From the Guidelines
For shingles, the recommended acyclovir dose is not explicitly stated in the provided evidence, but based on the available information, Acyclovir 800 mg orally twice a day for 5 days is a possible option. However, this dose and duration may not be optimal for shingles treatment. According to the provided evidence 1, Acyclovir can be administered in various doses, including 400 mg orally three times a day, 200 mg orally five times a day, or 800 mg orally twice a day, all for 5 days. Some key points to consider when treating shingles with acyclovir include:
- Starting treatment as soon as possible after symptoms appear
- Completing the full course of treatment, even if symptoms improve before finishing
- Adequate hydration while taking acyclovir
- Potential need for dose adjustment in patients with kidney impairment
- Alternative antiviral medications, such as valacyclovir or famciclovir, may be preferred due to less frequent dosing. It's essential to note that the provided evidence 1 is from 1998 and may not reflect the most recent guidelines or recommendations for shingles treatment.
From the FDA Drug Label
Herpes Zoster Infections: In a double-blind, placebo-controlled study of immunocompetent patients with localized cutaneous zoster infection, acyclovir (800 mg 5 times daily for 10 days) shortened the times to lesion scabbing, healing, and complete cessation of pain, and reduced the duration of viral shedding and the duration of new lesion formation In a similar double-blind, placebo-controlled study, acyclovir (800 mg 5 times daily for 7 days) shortened the times to complete lesion scabbing, healing, and cessation of pain; reduced the duration of new lesion formation; and reduced the prevalence of localized zoster-associated neurologic symptoms (paresthesia, dysesthesia, or hyperesthesia)
The recommended dose of acyclovir for shingles is 800 mg 5 times daily for 7 to 10 days 2.
From the Research
Acyclovir Dose for Shingles
- The recommended dose of acyclovir for the treatment of herpes zoster (shingles) is 800 mg five times daily for 7 days 3, 4.
- A study comparing the efficacy and safety of acyclovir and famciclovir found that acyclovir 800 mg five times daily was as effective as famciclovir 250 mg three times daily in treating acute uncomplicated herpes zoster 4.
- A meta-analysis of 14 randomized controlled trials found that 800 mg acyclovir five times daily was more effective than 200 mg acyclovir five times daily in improving the effective rate, shortening the blister stopping time, relieving pain faster, and shortening the scabbing time without increasing the adverse reaction rate 5.
- Another study found that antiviral drugs, including acyclovir, significantly reduce the intensity of acute pain, accelerate the healing of the vesicular rash, and reduce the duration of viral excretion during the acute phase of herpes zoster 6.
Comparison with Other Antiviral Agents
- Valacyclovir, a prodrug of acyclovir, has been shown to be more effective than acyclovir in hastening the healing of zoster-associated pain and postherpetic neuralgia (PHN) 3, 7.
- Famciclovir, another antiviral agent, has been found to be as effective as acyclovir in treating acute uncomplicated herpes zoster 4.
- A meta-analysis found that 900-1000 mg valacyclovir three times daily was more effective than 300 mg valacyclovir twice daily in improving the effective rate, shortening the blister stopping time, relieving pain faster, and shortening the scabbing time without increasing the adverse reaction rate 5.