From the Guidelines
The recommended treatment for shingles is antiviral medications such as acyclovir or famciclovir, which should be administered within 72 hours of rash onset to accelerate cutaneous healing and reduce the severity of acute pain. When treating shingles, the goal is to reduce morbidity, mortality, and improve quality of life by alleviating symptoms and preventing complications. The treatment options include:
- Antiviral medications:
- Acyclovir (dosage not specified in the study)
- Famciclovir (dosage not specified in the study) as stated in the study 1. It is essential to note that these medications are most effective when started within 72 hours of rash onset, as they work by inhibiting viral replication. Pain management is also crucial and can range from over-the-counter options to prescription medications. Additionally, keeping the rash clean and covered is vital to prevent spreading the virus to others. If the rash involves the eyes, immediate medical attention is necessary to prevent serious complications, including vision loss. The study 1 highlights the importance of prompt treatment, especially in individuals over 50 or those with a weakened immune system, as complications are more common in these groups.
From the FDA Drug Label
The recommended dosage of valacyclovir hydrochloride for treatment of herpes zoster is 1 gram 3 times daily for 7 days Therapy should be initiated at the earliest sign or symptom of herpes zoster and is most effective when started within 48 hours of the onset of rash.
The recommended treatment for shingles is valacyclovir hydrochloride 1 gram 3 times daily for 7 days, initiated at the earliest sign or symptom of herpes zoster, and most effective when started within 48 hours of the onset of rash 2.
- Key points:
- Dosage: 1 gram 3 times daily
- Duration: 7 days
- Initiation: at the earliest sign or symptom of herpes zoster
- Efficacy: most effective when started within 48 hours of the onset of rash
From the Research
Shingles Treatment Overview
- The recommended treatment for shingles includes antiviral medications, such as valaciclovir, aciclovir, and famciclovir, which can help reduce the duration and severity of symptoms 3, 4, 5.
- These medications are most effective when started within 72 hours of the onset of symptoms 3, 5.
- Adjunct medications, such as opioid analgesics, tricyclic antidepressants, or corticosteroids, may be used to relieve pain associated with shingles 4.
Antiviral Medications
- Valaciclovir has been shown to be at least as effective as aciclovir in controlling symptoms of shingles, and may alleviate zoster-associated pain and postherpetic neuralgia faster than aciclovir 3.
- Famciclovir has also been shown to be effective in treating shingles, with similar efficacy to valaciclovir 3, 5.
- Aciclovir has been shown to reduce the duration and intensity of zoster-associated pain, but may not prevent postherpetic neuralgia 5, 6.
Prevention of Postherpetic Neuralgia
- There is conflicting evidence on whether antiviral therapy during the acute phase of shingles can prevent postherpetic neuralgia 4, 7.
- A systematic review found that oral aciclovir did not reduce the incidence of postherpetic neuralgia significantly, and that further studies are needed to investigate the effect of other antiviral treatments 7.