From the Guidelines
Acyclovir, not aziclovir, is the recommended treatment for shingles, with a dosage of 800 mg five times daily for 7-10 days, ideally started within 72 hours of rash onset. The use of acyclovir in the treatment of herpes zoster (HZ) has been shown to accelerate the rate of cutaneous healing and reduce the severity of acute pain in adults 1. It is essential to note that the medication should be administered within 72 hours of rash onset for maximum effectiveness. Alternative antiviral medications, such as famciclovir, have similar efficacy when administered during the same period 1.
Key Considerations
- The dosage and duration of treatment may vary depending on the patient's immune status, with extended treatment up to 14 days for those with compromised immune systems.
- Common side effects of acyclovir include nausea, headache, and diarrhea, and patients should drink plenty of fluids to prevent kidney issues.
- Pain management with acetaminophen, NSAIDs, or prescription pain medications may be necessary, and keeping the rash clean and dry helps prevent secondary bacterial infections.
- Patients should seek immediate medical attention if they experience severe pain, involvement of the eye, or if they are immunocompromised, as complications can be more serious in these cases.
Treatment Options
- Valacyclovir (1000 mg three times daily for 7 days) and famciclovir (500 mg three times daily for 7 days) are alternative antiviral medications that may offer more convenient dosing schedules.
- These medications work by inhibiting viral DNA replication, reducing the severity and duration of the outbreak.
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 Herpes Zoster Infections : Acyclovir tablets is indicated for the acute treatment of herpes zoster (shingles).
The treatment for shingles with aziclovir, more accurately known as acyclovir, is 800 mg 5 times daily for 10 days or 800 mg 5 times daily for 7 days, as it has been shown to shorten the times to lesion scabbing, healing, and complete cessation of pain, and reduce the duration of viral shedding and the duration of new lesion formation 2. Treatment was most effective if started within the first 48 hours of rash onset 2.
From the Research
Shingles Treatment with Aziclovir
- Aziclovir, also known as acyclovir, is an antiviral medication used to treat herpes zoster (shingles) 3, 4, 5.
- The medication can be taken orally, with a typical dosage of 5 times daily for 7 days 3.
- Acyclovir has been shown to shorten the duration of post-herpetic neuralgia (PHN), a common complication of shingles, but does not affect its incidence 3, 4.
- Compared to other antiviral medications like famciclovir and valacyclovir, acyclovir has similar efficacy in reducing the duration and intensity of zoster-associated pain (ZAP) 4, 6.
- However, valacyclovir has been shown to be more effective than acyclovir in shortening the duration of PHN and is considered a more efficient treatment option 3, 6, 7.
Comparison with Other Antiviral Medications
- Famciclovir and valacyclovir have better oral bioavailability than acyclovir and require less frequent administration 4, 6.
- Valacyclovir has been shown to be more effective than famciclovir in accelerating the resolution of zoster-associated pain and PHN 7.
- A comparative study found that valacyclovir was more efficacious than famciclovir in managing herpes zoster, with significant benefits in reducing pain scores and accelerating the resolution of zoster-associated pain 7.
Administration and Efficacy
- Oral antiviral therapy, including acyclovir, is beneficial in selected elderly immunocompetent patients with herpes zoster, reducing the duration and intensity of ZAP and providing more rapid skin lesion healing 4.
- Acyclovir has been shown to be safe and effective in the treatment of herpes zoster, with minimal adverse effects when administered at lower doses 5.
- The efficacy of valacyclovir and famciclovir in herpes zoster has been demonstrated in several studies, with valacyclovir being considered a more effective treatment option 6, 7.