What is the treatment for Herpes Zoster (shingles) during pregnancy?

From the Guidelines

Shingles during pregnancy should be treated with antiviral medications, such as acyclovir, to reduce morbidity and mortality, and improve quality of life. The treatment of shingles during pregnancy is crucial to prevent complications and reduce the risk of transmission to others. According to the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1, acyclovir is the antiviral drug with the most reported experience in pregnancy and appears to be safe.

The preferred treatment for shingles during pregnancy is oral acyclovir, which should be started within 72 hours of rash onset for maximum effectiveness. The dosage and duration of treatment may vary, but the goal is to reduce pain and prevent complications. Other antiviral medications, such as valacyclovir and famciclovir, may also be considered safe alternatives, but acyclovir is the first choice due to its extensive clinical experience in pregnancy 1.

Some key points to consider when treating shingles during pregnancy include:

• Starting treatment within 72 hours of rash onset
• Keeping the rash clean and covered to prevent transmission
• Using acetaminophen for pain management
• Seeking immediate medical attention if shingles develops near the eye, affects a large body area, or occurs in the third trimester
• Monitoring for potential complications, such as visceral disease, which can be fatal if left untreated 1.

It is essential to note that while these antiviral medications cross the placenta, extensive clinical experience has not shown increased risk of birth defects or adverse pregnancy outcomes 1. Therefore, the benefits of treating shingles during pregnancy outweigh the potential risks, and acyclovir should be considered the first-line treatment to improve morbidity, mortality, and quality of life.

From the FDA Drug Label

Available data from pharmacovigilance reports with famciclovir use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. There are risks to the fetus associated with untreated herpes simplex virus during pregnancy. In animal reproduction studies with famciclovir, no evidence of adverse developmental outcomes was observed at systemic exposures of penciclovir (AUC) slightly higher than those at the maximum recommended human dose (MRHD) of famciclovir.

Shingles treatment during pregnancy with famciclovir may be considered, as there is no direct evidence of adverse effects on the fetus. However, the risk of untreated herpes zoster during pregnancy should also be taken into account.

• The decision to use famciclovir during pregnancy should be made after weighing the potential benefits and risks, and considering alternative treatment options.
• It is essential to consult the prescribing information and discuss the treatment plan with a healthcare provider. 2

From the Research

Shingles Treatment During Pregnancy

• Shingles, also known as herpes zoster, is a rare condition that can occur during pregnancy, and its development does not result in increased fetal mortality 3.
• The treatment for shingles during pregnancy typically involves oral acyclovir, which is recommended for pregnant women with uncomplicated herpes zoster 3.
• Other antiviral medications, such as valaciclovir, have also been shown to be effective in treating herpes zoster, with valaciclovir offering a simpler dosing regimen and accelerated resolution of pain compared to acyclovir 4, 5.
• The varicella and zoster vaccines are not recommended for pregnant women, and non-immune pregnant women should be advised to avoid exposure to varicella-zoster virus 3.
• Acyclovir has been used in pregnancy in certain cases, with peak and trough plasma concentrations in pregnant women being lower than in non-pregnant adults, but still effective in inhibiting viral replication 6.
• Valacyclovir has been shown to be safe and effective in the treatment of herpes simplex and herpes zoster, and may be useful in other viral infections 5.

Complications and Prophylaxis

• The major complications of shingles include subacute herpetic neuralgia and post-herpetic neuralgia, as well as zoster ophthalmicus, disseminated herpes zoster, and secondary bacterial infections 3.
• Pregnant women with shingles should be closely monitored for these complications, and treated promptly if they occur 3, 7.
• Prophylaxis measures, such as avoiding exposure to varicella-zoster virus, are important for non-immune pregnant women 3.