From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For shingles, I recommend prescribing valacyclovir 1,000 mg three times daily for 7 days, starting within 72 hours of rash onset for optimal effectiveness, as supported by the most recent and highest quality study 1. Gabapentin can be prescribed for pain management, starting at 300 mg once daily on day 1, then 300 mg twice daily on day 2, and 300 mg three times daily on day 3, with gradual titration up to 1,800 mg daily divided into three doses as needed for pain control. Valacyclovir works by inhibiting viral DNA replication, reducing the severity and duration of the shingles outbreak, as shown in studies 2, 3, 4. Gabapentin helps manage neuropathic pain by modulating calcium channels and neurotransmitter release. Some studies suggest that combination therapy with valacyclovir, methylprednisolone, and pregabalin may have better efficacy in managing acute herpes zoster neuralgia 5, but the current recommendation prioritizes valacyclovir and gabapentin based on the strongest evidence. Patients should be advised to take valacyclovir with or without food and complete the full course even if symptoms improve. For gabapentin, patients should be warned about potential side effects including dizziness and drowsiness, and the medication should be tapered when discontinuing to avoid withdrawal symptoms. Elderly patients or those with renal impairment may require dose adjustments for both medications. Key points to consider when prescribing valacyclovir and gabapentin for shingles include:
- Starting valacyclovir within 72 hours of rash onset for optimal effectiveness
- Gradually titrating gabapentin to minimize side effects
- Monitoring patients for potential side effects and adjusting doses as needed
- Considering combination therapy for patients with severe or persistent pain
- Prioritizing valacyclovir and gabapentin based on the strongest evidence 1.