From the Guidelines
Treatment of herpes zoster should prioritize antiviral medications, such as acyclovir or famciclovir, started within 72 hours of rash onset, along with pain management and supportive care to reduce morbidity, mortality, and improve quality of life. The treatment options for herpes zoster include:
- Antiviral medications: acyclovir (800 mg five times daily) or famciclovir (500 mg three times daily) should be started within 72 hours of rash onset and continued for 7 days to reduce viral replication, decrease pain, and accelerate healing 1.
- Pain management: involves acetaminophen or NSAIDs for mild pain, while more severe pain may require gabapentin, pregabalin, tricyclic antidepressants like amitriptyline, or in some cases, short-term opioids.
- Supportive care: keeping the rash clean and covered helps prevent secondary bacterial infections and transmission to others.
- Prevention: the zoster vaccine, specifically the recombinant zoster vaccine (RZV), is recommended for adults over 50 to prevent herpes zoster and related complications, with a higher efficacy compared to the live, attenuated virus vaccine (ZVL) 1. It is crucial to prioritize prompt treatment to reduce the risk of postherpetic neuralgia, a painful complication that can persist for months or years after the rash resolves. Key considerations in treatment include:
- Starting antiviral medications within 72 hours of rash onset to maximize efficacy 1.
- Recommending the RZV vaccine for adults over 50 to prevent herpes zoster and related complications 1.
- Providing supportive care, such as keeping the rash clean and covered, to prevent secondary bacterial infections and transmission to others.
From the FDA Drug Label
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.
The treatment options for herpes zoster include famciclovir, which should be initiated as soon as possible after diagnosis, and preferably within 72 hours of the onset of the zoster rash.
- Key points:
- Initiate treatment as soon as possible after diagnosis
- Preferably within 72 hours of the onset of the zoster rash
- Famciclovir is a prescription antiviral medicine used to treat shingles (herpes zoster) 2
From the Research
Treatment Options for Herpes Zoster
The treatment options for herpes zoster include:
- Antiviral medications such as acyclovir, valacyclovir, and famciclovir, which can help reduce the severity and duration of the rash, as well as the pain associated with it 3, 4, 5
- Adjunct medications such as opioid analgesics, tricyclic antidepressants, or corticosteroids, which can help relieve the pain associated with acute herpes zoster 4
- Immunization, which is recommended for most adults 60 years and older to prevent herpes zoster and postherpetic neuralgia 4, 6
Antiviral Medications
Antiviral medications are the primary treatment for herpes zoster. The available options include:
- Acyclovir, which has been shown to reduce the duration and intensity of zoster-associated pain (ZAP) and provide more rapid skin lesion healing 3
- Valacyclovir, which has been shown to be at least as effective as acyclovir in controlling the symptoms of acute herpes zoster and alleviating zoster-associated pain and postherpetic neuralgia 5
- Famciclovir, which has been shown to be similar in efficacy to acyclovir and valacyclovir in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia 5
Prevention of Postherpetic Neuralgia
Postherpetic neuralgia is a common complication of herpes zoster. The available evidence suggests that:
- Antiviral therapy during the acute phase may not prevent postherpetic neuralgia 4
- Gabapentin, a medication commonly used to treat nerve pain, may not be effective in preventing postherpetic neuralgia when used in low doses 7
- Immunization is recommended for most adults 60 years and older to prevent herpes zoster and postherpetic neuralgia 4, 6
Management of Postherpetic Neuralgia
The management of postherpetic neuralgia includes: