Trubrexa
Trubrexa (lidocaine / capsaicin) is a patch that's applied to the skin to treat joint and muscle pain. Trubrexa is made up of two different pain medications: lidocaine and capsaicin. The typical dose in adults and children ages 12 years and older is to apply one patch once per day for up to 12 hours at a time. Some of the more common side effects of Trubrexa (lidocaine / capsaicin) include skin irritation, itchiness, and dryness. You're at risk for more severe side effects, such as heart rhythm problems, if you leave the patch on longer than 12 hours per day.
What is Trubrexa (lidocaine / capsaicin)?
What is Trubrexa (lidocaine / capsaicin) used for?
Relief of short-term and long-term pain in muscles and joints caused by muscle soreness or stiffness, strains, sprains, arthritis, and backaches
How Trubrexa (lidocaine / capsaicin) works
Trubrexa (lidocaine / capsaicin) is a combination of two medications that work together to treat pain:
Lidocaine is a local anesthetic. It blocks sodium channels in nerves that send pain signals to the brain. This results in numbness and lower sensitivity to pain.
Capsaicin is a local analgesic that binds to the transient receptor potential vanilloid 1 receptor (TRPV1). Over time, it lowers your body's sensitivity to pain.
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What are the side effects of Trubrexa (lidocaine / capsaicin)?
Common Side Effects
- Skin burning or stinging
- Dry skin
- Itchy skin
Other Side Effects
- Dizziness
- Sleepiness
- Blurry vision
Serious Side Effects
- Severe blood problem (methemoglobinemia): seizures, loss of consciousness, fast heart beat, trouble breathing, feeling dizzy or faint, feeling tired, skin color turning blue or pale
- Serious allergic reactions: swelling of the face, difficulty breathing, trouble speaking, throat tightening up, red and itchy rash, lightheadedness, clammy skin
Source:Â DailyMed
Pros and cons of Trubrexa (lidocaine / capsaicin)
Pros
Applied directly to the skin once per day
Each patch can be used twice in a day (put the clear plastic film back on in between use)
Can be an option for children older than 12 years old
Cons
Brand name only
Can cause skin irritation
Can't wear patch if using heating pads or electric blankets
Pharmacist tips for Trubrexa (lidocaine / capsaicin)
Always wash your hands after applying the Trubrexa (lidocaine / capsaicin) patch. This gets rid of medication that might've accidentally got on your fingers.
You can leave Trubrexa (lidocaine / capsaicin) on your skin for 12 hours at a time. After that, you need to remove the patch and leave it off for 12 hours before applying a new patch (12 hours on, 12 hours off).
Each Trubrexa (lidocaine / capsaicin) patch can be used twice in 24 hours. Once you've applied the Trubrexa (lidocaine / capsaicin) patch once, you can put the clear plastic film back on the sticky side of the patch. You can use that same patch again when it's time for your next dose.
After you've used the Trubrexa (lidocaine / capsaicin) patch twice, you need to discard that patch. Before throwing it away, fold the patch in half by putting the sticky sides together. This will keep someone from accidentally touching the medication side of the patch and getting it on their skin. Discarded patches can be dangerous if a child or pet chews or eats them because used patches still contain some medication.
Apply Trubrexa (lidocaine / capsaicin) on dry, intact skin. Never apply to broken skin because this will cause too much medication to be absorbed into your blood and put you at higher risk for side effects, such as irritation and dizziness.
Don't apply Trubrexa (lidocaine / capsaicin) to the face, eyes, mouth, nose, or scalp. Doing so can raise your risk for exposure to sensitive areas of your body and cause extreme irritation and pain. Breathing in Trubrexa (lidocaine / capsaicin) can cause coughing or sneezing because of irritation of your airways.
Avoid using a heating pad or electric blanket over your Trubrexa (lidocaine / capsaicin) patch because the heat can cause you to absorb more medication, which can put you at higher risk for side effects. But it's okay to wear clothing over your patch.
If you experience irritation or burning after applying Trubrexa (lidocaine / capsaicin), remove the patch. Then, you can try putting the patch on again once the irritation or burning goes away. But if either of these come back again, it's recommended to contact your healthcare provider for other treatment options because Trubrexa (lidocaine / capsaicin) might not be appropriate for you.
Don't use Trubrexa (lidocaine / capsaicin) with other medications that also contains lidocaine or capsaicin. Doing so can raise your risk for side effects. Both lidocaine and capsaicin can be found in many over-the-counter products. Ask your pharmacist if you're not sure if something you're using already has lidocaine or capsaicin.
Store Trubrexa (lidocaine / capsaicin) up and away and out of children's reach and sight. This prevents them from accidentally touching or swallowing medication that's left out. If you think that your child might’ve accidentally swallowed a Trubrexa (lidocaine / capsaicin) patch, call your Poison Control Center at 1-800-222-1222 right away, even if you aren't completely sure.
Frequently asked questions about Trubrexa (lidocaine / capsaicin)
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What are the risks and warnings for Trubrexa (lidocaine / capsaicin)?
Trubrexa (lidocaine / capsaicin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Blood problems (methemoglobinemia)
Risk factors: Lung or heart problems | Glucose-6-phosphate dehydrogenase (G6PD) deficiency | Infants under 6 months old | Taking medications or foods containing nitrates
The lidocaine in Trubrexa can cause a rare, but serious, condition known as methemoglobinemia. This is a condition where your blood can't get enough oxygen to your body. The risk is higher in certain people, such as infants younger than 6 months old and people with heart or lung problems. Cases of methemoglobinemia after the use of local anesthetics have happened within minutes to one or two hours. This reaction can develop after using the medication for the first time or even if you've used it previously.
Contact your healthcare team right away if you notice notice symptoms of methemoglobinemia such as headaches, dizziness, trouble breathing, and gray- or blue-colored skin. If not treated right away, it can lead to more serious problems, such as seizures and coma.
Risk of too much medication
Risk factors: Having smaller body size | Applying Trubrexa patch for a longer time than recommended | Applying multiple Trubrexa patches at a time
If Trubrexa covers too large of an area on the body or if you wear the patch for longer than 12 hours at a time, your body might absorb too much lidocaine and capsaicin. The risk is higher for certain people, such as those with smaller body size or those whose bodies have a hard time getting rid of lidocaine or capsaicin. Let your healthcare team know right away if you experience symptoms of lidocaine or capsaicin toxicity, such as confusion, trouble breathing, or pain and burning sensation.
Unintended capsaicin exposure
Getting Trubrexa (lidocaine / capsaicin) onto sensitive skin areas can cause painful and severe irritation. Inhaling capsaicin can cause coughing and sneezing. Don't apply Trubrexa (lidocaine / capsaicin) to sensitive areas (e.g., face, mouth, nose, scalp) or skin areas that are broken or damaged. Also, wash your hands immediately after applying Trubrexa (lidocaine / capsaicin) patch. And wash all skin areas that had contact with the patch after you remove it from your body. This is to lower the risk of unintentionally transferring the medication to other parts of the body. If you accidentally get Trubrexa (lidocaine / capsaicin) onto sensitive skin areas, make sure to wash with water.
Application site pain
Some people experience skin reactions after applying Trubrexa (lidocaine / capsaicin). Symptoms can include blisters, burning, changes in skin color, and itching. The reactions are typically mild and get better within minutes to hours. Let your healthcare team know if you experience severe reactions that don't get better over time.
Loss of sensory function
Risk factors: History of sensory function problems
It's possible for Trubrexa (lidocaine / capsaicin) to lower your sensory function, such as sensing heat with your hands. This problem tends to be mild and goes away. If your sensory function worsens or completely goes away, contact your healthcare provider immediately. You might have to stop using Trubrexa (lidocaine / capsaicin).
Serious allergic reaction to topical pain medications
Some people have reported allergic reactions after using Trubrexa (lidocaine / capsaicin). Let your care team know if you have a history of allergy to topical pain medications, such as ropivacaine (Naropin), bupivacaine (Marcaine), or lidocaine. Watch out for signs and symptoms of allergic reactions, such as hives, trouble breathing, swelling of your face, lips, or throat. Get medical attention right away if you have these signs and symptoms.
High blood pressure
Risk factors: High blood pressure | History of heart problems or stroke
The pain caused by Trubrexa (lidocaine / capsaicin) can lead to a small rise in your blood pressure. You might be at higher risk of complications from this rise in blood pressure if you already have high blood pressure or if you have a history of heart problems or stroke. Your provider might monitor your blood pressure during treatment with Trubrexa (lidocaine / capsaicin). Let your healthcare provider know your medical history and if you're taking medication for blood pressure before receiving Trubrexa (lidocaine / capsaicin).
Trubrexa (lidocaine / capsaicin) dosage forms
Typical dosing for Trubrexa (lidocaine / capsaicin)
Each Trubrexa patch contains lidocaine 4.75% and capsaicin 0.025%.
Adults and children ages 12 years and older: The typical dose is to apply 1 patch to the most painful area once a day. The patch can be worn for up to 12 hours at a time within a 24-hour period (12 hours on, 12 hours off).
Each Trubrexa (lidocaine / capsaicin) patch can be used twice daily. After the first use, put the clear plastic film back on the sticky side of the patch to save it for later.
How much does Trubrexa (lidocaine / capsaicin) cost?
Trubrexa (lidocaine / capsaicin) contraindications
Allergy to amide local anesthetics (e.g., lidocaine, prilocaine, ropivacaine, bupivacaine)
What are alternatives to Trubrexa (lidocaine / capsaicin)?
Relief of short-term and long-term pain in muscles and joints caused by muscle soreness or stiffness, strains, sprains, arthritis, and backaches
Nerve pain caused by shingles (postherpetic neuralgia)
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References
Best studies we foundChang, A., et al. (2023). Capsaicin. StatPearls.
Fattori, V., et al. (2016). Capsaicin: Current understanding of its mechanisms and therapy of pain and other pre-clinical and clinical uses. Molecules.
Karnina, R., et al. (2021). Molecular mechanisms of lidocaine. Annals of Medicine and Surgery.
Ludlow, J. T., et al. (2023). Methemoglobinemia. StatPearls.
ScienceDirect. (n.d.). Local anesthetic agent.
Strand Health Group. (2024). Trubrexa- lidocaine and capsaicin patch [package insert]. DailyMed.
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