From the Guidelines
Shingles treatment should begin as soon as possible after symptoms appear, ideally within 72 hours of rash onset, with antiviral medications such as acyclovir, famciclovir, or valacyclovir being the primary treatment options. The goal of treatment is to reduce the severity and duration of the outbreak by preventing viral replication, thereby improving morbidity, mortality, and quality of life outcomes. According to the most recent and highest quality study 1, high-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts, while oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts.
Some key points to consider in the treatment of shingles include:
- Starting antiviral medication within 72 hours of rash onset to maximize efficacy, as noted in 1 and 1
- Using antiviral medications such as acyclovir (800 mg five times daily for 7-10 days), valacyclovir (1000 mg three times daily for 7 days), or famciclovir (500 mg three times daily for 7 days) to reduce the severity and duration of the outbreak
- Managing pain with options ranging from over-the-counter medications like acetaminophen or ibuprofen to prescription medications such as gabapentin or pregabalin for more severe pain
- Using topical treatments like calamine lotion or lidocaine patches to provide relief for skin discomfort
- Keeping the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox
- Considering the shingles vaccine (Shingrix) after recovery to prevent future outbreaks, especially for individuals over 50
It's essential to seek immediate medical attention if the rash appears near the eyes, as ocular involvement can lead to vision complications requiring specialized treatment. Overall, prompt and effective treatment of shingles can significantly improve patient outcomes, reducing the risk of complications and improving quality of life.
From the Research
Treatment Options for Shingles
- Antiviral medications such as valacyclovir, acyclovir, and famciclovir are commonly used to treat shingles 2, 3, 4.
- These medications can help reduce the severity and duration of shingles symptoms, including pain and rash 2, 3.
- Valacyclovir has been shown to be effective in reducing zoster-associated pain (ZAP) and zoster-associated abnormal sensations (ZAAS) 2, 4.
- Famciclovir is also effective in treating shingles, but valacyclovir may be more efficacious in reducing pain scores 4.
- Combination therapy with an immunostimulatory vaccine virus and acyclovir may also be a potential treatment option for shingles 5.
Administration and Dosage
- Valacyclovir can be administered orally at a dose of 1.5 g twice daily for 7 days 2.
- Famciclovir can be administered orally at a dose of 500 mg three times daily for 7 days 4.
- Acyclovir can be administered orally, but the exact dosage and administration schedule may vary depending on the specific treatment regimen 3, 5.
Patient Considerations
- Immunocompetent patients over 18 years of age can be treated with oral antiviral medications such as valacyclovir and famciclovir 2, 3, 4.
- Elderly patients and those with compromised immune systems may require closer monitoring and potentially different treatment regimens 3, 5.
- Patients should be followed up regularly to assess the effectiveness of treatment and potential side effects 2, 4.