What is the treatment for Herpes Zoster (shingles)?

From the Guidelines

Shingles treatment should involve antiviral medications like acyclovir or famciclovir, which have been shown to accelerate cutaneous healing and reduce acute pain severity when administered within 72 hours of rash onset 1. The treatment approach for shingles typically includes the use of antiviral medications to manage the condition effectively.

• The medications of choice are acyclovir and famciclovir, both of which are nucleoside analogs approved by the FDA for treating herpes zoster (HZ) 1.
• These medications are most effective when started within 72 hours of the onset of the rash, as they can accelerate the rate of cutaneous healing and reduce the severity of acute pain in adults with HZ 1.
• In terms of specific dosing, while the provided evidence does not specify the exact dosages, clinical guidelines often recommend acyclovir 800 mg five times daily or famciclovir 500 mg three times daily for 7-10 days.
• Pain management is also a critical component of shingles treatment, with options ranging from over-the-counter medications like acetaminophen or ibuprofen to prescription medications such as gabapentin or pregabalin for more severe cases.
• Additionally, topical treatments including calamine lotion, cool compresses, or colloidal oatmeal baths can help soothe the rash and alleviate discomfort.
• It is essential to keep the rash clean and avoid scratching to prevent infection, and individuals experiencing severe pain, a rash near the eyes, or those with a weakened immune system should seek immediate medical attention.

From the FDA Drug Label

Herpes Zoster VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.

Herpes Zoster (Shingles) There are no data on treatment initiated more than 72 hours after onset of zoster rash Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster.

Herpes Zoster Infections : Acyclovir tablets is indicated for the acute treatment of herpes zoster (shingles).

The treatment for shingles includes valacyclovir (PO) 2, famciclovir (PO) 3, and acyclovir (PO) 4. It is recommended to initiate treatment as soon as possible after a diagnosis of herpes zoster.

From the Research

Treatment Options for Shingles

• Antiviral medications such as acyclovir, valacyclovir, and famciclovir are commonly used to treat shingles 5, 6, 7, 8, 9
• These medications are most effective when started within 72 hours after the onset of the rash 6, 7, 8
• Valacyclovir has been shown to be more effective than acyclovir and equally effective as famciclovir in hastening the healing of zoster-associated pain and postherpetic neuralgia 5
• Famciclovir and valacyclovir have a better oral bioavailability than acyclovir and require less frequent administration 7
• The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 6

Management of Postherpetic Neuralgia

• Postherpetic neuralgia is the most common complication of shingles, occurring in about one in five patients 8
• Treatment is focused on symptom control and includes topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants 8
• Narcotics may be required for adequate pain control in some patients 6
• Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients 6

Prevention

• The varicella zoster virus vaccine decreases the incidence of herpes zoster and is approved for adults 50 years and older 8
• The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends this vaccine for adults 60 years and older, except for certain immunosuppressed patients 8