From the Guidelines
The recommended treatment for acute shingles is antiviral medication started within 72 hours of rash onset, with first-line options including acyclovir, famciclovir, or valacyclovir. According to the study by 1, two nucleoside analogs, acyclovir and famciclovir, have been approved by FDA for treating herpes zoster (HZ). If administered within 72 hours of rash onset, acyclovir has accelerated the rate of cutaneous healing and reduced the severity of acute pain in adults who have HZ.
Key Considerations
- Antiviral therapy should be initiated as soon as possible, ideally within 72 hours of rash onset, to maximize its effectiveness in reducing the severity and duration of acute pain, and potentially decreasing the risk of postherpetic neuralgia.
- Pain management is also essential, typically with acetaminophen, NSAIDs, or in more severe cases, gabapentin, pregabalin, or short-term opioids.
- Topical treatments like calamine lotion or cool compresses can provide symptomatic relief.
- Corticosteroids may be considered in certain patients to reduce inflammation and pain, but should be used cautiously.
- Patients should keep the rash clean and avoid scratching to prevent secondary bacterial infections.
Treatment Options
- Acyclovir (800 mg five times daily for 7-10 days)
- Famciclovir (500 mg three times daily for 7 days)
- Valacyclovir (1,000 mg three times daily for 7 days) As noted in the study by 1, oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts, but oral therapy should probably be reserved for mild cases of VZV disease in patients with transient immune suppression or as treatment to complete therapy once the patient has shown a clinical response to intravenous acyclovir.
From the FDA Drug Label
Herpes zoster (shingles):The recommended dosage of famciclovir tablets for the treatment of herpes zoster is 500 mg every 8 hours for 7 days. Therapy should be initiated as soon as herpes zoster is diagnosed. The recommended treatment for acute shingles is famciclovir 500 mg every 8 hours for 7 days, initiated as soon as possible after diagnosis 2.
- Key points:
- Dosage: 500 mg every 8 hours
- Duration: 7 days
- Initiation: As soon as herpes zoster is diagnosed
From the Research
Treatment Options for Acute Shingles
The treatment for acute shingles (herpes zoster) typically involves antiviral medications, which can help reduce the severity and duration of the symptoms. Some of the commonly used antiviral medications for treating acute shingles include:
- Aciclovir: taken 5 times daily for 7 days 3
- Famciclovir: taken 3 times daily for 7 days 3, 4
- Valaciclovir: taken 3 times daily for 7 days, and has been shown to be more effective than aciclovir in shortening the duration of post-herpetic neuralgia (PHN) 3, 5
Benefits of Antiviral Medications
Antiviral medications can provide several benefits in the treatment of acute shingles, including:
- Reducing the duration and intensity of zoster-associated pain (ZAP) 6
- Hastening the healing of skin lesions 6
- Reducing the incidence of PHN 3, 5
- Improving the quality of life of older patients 3
Comparison of Antiviral Medications
Studies have compared the efficacy of different antiviral medications in treating acute shingles. For example:
- Famciclovir has been shown to be superior to valacyclovir in relieving acute pain in adult Japanese immunocompetent patients with herpes zoster 4
- Valacyclovir has been shown to be more effective than acyclovir in shortening the duration of PHN 3, 5
- Famciclovir and valacyclovir have been shown to be equally effective in hastening the healing of zoster-associated pain and PHN 5
Additional Treatment Options
In addition to antiviral medications, other treatment options may be used to manage the symptoms of acute shingles, including: