From the FDA Drug Label
The efficacy and safety of VALTREX have not been established in: Immunocompromised patients other than for the suppression of genital herpes in HIV‑1−infected patients with a CD4+ cell count greater than or equal to 100 cells/mm 3.
The FDA drug label does not provide information to support the use of valtrex in patients with lupus for the treatment of shingles. Lupus patients are considered immunocompromised, and the label explicitly states that the efficacy and safety of valtrex have not been established in immunocompromised patients, except in the case of HIV-1-infected patients with a CD4+ cell count greater than or equal to 100 cells/mm3. Therefore, valtrex should be used with caution in patients with lupus, and the decision to use valtrex in this population should be made on a case-by-case basis, considering the potential risks and benefits. 1
From the Research
Valtrex (valacyclovir) is an appropriate treatment for shingles in patients with lupus, typically prescribed at 1 gram three times daily for 7 days, as supported by the most recent and highest quality study 2.
Treatment Considerations
When treating shingles in patients with lupus, it is essential to consider the potential for compromised immune systems due to their condition or immunosuppressive medications. Prompt antiviral therapy is crucial to reduce the risk of complications like postherpetic neuralgia.
- Dosage adjustments may be necessary for patients with kidney impairment, which can occur in lupus nephritis.
- Patients should maintain adequate hydration and monitor for any unusual side effects or lupus flares while taking Valtrex.
- Some patients may also benefit from pain management with medications like acetaminophen, gabapentin, or lidocaine patches.
Monitoring and Follow-up
Regular follow-up with both rheumatology and primary care providers is recommended during treatment to monitor both the shingles response and any impact on lupus disease activity. This close monitoring will help identify any potential issues early on and ensure the best possible outcomes for patients with lupus and shingles. According to 3, combination therapy with valacyclovir, methylprednisolone, and pregabalin has better efficacy compared to valacyclovir and pregabalin and valacyclovir alone in the management of acute herpes zoster neuralgia. However, the most recent and highest quality study 2 supports the use of valacyclovir as a preferred treatment option due to its significant reduction in risk of herpes-zoster-associated pain.