From the Guidelines
Pregnant women with shingles should receive standard doses of valacyclovir (Valtrex), not lower doses. The recommended regimen for immunocompetent adults with herpes zoster is valacyclovir 1 gram three times daily for 7 days. This same dosing applies to pregnant women, as pregnancy itself is not a reason to reduce the dose. Valacyclovir is considered relatively safe during pregnancy (FDA Category B), with no clear evidence of increased birth defects or adverse pregnancy outcomes 1. Adequate treatment of shingles is important during pregnancy to reduce the risk of complications, including postherpetic neuralgia. Early treatment (within 72 hours of rash onset) is most effective. While treating shingles in pregnancy, healthcare providers should monitor for potential side effects such as headache, nausea, or abdominal pain. The benefits of treating shingles with standard-dose valacyclovir typically outweigh the theoretical risks to the fetus, as untreated maternal infection could potentially lead to more serious complications. Some key points to consider when treating shingles in pregnant women include:
- The importance of early treatment to reduce the risk of complications
- The need to monitor for potential side effects
- The relatively safe profile of valacyclovir during pregnancy, as supported by studies such as those published in MMWR Recommendations and Reports 1
- The potential consequences of untreated maternal infection, which can be severe and even life-threatening.
From the FDA Drug Label
8 USE IN SPECIFIC POPULATIONS
- 1 Pregnancy Risk Summary Clinical data over several decades with valacyclovir and its metabolite, acyclovir, in pregnant women, have not identified a drug associated risk of major birth defects.
The FDA drug label does not provide guidance on dose adjustment of valacyclovir for shingles in pregnant women.
- Key points:
- No dose adjustment is specified for pregnant women.
- The label discusses the risk of untreated herpes simplex during pregnancy but does not provide dosing recommendations for valacyclovir in this population.
- Animal studies showed no adverse developmental outcomes at exposures up to 4 (rats) and 7 (rabbits) times the human exposure at the maximum recommended human dose (MRHD) 2. Given the lack of specific dosing guidance for pregnant women with shingles, a conservative approach would be to consult the prescribing information and consider the potential risks and benefits of valacyclovir treatment in this population.
From the Research
Treatment of Shingles in Pregnant Women
- The management of herpes zoster (shingles) during pregnancy is crucial to minimize maternal morbidity, as it does not result in increased fetal mortality but can cause significant burden on the mother 3.
- According to the study, pregnant women with an uncomplicated HZ should be treated with oral acyclovir, but there is no direct mention of using valacyclovir for shingles in pregnant women 3.
Valacyclovir Dosage for Shingles
- Studies have shown that valacyclovir is effective in treating herpes zoster in immunocompetent patients, with a recommended dosage of 1,000 mg three times daily for 7 days 4, 5, 6, 7.
- However, there is no specific guidance on the dosage of valacyclovir for shingles in pregnant women, and the standard treatment is oral acyclovir 3.
Considerations for Pregnant Women
- The varicella and zoster vaccines are not recommended for pregnant women, and non-immune pregnant women should avoid exposure to VZV 3.
- The use of valacyclovir in pregnant women is not well-studied, and its safety and efficacy in this population are not established 3, 4, 5, 6, 7.
Conclusion Not Provided as per Request
- No research papers directly address the question of whether a lower dose of valacyclovir should be used to treat shingles in pregnant women, and more studies are needed to determine the safety and efficacy of valacyclovir in this population.