Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate is a pain-relief medicine that you rub on the skin over the painful area. It is sold in India as an ointment or gel. It mixes five ingredients that act on pain in different ways. Capsaicin comes from chili peppers. Gabapentin is a nerve-pain medicine. Ketoprofen is an anti-inflammatory painkiller (an NSAID). Lignocaine, also called Lidocaine, is a numbing medicine. Methyl salicylate, also known as oil of wintergreen, is used in deep-heating rubs. Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate is meant for local pain, such as nerve pain or aching muscles and joints, and should be used as your doctor advises.

Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate brings together five medicines that have each been used on the skin for pain. The idea is to work on pain at the spot where it is felt, instead of sending a tablet through the whole body.

Each part has its own job. Ketoprofen is an NSAID. It blocks an enzyme called cyclo-oxygenase, which the body uses to make prostaglandins, chemical messengers that drive swelling and pain. Ketoprofen applied to the skin is used for sprains, bruising, tendon inflammation, small-joint arthritis and sudden low-back pain.

Capsaicin first causes a burning feeling. With repeated use, it wears down the nerve endings' ability to send pain signals. Lignocaine numbs the area by calming nerve membranes so they pass on fewer signals. Gabapentin, when taken by mouth, eases nerve pain by changing the way the body senses pain. Gel forms of gabapentin have been studied for nerve pain from diabetes, though the research so far is small. Methyl salicylate belongs to the salicylate family, the same family as aspirin. This is why labels warn people with aspirin allergy.

Some cautions need medical supervision. Ketoprofen on the skin can cause photoallergy, a skin reaction triggered by sunlight. For this reason, European regulators made topical ketoprofen prescription-only. Methyl salicylate can be absorbed through the skin. In reported cases, heavy use raised the blood-thinning effect of warfarin and led to bruising and bleeding. Swallowing products with methyl salicylate can cause serious poisoning.

Because Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate contains several active medicines, use it only on the area your doctor names, for the time your doctor sets. Tell your doctor about any other pain gels, patches or blood thinners you use.

Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate is a fixed-dose combination (several medicines in set amounts in one product) for use on the skin only. It is available as an ointment or gel and contains:

• Capsaicin - the substance that makes chili peppers hot; works on pain-sensing nerve endings
• Gabapentin - a nerve-pain medicine from the anticonvulsant (anti-seizure) group
• Ketoprofen - a non-steroidal anti-inflammatory drug (NSAID)
• Lignocaine (Lidocaine) Hydrochloride - a local anaesthetic (numbing medicine)
• Methyl Salicylate - a salicylate pain reliever, also called oil of wintergreen

The strength of each ingredient can differ between brands, so check the label on your pack.

Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate is used on the skin for local pain. The ingredients in it have been used for:

• Nerve pain - capsaicin and lignocaine skin products are used for nerve pain after shingles (postherpetic neuralgia), and capsaicin and gabapentin gels have been studied in nerve pain from diabetes. Most of the capsaicin evidence for these nerve pains comes from higher-strength products.
• Muscle and joint pain - capsaicin and methyl salicylate rubs are used for minor aches of muscles and joints from arthritis, backache, strains and sprains.
• Pain and swelling after minor injury - ketoprofen on the skin is used for sprains, bruising and tendon inflammation (tendonitis).
• Arthritis in small joints and sudden low-back pain - ketoprofen gel is used for both.

1. Several pain pathways in one product - Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate pairs an anti-inflammatory (ketoprofen), a numbing medicine (lignocaine), a nerve-calming chili extract (capsaicin), a nerve-pain medicine (gabapentin) and a salicylate rub in a single application.
2. Swelling and pain from minor injuries - ketoprofen on the skin reduces the signs of inflammation by blocking prostaglandin production, which helps with sprains, bruising and tendon pain.
3. Targeted to where it hurts - NSAID gels applied to the skin are less likely to cause side effects than NSAID tablets.
4. Help for nerve pain - capsaicin and lignocaine are both used on the skin for nerve pain after shingles. In a small uncontrolled study of 23 people with different types of nerve pain, gabapentin gel caused few side effects. Most of the evidence for capsaicin in shingles and diabetic nerve pain comes from higher-strength products, and low-strength capsaicin lotions have shown little benefit over a dummy treatment.

Common Side Effects (Usually Mild and may lessen with continued use)

• Burning or stinging where it is applied. The burning from capsaicin usually fades within several days of regular use.
• Redness of the skin
• Itching or skin irritation
• Cough, sneezing or throat irritation if dried product on the skin is breathed in

Serious Side Effects (Seek Urgent Medical Attention)

• Photoallergy (photosensitivity reaction) - an allergic skin reaction to ketoprofen that is triggered by sunlight, even dim sunlight. It can show up as a rash, redness or blisters on treated skin that has been in the sun. Using sunscreens or cosmetics that contain octocrylene can add to this risk. Stop using Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate straight away if any skin reaction appears.
• Skin burns - rare cases of serious skin burns have been reported with rubs that contain methyl salicylate, menthol or capsaicin, in many cases after just one application. Get help for pain, swelling or blistering where you applied it.
• Severe burning at the application site
• Eye pain or irritation after contact
• Allergic reaction - rash, swelling of the face or throat, or trouble breathing or swallowing
• Bleeding or unusual bruising in people who also take warfarin
• Signs of too much medicine in the blood - ringing in the ears, confusion, dizziness, shaking, fits (seizures), slow heartbeat or fainting

Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate is for use on the skin only. Do not swallow it.

1. Use it only on the area your doctor told you to treat, and only as often as your doctor or the pack says.
2. Apply a thin layer over the painful area and rub it in gently.
3. Do not put it on cut, broken, infected or rashy skin.
4. Keep it away from your eyes, nose and mouth. If it gets into your eyes, rinse with cold water and call a doctor.
5. Wash your hands with soap and water after each use. If you are treating your hands, wait 30 minutes before washing them, and do not touch your eyes, nose or mouth until you do.
6. Do not cover the area with a tight bandage. Do not use a heating pad, hot water bag or heat lamp on it.
7. Do not apply it just before or just after a bath, a swim or hard exercise.
8. Keep the treated skin covered from sunlight while using Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate and for two weeks after you stop, because of the ketoprofen in it. Do not use sunbeds during treatment.
9. Use it at about the same times each day if your doctor has asked you to use it regularly, and keep using it for as long as your doctor advises.

Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate works on pain in five ways at the same spot:

• Ketoprofen - an NSAID. It blocks an enzyme called cyclo-oxygenase (COX). The body uses COX to make prostaglandins, which are chemical messengers that cause swelling, redness and pain. Less prostaglandin means less inflammation and pain.
• Capsaicin - attaches to a pain receptor on nerve endings called TRPV1. This is why it first causes a burning feeling. With repeated use, the constant switching-on of TRPV1 uses up the chemical messengers these nerves need, so they send fewer pain signals.
• Lignocaine (Lidocaine) - a local anaesthetic. It steadies the outer layer (membrane) of nerve cells and blocks the movement of charged particles that nerves need to fire. This stops pain signals from starting and travelling, which numbs the area.
• Gabapentin - an anticonvulsant (anti-seizure medicine). Taken by mouth, it eases nerve pain by changing the way the body senses pain. In lab studies, it attaches tightly to one part of the calcium channels on nerve cells, called the alpha-2-delta subunit. Calcium channels are tiny gates that help nerves pass on signals. The exact way gabapentin eases pain is still not fully known. Gel forms of gabapentin have been studied on the skin for nerve pain.
• Methyl Salicylate - a salicylate, from the same chemical family as aspirin. It is used in deep-heating rubs for sore muscles and joints, and some of it passes through the skin into the blood. It is thought to work as a counter-irritant: it mildly irritates nerve endings in the skin, and this feeling masks deeper muscle and joint pain. Once it soaks into the tissues, it is also thought to briefly block the COX enzyme, so less prostaglandin is made.

• Wash your hands well after each use, so capsaicin does not reach your eyes or mouth.
• Protect treated skin from sunlight with clothing during use and for two weeks after you stop, because ketoprofen can cause a sun-triggered skin allergy.
• Check your sunscreen, shampoo and skin creams for octocrylene, as it can add to skin reactions with ketoprofen.
• Do not use a heating pad, hot water bag or tight bandage over the treated skin.
• Do not use other pain rubs, gels or patches on the same area at the same time unless your doctor says so.
• If you take warfarin, tell your doctor before you start, and do not use more than prescribed.
• Expect some burning for the first few days. Stop and call your doctor if the burning is severe.

• Store at room temperature. One US label for a cream that contains methyl salicylate and capsaicin says to store it below 32°C (90°F). Always follow the storage temperature printed on your pack.
• Keep the tube tightly closed in its original pack.
• Protect from light, extra heat and moisture. Do not keep it in the bathroom.
• Keep out of the reach and sight of children and pets. Swallowing products with methyl salicylate can cause serious poisoning.

Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate is applied to the skin, so meals do not change how it works.

• Chili peppers - if you are allergic to chili peppers, tell your doctor before use, because capsaicin is the hot substance in chili peppers.
• Alcohol - alcohol can add to the drowsiness that gabapentin taken by mouth can cause. Ask your doctor whether drinking is safe for you.

• Warfarin (blood thinner) - methyl salicylate used on the skin raised the INR (a blood test of clotting time) in people taking warfarin, and some had bruising or stomach bleeding. Warfarin users need their doctor's advice before use and should not use more than prescribed.
• Other pain rubs, gels or sprays - one methyl salicylate label says not to use it together with other skin pain products. Using several at once adds more of the same medicines to your skin.
• Medicated patches - do not put a medicated patch on the same area as a methyl salicylate rub.
• Sunscreens and cosmetics with octocrylene - octocrylene can cause skin reactions in people using ketoprofen on the skin. It is found in some sunscreens, shampoos, skin creams, make-up removers and hair sprays.
• Aspirin and other NSAIDs (if you are allergic) - do not use Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate if you have ever had asthma, a runny or blocked nose, hives or another allergic reaction after taking aspirin, ibuprofen or another NSAID. Ketoprofen is an NSAID and methyl salicylate is a salicylate.
• Other numbing medicines - tell your doctor if you are allergic to amide-type local anaesthetics (the group of numbing medicines that lignocaine belongs to).
• Heart rhythm medicines such as mexiletine - tell your doctor, as a lignocaine skin label says the harmful effects of lignocaine and these medicines can add up.

Do not use Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate if you have had:

• A skin reaction to sunlight with any medicine in the past (photosensitivity reaction)
• A skin allergy to ketoprofen or to tiaprofenic acid (another NSAID), fenofibrate (a cholesterol medicine), sunscreens (UV blockers) or perfumes
• Asthma, a runny or blocked nose, or hives after aspirin or any other NSAID, or any allergy to ketoprofen itself
• An allergy to aspirin - ketoprofen labels rule out use after allergic reactions to aspirin, and methyl salicylate in Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate is a salicylate, from the same family as aspirin

Take care, and tell your doctor first, if you have:

• Asthma or allergies such as hay fever - NSAIDs like ketoprofen may not be suitable. Tell your doctor first.
• Stomach ulcer, now or in the past - NSAIDs may not be suitable.
• Heart, liver or kidney conditions - NSAIDs may not be suitable. Gabapentin labels also ask people with kidney or lung disease to tell their doctor.
• Bleeding or clotting problems, or past stroke - NSAIDs may not be suitable, and methyl salicylate can add to bleeding risk with warfarin.
• Broken, cut, infected or irritated skin - do not apply Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate on these areas.
• Chickenpox - NSAIDs may not be suitable during chickenpox.

Use Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate exactly as your doctor prescribes. The amount and number of applications depend on the area being treated and your condition.

For comparison, US labels for methyl salicylate rubs state that adults and children over 12 should apply a thin layer no more than 3 to 4 times a day. A UK label for a ketoprofen gel states that it is applied two or three times a day, and that use should not go beyond 10 days. Because Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate contains ketoprofen, the stricter ketoprofen gel limits (two or three times a day, for no more than 10 days) are the safer guide unless your doctor tells you otherwise. Your doctor may advise a different schedule for Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate. Do not use more, more often or over a larger area than prescribed.

Overdose is most likely if the product is swallowed, or if too much is used over a large area or too often.

Signs of methyl salicylate poisoning include:

• Nausea or vomiting, which may contain blood
• Ringing in the ears, eye burning or vision problems
• Fast breathing or trouble breathing
• Confusion, agitation, drowsiness, dizziness, fever, fits (seizures) or collapse
• Passing little or no urine

Too much lignocaine in the blood can cause dizziness, shaking, fits, slow heartbeat and low blood pressure.

If someone has swallowed Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate or has these signs, go to the nearest hospital emergency department straight away. Do not make the person vomit unless a doctor tells you to. Take the tube with you.

If you use Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate only when you have pain, there is no set schedule to miss. If your doctor asked you to use it regularly, apply it when you remember. If it is almost time for your next application, skip the missed one and carry on as usual. Do not apply extra to make up for a missed one.

Stop using Capsaicin + Gabapentin + Ketoprofen + Lidocaine Hydrochloride + Methyl Salicylate and contact your doctor if you notice:

• Any rash, redness, blisters or skin reaction, especially on skin that has been in sunlight
• Severe burning, pain, swelling or blistering where it was applied
• Eye pain or irritation
• Pain that gets worse, lasts more than 7 days, or clears up and then comes back
• Unusual bruising, bleeding gums, blood in vomit or black stools, especially if you take warfarin

Get emergency help for:

• Swelling of the face or throat, or trouble breathing or swallowing
• Ringing in the ears, confusion, fits (seizures) or fainting
• Swallowing of the product by anyone, especially a child