Tibetree Cheezheng Joint Analgesic Patch

For the relief of pain or itching, Camphor (natural) is typically applied to the affected area no more than 3 to 4 times daily.

• Topical Analgesic: Apply a thin layer of 3% to 11% camphor product to the painful site.
• Antitussive (Cough Suppressant): Apply a thick layer of a camphor-containing rub (usually 4.7% to 5.3%) to the chest and throat.

Caution: Camphor is highly toxic to children.

• Children under 2 years: Use is strictly contraindicated.
• Children 2 to 12 years: Use only under strict medical supervision and in concentrations specifically labeled for pediatric use. Never apply to the nostrils or face of a child, as it may cause respiratory distress or seizures.

Renal Impairment

No specific dosage adjustments are provided for topical use; however, caution is advised in patients with severe renal failure due to the potential for systemic accumulation of metabolites.

Hepatic Impairment

Because camphor is metabolized by the liver, patients with significant hepatic dysfunction should use camphor-containing products sparingly and monitor for signs of systemic toxicity.

Elderly Patients

Elderly patients often have thinner, more permeable skin. Use the lowest effective amount to minimize systemic absorption.

• Topical Use Only: Never ingest camphor. Even small amounts (1 teaspoon of 10% camphor) can be fatal to a child.
• External Application: Apply to clean, dry skin. Do not wrap the treated area with tight bandages or use heating pads, as this increases the risk of severe burns and systemic absorption.
• Storage: Store at room temperature (20°C to 25°C) in a tightly closed container, away from heat or open flames, as camphor is highly flammable.

Since camphor is used on an as-needed basis for symptom relief, a missed dose is generally not a concern. Do not apply double the amount to make up for a missed application.

Signs of systemic camphor poisoning include nausea, vomiting, abdominal pain, headache, dizziness, confusion, tremors, and seizures. If ingestion is suspected, contact a Poison Control Center or seek emergency medical attention immediately. Do not induce vomiting unless instructed by medical professionals.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance.

• Skin Irritation: A mild stinging, burning, or tingling sensation at the site of application is expected.
• Erythema: Temporary redness of the skin due to increased localized blood flow (rubefacient effect).

• Contact Dermatitis: Some individuals may develop an itchy rash or hives (urticaria) at the application site.
• Dryness: Repeated use may lead to localized skin peeling or dryness.

• Hypersensitivity Reactions: Severe allergic reactions, though rare, can occur in individuals sensitive to plant terpenes.
• Chemical Burns: Occurs if applied under tight bandages or with external heat sources.

> Warning: Stop taking Camphor (natural) and call your doctor immediately if you experience any of these:

• Seizures: Camphor is a potent neurotoxin when absorbed systemically; seizures can occur rapidly after ingestion or excessive topical application.
• Respiratory Distress: Shortness of breath or wheezing, especially if the product was applied near the face.
• Hepatotoxicity: Signs of liver stress, such as yellowing of the eyes/skin (jaundice), though this is typically associated with chronic systemic exposure.
• Severe Confusion or Hallucinations: Indicative of central nervous system (CNS) toxicity.

Prolonged or excessive use of camphor on large skin areas can lead to chronic systemic toxicity, manifesting as chronic nausea, weight loss, and neurological irritability. It is not intended for long-term daily use without medical oversight.

While the FDA does not currently mandate a formal "Black Box Warning" for topical camphor, it has issued multiple Safety Communications regarding the danger of camphor ingestion in children. All camphor products must carry a warning: "For external use only. Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away."

Report any unusual symptoms to your healthcare provider.

Camphor (natural) is safe when used as directed but carries significant risks if misused. It must never be applied to broken, irritated, or abraded skin, as this dramatically increases systemic absorption and the risk of toxicity.

No formal FDA black box warnings exist for Camphor (natural), but it is subject to strict concentration limits (11%) and mandatory safety labeling regarding pediatric ingestion risks.

• Allergic Reactions: Patients with a known allergy to camphor or members of the Lauraceae family should avoid use.
• Seizure Disorders: Use with extreme caution in patients with a history of epilepsy or other seizure disorders, as camphor can lower the seizure threshold.
• Flammability: Camphor is highly flammable. Do not use near sparks, open flames, or while smoking. Do not add camphor directly to boiling water.
• Mucous Membrane Avoidance: Do not apply to the eyes, inside the mouth, or inside the nostrils.

Routine lab tests are generally not required for intermittent topical use. However, for patients using high concentrations over large areas, healthcare providers may monitor:

• Liver Function Tests (LFTs): To assess for potential hepatotoxicity.
• Neurological Assessment: Monitoring for tremors or hyperreflexia.

Topical camphor typically does not interfere with the ability to drive. However, if systemic absorption occurs and causes dizziness or confusion, patients should avoid operating heavy machinery.

There are no known direct interactions between topical camphor and alcohol. However, alcohol may exacerbate the CNS-depressant or irritating effects if systemic camphor toxicity is present.

Camphor can be stopped abruptly without withdrawal symptoms. If symptoms of pain or cough persist for more than 7 days, or if they clear up and occur again within a few days, discontinue use and consult a physician.

> Important: Discuss all your medical conditions with your healthcare provider before starting Camphor (natural).

• Oral Camphor Products: Camphor should never be combined with any oral medication containing camphor, as the cumulative dose can quickly reach toxic levels.

• Warfarin and Anticoagulants: Although primarily topical, camphor may theoretically enhance the effects of anticoagulants if absorbed systemically in large amounts. Monitor for increased bruising or bleeding.
• Other Counterirritants: Using camphor simultaneously with Menthol, Capsaicin, or Methyl Salicylate may increase the risk of skin irritation or chemical burns.

• Topical Steroids: Applying camphor and a topical steroid to the same area may alter the absorption of the steroid. It is generally recommended to space applications by several hours.

There are no significant food interactions with topically applied camphor. However, users should avoid consuming large amounts of caffeine if they experience tremors or restlessness from camphor use.

• St. John's Wort: May theoretically interact with the metabolic pathways (CYP enzymes) if camphor is systemically absorbed.
• Essential Oils: Use caution when combining with other terpene-rich oils (e.g., eucalyptus, tea tree oil) as they may increase the risk of skin sensitization.

Camphor does not typically interfere with standard blood or urine laboratory tests. However, its metabolites may occasionally interfere with certain urine toxicology screens depending on the assay used.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.

• Pediatric Patients (<2 years): Due to the high risk of fatal seizures and respiratory collapse.
• Oral Ingestion: Camphor is strictly for external use. Ingestion is considered a medical emergency.
• Broken or Damaged Skin: Do not apply to wounds, rashes, or infected skin.
• Hypersensitivity: Known allergy to camphor or any component of the formulation.

• Pregnancy and Lactation: Use only if the potential benefit outweighs the risk to the fetus or infant.
• History of Seizures: Patients with epilepsy should use camphor only under medical supervision.
• Asthma or Emphysema: Inhaling strong camphor vapors may trigger bronchospasm in sensitive individuals.

Patients allergic to other terpenes (found in turpentine, pine oil, or menthol) may exhibit cross-sensitivity to camphor.

> Important: Your healthcare provider will evaluate your complete medical history before prescribing Camphor (natural).

Camphor (natural) is classified as FDA Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Camphor crosses the placenta. Use during pregnancy is generally discouraged, especially on large surface areas, unless deemed necessary by a healthcare provider.

It is unknown if camphor is excreted in human milk. However, because of the risk of systemic absorption and the extreme sensitivity of infants to camphor toxicity, nursing mothers should avoid applying camphor to the breast area or using it extensively while breastfeeding.

As noted, camphor is contraindicated in children under 2 years. In older children, it must be used with extreme caution. The thin skin of children allows for faster absorption, increasing the risk of CNS toxicity.

Older adults may have more sensitive skin and a higher risk of systemic absorption. Healthcare providers should monitor for signs of confusion or dizziness, which may increase fall risk in this population.

Since camphor metabolites are excreted renally, patients with a GFR <30 mL/min should use camphor sparingly to avoid metabolite accumulation.

In patients with Child-Pugh Class B or C impairment, the metabolism of absorbed camphor may be significantly delayed. Use with caution.

> Important: Special populations require individualized medical assessment.

Camphor (natural) acts as a TRP channel modulator. It is a potent agonist of TRPV1 and TRPV3 (vanilloid receptors) and an antagonist of TRPM8 (menthol receptor) at higher concentrations. By stimulating these receptors on sensory nerves, it induces a local desensitization, which results in analgesic and antipruritic effects. It also causes local vasodilation (rubefacient effect), which helps increase blood flow to injured tissues.

• Onset of Action: 5–15 minutes for topical cooling/warming sensation.
• Duration: 2–4 hours.
• Tolerance: Repeated application over long periods may lead to tachyphylaxis (reduced response).

| Parameter | Value |

|---|---|

| Bioavailability | High (if ingested); Low (topical on intact skin) |

| Protein Binding | Approximately 60% |

| Half-life | 1.5 to 3 hours (metabolites) |

| Tmax | 1 hour (post-ingestion/absorption) |

| Metabolism | Hepatic (Hydroxylation via CYP enzymes) |

| Excretion | Renal (>90% as glucuronides) |

• Molecular Formula: C10H16O
• Molecular Weight: 152.23 g/mol
• Solubility: Slightly soluble in water; highly soluble in alcohol, ether, and chloroform.
• Structure: A bicyclic monoterpene ketone with a characteristic bridgehead structure.

Camphor is a Non-Standardized Plant Allergenic Extract [EPC] and a Topical Analgesic/Counterirritant. It is pharmacologically related to menthol and eucalyptol.