Capsaicin (standardised)

Tier 3 — weak evidence · Thermogenesis · Pain · Metabolic

The pungent compound from chili peppers, in standardised oral or topical preparations. Topical 0.025–0.075% creams have FDA-cleared use for arthritis and post-herpetic neuralgia; high-dose 8% patches require clinician application. Oral capsaicin shows small thermogenic and appetite-suppressant effects in trials but the GI burning sensation limits dose tolerance. Skin sensitisation and severe local burning are the main risks.

Dose: Topical 0.025–0.075% cream 3–4× daily; oral 2–6 mg/day with food