatment of painful diabetic neuropathy (Bash a and Whitehouse, 1991 ; Tandan et al. , 1992), the effect of local capsa icin treatment for chronic rhinopathy (Eberle and Gluck, 1994), its use in the management of sur­gical neuropathic pain in cancer patients (Ellison et al., 1997), and the effect of topical capsaicin on substance P immunoreactivi ty (Munn et aI., 1997). Addition­ally, a meta-analysis of tri als of topical capsaicin for the treatment of diabetic neu­ropathy, osteoarthritis, post-herpetic neuralgia, and psoriasis has been published (Z hang and Li Wan Po, 1994).

Other studies on the anti-inflammatory ac ti on of capsa icin analogs suggest that the antioxidant nature of the methoxyphenol ring of capsa icin may interfere with the oxygen radical transfer mechani sm common to lipoxygenase and cyclo-oxyge­nase. Cayenne is thought to cause a dose-related (1 - 100 nM) hemol ysis of human red blood cell s, and is associated with significant changes in erythrocyte membrane lipid components (decreasing phospholipid and cholesterol content), as well as an acetylcholinesterase activity. There are reported alterations in membranes including calcium homeostasis, lysosomal leakage, and alterations in antioxidant enzyme defense systems (Leung and Foster, 1996).

German pharmacopeial grade cayenne pepper consists of dried, ripe fruit of C. frutescens L. sensu latiore., usually removed from the calyx. It must contain not less than 0.4% capsaicinoids with reference to the dried drug. Determination of total capsaicinoids is carried our with liquid chromatography. Botanical identi fica­tion must be confirmed by thin-layer chromatograp hy (TLC), macroscopic and microscopic examinations, and organoleptic evaluation. Fruit from C. annuum L.

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54 Herbal Medicine

vaL longum (de Candolle) Sendtner may not be present (DAB, 1997). The Ger­man Homeopathic Pharmacopoeia, however, requires the dried ripe fruits of C. annuum L. and considers the fruits of C. frutescens L. to be foreign constituents (GHp, 1993) .

J apanese pharmacopeial grad e cayenne pepper consists of the fruit of C. annuum L. o r its var ieties. Identity is confirmed by TLC plus macroscopic and organoleptic evaluations. It must co ntain no t less than 9 .0% ether-soluble extrac­tive (jSHM, 1993).

Description Caye nne consists of the dri ed fruits of vari ous capsa icin-ri ch Capsicum species [Fam. Solanaceae] and its preparations in effective dosage. Cayenn e pepper consists of the dried , ripe, usually removed from the calyx, fruits of C. frutescens L. , and its preparations in effective dosage. The preparations con­tain capsaicinoids .

Chemistry and Pharmacology Cayenne pepper contains up to 1.5% capsaicinoids (pungent principles) including 0. 1-1 % capsaicin, 6,7 -dihy­drocapsaicin, nordihydrocapsaicin, homodihydrocapsaicin , and homocap­saicin ; fi xed oils (Budavari, 1996; Leung and Foster, 1996; Wood, 1987); carotenoid pigments inclu ding capsan­thin, capsorubin, alpha- and beta­carotene (Budavari, 1996; But et ai., 1997; Leung and Foster, 1996); steroid glycosides, including capsicosides A, B, C, and D (But et ai., 1997); 9- 17% fa ts; 12- 150/0 proteins; vitamins A and C; trace of volatile oil (Leung and Fos­ter, 1996; Newall et ai. , 1996).

The Commission E reported local hyperemic and local nerve-damaging activity.

The British Herbal Pharmacopoeia reported rubefacient and vasostimulant actions (BHP, 1996). The Merck Index reported the therapeu tic category of capsaici n, a pungent principle isolated from cayenne or paprika, as topical analgesic (Budavari, 1996). Cayenne has been shown to have counterirritant, antiseptic, diaph oretic, rubefacient, and gastric stimulating properties (Newall et ai. , 1996; Stecher, 1968).

Uses T he Commission E approved cayenne fo r painful muscle spasms in areas of shoulder, arm, and spine of adults and children . Prepara tions are used to treat arthritis, rheumatism, neuralgia, lum­bago, and chilblains. It is also used as a deterrent for thumb sucking or nail bit­ing in children (Leung and Foster, 1996). Human studies on cayenne have found different results in duod enal ulcer pa tients. One stud y administered 10 g of red chilies in wheatmeal to the control group and duodenal ulcer suf­ferers and fo und no significant effect on acid or pepsin secretion, or on sodium, potassium, and chloride concentrations in the gastric aspirate (Pimparkar et a I. , 1972). In contrast, a study on capsicum showed that it increased acid concentra­tion and DNA content of gastric aspi­rates in control subjects as well as in patients with duod enal ulcers (Locock, 1985).

Contraindications Application on injured skin, allergies to cayenne preparations.

Side Effects In rare cases hypersensitivi ty reaction may occur (urticaria).

Use During Pregnancy and Lactation No restrictions known.

Interactions with Other Drugs None known. Note : No addi tional heat applica tion.

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Dosage and Administration Unless otherwise prescribed: Prepara­tions of cayenne exclusively for external uses. Liniment: Hot oil emulsion containing dried cayenne powder or alcoholic tinc­ture, applied locall y by friction method. Ointment or cream: Semi-l iquid prepa­rati on contai ning 0.02-0.05% capsaici­noids in an emulsion base, applied to affected area. Poultice : Semi-solid paste or plaster containing 10-40 g capsaicinoids per cm2, appli ed locally. Tincture 1:10 (glml) , 90% ethanol: Aqueous-alcoholic preparation contain­ing 0.005-0.01 % capsaicinoids, applied locally. Duration of admini stration: Not longer than two days; 14 days must pass before a new application can be used in the same location. Longer use on the same area may cause damage to sensi­tive nerves.

Warning: Cayenne preparations irri ­tate the mucous membranes even in very low concentrations and cause a painful burning sensation. Avoid con­tact of cayenne preparations with mucous membranes, especially the eyes.

References Arky, R. et aI., 1999. Physicians · Desk Reference for

Nonprescription Drugs and Dietary Supplements. Montvale, Nj: M edical Economics Company, Inc. 642.

Basha, K.M. and F. W Whitehouse. 1991. Cap­sa icin: a therapeutic option for painful diabetic neuropathy. Hen ry ford H osp MedJ 39(2): 138-140.

!jerns tein j .E. , D.R. Bi ckers, M.V. Dahl , j .Y. Roshal. 1987. Treatment of chronic postherpetic neuralgia with topi cal capsaicin. A preliminary srudy.} Am Acad Dermatol 17 (1):93 -96 .

Hernstein.l .E. , N.J. Korman, D.R. Hickers, M.Y. Dahl, L.E. Millikan. 1989. Topical capsaicin treatment of chronic posthcrpetic neuralgia. J Am Acad Dermatol 21(2 Pr 1): 265-270.

British Herbal Pharlllacopoeia (B HP). 1996. Exeter, U.K.: British H erba l Medi cine Assoc iation. 55- 56.

I~u d avari, S. (ed.). 1996. Th e Merck Index: All Encyclupedia of Chemicals, Drugs, and Biologi­cals, 12th ed. Wh ire house Station, N . .J. : Merck & Co, Inc. 287-289.

!jut, P. l~H . ct al. (eds.). 1997. International Colla­tion of Traditi(!I1a l and folk Medicine. Singapo re: World Scientifi c. 138- 139.

Cayenne pepper 55

Der Marderosian, A. (ed .). 1999. The Review of Natural Products. Sr. Louis: Facts and Compar­Iso ns.

Deutsches Arzneibuch (DAB 1997). 1997. Stuttgart: Deutsch er Apotheker Verlag.

Eberle L and U. Gluck. 1994. Klinische Erfahrun­gen mit lokaler Capsaicinbehandlung be i chro­nischer Rhinopathi c lClinical ex periences with local capsaicin treatment of chronic rhinopathyJ. HNO 42( 11 ):665-669.

Ell ison, N. et al. 1997. Phase III pl acebo-controll ed trial of ca psaicin crcam in the management of surgical neuropathic pain in cancer paticnts. ] Clin 0Ilco/ 15(8): 2974-2980.

Garrett, N.E., S.c. C ru wys, B.L. Kidd, D.Il. Tom­linson. 1997. Effect of capsaicin on substance P and nerve growth fac tor in adjuvant arthritic rats. Neurosc i Lett 230( 1):5-8 .

T he Gerlllall Homeopathic Pharmacopoeia (G HP). 1993. Translation of Homoopathisches Arzlleibuch (HAB I), 5th suppl. 199 1 to the first editi on 1978. Stuttgart: Deutsch er Apotheker Verlag. 275-277.

lwu, M.M. 1990. Handbook of African Medicinal Plants. Boca Raton: C RC Press. 139-140.

The Japanese Standards for Herba l Medicilles US HM). 1993. Tokyo: Yaku ji Nippo, Ltd. 59-60.

Kapoor, L.D. ·1990. Hall dbook of Ayurvedic Medic ­ilia I Plants. Boca Ra ton: CRC Press. 98 .

Karnick, C.R. 1994. Pharmacopoeial Standards of Herbal Plallt s, Vol. 1. Delhi : Sri Satgu ru Publi ca­tions. 79-8 0.

Lembeck, F. 198 7. Colu mbus, Capsicum and cap­saicin: past, present and future . Acta Physiol HUllg 69(3-4) :265 -273 .

Leun g, A.Y. and S. Foster. 1996. Ellcyclopedia of Common Natural Ingredients Used ill Food, Drugs and Cosmetics, 2nd ed. New York: j ohn Wil ey & Sons, Inc.

Lacock, R.A. 1985. Capsicum. Call PI,a,.,n } 118:517- 519.

M enke, J .J. and .J. R. Heins. 1999. Treatment of posth erpetic neuralgia. J Am Pharm Assoc (Wash) 39(2):217-22 1.

Munn, S.£. et al. 1997. The effect of topical cap­saici n on substance P immunoreactivity: a clini ­ca l tri al and immunohistochemical analysis [Ierter]. Acta Derm Venereol (Stockh) 77(2): 158-1 59.

Nadbrni , K.M. 1976. Ill diall Materia Medica. Bombay: Popu lar Prakashan . 268-27 1.

Newall, C.A., L.A. Anderson, J.D. Phillipson. 1996 . Herbal Medicill es: A Guide for Health­Care Professiollals. London: T he Pharmaceutical Press.

Palevirch, D. and L.E. Craker. 1995. Nutriti onal and medica l importance of red pepper (Cap ­sicum spp.). J Herbs Spices Med Plants 3(2)55- 83.

Peikert A., M . Hentrich , C. Ochs. 199 1. Topical 0.0250/0 capsaic in in chronic post-herpetic neu­ralgia: efficacy, predi ctors of response and long­term course .} NellroI238(8): 452-456.

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I'imparkar, B. .0. et al. 1972. Effects of com­mon ly used spi ces on human gastric secretion. } Assoc Physicialls Illdia 20:90 1-9 10.

Shih-Chen, L. , F.P. Smith, G .A. Stuart. 1973 . Chi­nese Medicinal Herbs . San Francisco, CA: Georgetown Press.

Stecher, P.G. et al. 1968. The Merck Illdex: All Ellcyclopedia of Chemicals alld Drugs, 8th ed. Rahway, N.J .: Merck & Co., Inc.

Taber, C. W 1962. Taber's Cyclopedic Medical Dic­tiollary, 9th ed. Phil adelphia: EA. Davis Com­pany. C- l I.

Tandan, R. , G.A. Lewis, I~ B. Krusin ski , G.B. Bad­ge r, Tj. Fri es. 1992. To pical capsaicin in painful diabetic neuropathy. Controlled study with long­term fol low-up . Diabetes Care 15(1):8-14.

Tyler, V. 1993 . The Honest Herbal, Jed ed. New York: Pharmace utical Pro ducts Press.

Walker, F.O. and S.F. Lewis. 1990. Somesthetic and electrophysiologic effects of topical 0 .025 % cap­sa icin in man. Reg Anesth 15(2):61-66.

Watson , c. r., R.j. Evans, V.R . Watt. 1988 . Post-her­petic neuralgia and topical capsa icin. Pain 33(3):333- 340.

Watson c.r. et al. 1993 . A randomized vehicle-con­troll ed trial of topical capsaicin in th e treatment of postherperic neura lgia . Clin Ther 15(3):5 10-526.

Westerman, R.A. et a1.1988 . Effects of topical cap­sa ic in on normal skin and affected dermaromes in herpes zoster. Clill Exp NeUl·0 /25:71-84.

Whi stler, WA. 1992. Polynesian Herbal Medicille . Lawai, Kauai, Hawaii: National Tropical Botani­cal Garden . 237 .

Wood, A.B. 1987 . Determination of th e pungent princ ipl es of chili es and ginger by reversed-phase hi gh-performance liquid chromatogra phy with use of a single standard substance. Flavour Fra­grance} 2:1 - 12.

Zhang, WY. and A. Li Wan Po . 1994. The effective­ness of topically applied capsaicin. A meta-analy­sis. Eur} Clin Pharmaco/46(6):517-522 .

Additional Resources British Herbal Pharmacopoeia (B HP). 19 83 . Keigh­

ley, U. K.: British H erbal Medicin e Association. Bruneton, J. '1995 . Pharmacognosy, Phytochem­

istry, Medicillal Plallts. Pa ris: Lavoisier Publish­ing.

Delltsches Arzlleibuch, lOth ed. (DAB 10). 199 1. (Wi th subseq uent supp lements through 1996.) Stuttgart: Deutscher Apotheker Verlag.

Gri eve, M . 1979 . A Modem Herbal. New York: Dover Publi cations, Inc.

Wren, R.C. 1988. Potter's New Cyclopaedia of Botanical Dmgs and Preparatioll s. Essex: The C. W Daniel Com pany Ltd.

This material was adapted from The Complete German Commissioll E MOllographs-Therapeutic Guide to Herbal Medicines. M . Blumenthal, WR. Busse, A. Goldberg, j. Gruenwald, THall , C. W Riggin s, R.S. Ri s­rer (cds .) S. Klein and R.S . Ri ster (trans.). 1998 . Ausrin: American Botanical Counc il; Boston : Integrative Medicin e Communications. 1) The Overview section is new information. 2) Description, Chem istry and Pharmaco logy, Uses, Contraindi cations, Side Effects, [nteractions with

Other Drugs, and Dosage secrions have been drawn from the original wo rk. Additional information has been add ed in some or all of these sections, as noted with references.

3) The dosage for equivalent preparations (tea infusion, fluidextract, and tincture) have been provided based on the following exam ple: Unless otherwise prescribed: 2 g per day of [powdered , crushed, cut or whole] [plant part] Infusion: 2 g in 150 ml of water Fluidextract 1: 1 (glml): 2 ml T incture 1: 5 (glml) : 10 ml

4) The References and Additional Resources sections are new sectio ns. Add itional Resources are not cited in the monograph but are included for research purposes.

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