From the Guidelines
Herpes zoster treatment should be initiated with oral antiviral medications, such as acyclovir or famciclovir, within 72 hours of rash onset to accelerate cutaneous healing and reduce the severity of acute pain. The treatment options include acyclovir and famciclovir, which have been approved by the FDA for treating herpes zoster 1. When administered within 72 hours of rash onset, these medications have been shown to have similar efficacy in reducing the severity of acute pain and accelerating the rate of cutaneous healing 1. Some key points to consider when treating herpes zoster include:
- Initiating treatment as soon as possible after symptom onset
- Using oral antiviral medications, such as acyclovir or famciclovir, for 7 days
- Considering pain management options, such as acetaminophen or NSAIDs for mild pain, and gabapentin or pregabalin for more severe pain
- Being aware of the potential need for hospitalization and intravenous acyclovir in patients with ophthalmic involvement, immunocompromised status, or severe disease. The goal of treatment is to reduce the severity of symptoms, accelerate healing, and prevent complications, such as postherpetic neuralgia 1.
From the FDA Drug Label
Herpes Zoster VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. Herpes Zoster Infections : Acyclovir tablets is indicated for the acute treatment of herpes zoster (shingles). Herpes zoster (shingles) Human Immunodeficiency Virus (HIV)-Infected Adult Patients are not indicated but • Herpes zoster (shingles) is indicated for Immunocompetent Adult Patients
The treatment for herpes zoster includes valacyclovir (PO) and acyclovir (PO) in immunocompetent adults, and famciclovir (PO) in immunocompetent adult patients 2, 3, 4.
From the Research
Treatment Options for Herpes Zoster
- Antiviral medications are the primary treatment for herpes zoster, with options including acyclovir, valacyclovir, and famciclovir 5, 6, 7.
- Valacyclovir has been shown to be effective in reducing the duration and intensity of zoster-associated pain (ZAP) and postherpetic neuralgia 8, 6, 7.
- Famciclovir is also effective in treating herpes zoster, but valacyclovir may be more efficacious in resolving ZAP 7.
- Antiviral therapy should be initiated within 72 hours of rash onset for optimal benefit 5, 6, 9.
Patient Characteristics and Antiviral Receipt
- Antiviral prescriptions are more common among older adults, with the proportion of patients receiving antivirals increasing with age up to 65 years 9.
- Female patients and those of higher socioeconomic status are more likely to receive antiviral prescriptions 9.
- Immunocompromised patients with herpes zoster are more likely to receive antiviral prescriptions, but these medications are not always prescribed routinely in this patient group 9.
Dosage and Administration
- Valacyclovir can be administered at a dose of 1.5 g twice daily for 7 days, which has been shown to be safe and effective in treating uncomplicated herpes zoster in immunocompetent patients over 18 years of age 8.
- Famciclovir can be administered at a dose of 500 mg three times daily for 7 days, which has been shown to be effective in treating herpes zoster 7.
- Antiviral therapy should be started as soon as possible after symptoms appear, ideally within 72 hours of rash onset 5, 6, 9.