From the Guidelines
The recommended treatment for Herpes zoster is antiviral medications, specifically acyclovir or famciclovir, administered within 72 hours of rash onset. When considering treatment options, it's crucial to prioritize those that have been shown to accelerate cutaneous healing and reduce the severity of acute pain. According to the study published in MMWR Recommendations and Reports 1, two nucleoside analogs, acyclovir and famciclovir, have been approved by the FDA for treating Herpes zoster. Key points to consider in the treatment of Herpes zoster include:
- Administering antiviral medication within 72 hours of rash onset to maximize efficacy
- The use of acyclovir or famciclovir as first-line treatment options, as they have been shown to have similar efficacy in reducing the severity of acute pain and accelerating cutaneous healing 1
- The importance of pain management, which may involve the use of acetaminophen, NSAIDs, or other medications as needed
- The potential need for hospitalization and IV acyclovir in severe cases, particularly in immunocompromised patients
- The consideration of corticosteroids for severe pain in patients over 50 without contraindications. It's also essential to keep the rash clean and dry to prevent bacterial superinfection. By prioritizing these treatment strategies, patients with Herpes zoster can experience improved outcomes in terms of morbidity, mortality, and quality of life.
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 Herpes zoster is famciclovir 500 mg every 8 hours for 7 days, and therapy should be initiated as soon as Herpes zoster is diagnosed 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 Herpes Zoster
The recommended treatment for Herpes zoster includes:
- Antiviral agents such as acyclovir, valacyclovir, and famciclovir, which are effective in reducing the severity and duration of acute herpes zoster when given within 72 hours of rash onset 3, 4, 5, 6
- These antiviral agents can shorten the duration of acute herpes zoster and alleviate the pain of postherpetic neuralgia (PHN) 3, 4, 5, 6
- Specific analgesics such as anticonvulsants, tricyclic antidepressants, opioids, and topical treatment modalities like lidocaine-containing patches and capsaicin cream can offer moderate pain relief to some patients with PHN 3, 6
Prevention of Herpes Zoster
- Prevention of herpes zoster and PHN with prophylactic vaccination using the zoster virus vaccine is an effective strategy to reduce the morbidity of these conditions 3, 6
- The varicella zoster virus vaccine decreases the incidence of herpes zoster and is approved for adults 50 years and older 6
Comparison of Antiviral Agents
- Valacyclovir and famciclovir have been shown to be at least as effective as acyclovir in controlling the symptoms of acute herpes zoster 4, 5, 7
- Famciclovir may be superior to valacyclovir in the relief of acute pain of herpes zoster, especially in patients aged 50 years or older 7
- The choice of antiviral agent may depend on individual patient factors, such as age, immune status, and severity of symptoms 4, 5, 6, 7