What is the treatment for shingles?

From the Guidelines

The treatment for shingles typically involves antiviral medications such as acyclovir, valacyclovir, or famciclovir for 7-10 days, which are most effective when started within 72 hours of rash onset. These medications work by inhibiting viral replication, reducing the severity and duration of the outbreak 1.

Key Considerations

• Antiviral therapy should be initiated as soon as possible, ideally within 72 hours of rash onset, to maximize its effectiveness.
• Pain management is crucial and can range from over-the-counter options like acetaminophen or ibuprofen to prescription medications such as gabapentin, pregabalin, or tricyclic antidepressants for more severe pain.
• Topical treatments, including calamine lotion, cool compresses, or colloidal oatmeal baths, can help soothe the rash.
• For patients over 50 or those with compromised immune systems, the illness may be more severe, potentially requiring stronger pain management or even hospitalization.
• It is essential to keep the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox.
• If you experience severe symptoms, involvement of the eyes, or have a weakened immune system, seek immediate medical attention as complications can be serious.

Prevention of Shingles

Some patients, especially those with compromised immune systems or taking certain medications like JAK inhibitors, are at an increased risk of developing shingles and may benefit from vaccination against herpes zoster before initiating such treatments 1.

Important Medications

• Acyclovir (800 mg five times daily)
• Valacyclovir (1000 mg three times daily)
• Famciclovir (500 mg three times daily) These medications are the cornerstone of shingles treatment, aiming to reduce the severity and duration of the disease when started promptly.

From the FDA Drug Label

FAMCICLOVIR tablet, for oral use Initial U. S. Approval: 1994 INDICATIONS AND USAGE Famciclovir tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: Immunocompetent Adult Patients( 1. 1) • Herpes labialis (cold sores) o Treatment of recurrent episodes • Genital herpes o Treatment of recurrent episodes o Suppressive therapy of recurrent episodes • Herpes zoster (shingles) DOSAGE AND ADMINISTRATION Immunocompetent Adult Patients ( 2.1) Herpes labialis (cold sores) 1500 mg as a single dose Genital herpes Treatment of recurrent episodes Suppressive therapy Herpes Zoster (shingles) 500 mg every 8 hours for 7 days, but for the first day the dosage is 1000 mg twice daily for 1 day then 500 mg every 8 hours for 6 more days for a total of 7 days

The treatment for shingles is famciclovir 1000 mg twice daily for 1 day, then 500 mg every 8 hours for 6 more days for a total of 7 days 2.

• The dosage is adjusted based on renal function.
• Contraindications include known hypersensitivity to the product or its components.
• Adverse reactions may include headache and nausea.

From the Research

Treatment Options for Shingles

• Antiviral medications such as acyclovir, famciclovir, and valacyclovir are commonly used to treat shingles, with the most effective results when started within 72 hours of the onset of the rash 3, 4, 5, 6
• The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 3
• For postherpetic neuralgia, treatment options include:
  • Tricyclic antidepressants or anticonvulsants, often given in low dosages, to control neuropathic pain 3, 4, 6
  • Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients 3, 4, 6
  • Gabapentin, pregabalin, long-acting opioids, or tramadol may be used to treat postherpetic neuralgia 4, 6

Prevention of Shingles

• The varicella zoster virus vaccine can decrease the incidence of herpes zoster and is approved for adults 50 years and older 6
• The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends this vaccine for adults 60 years and older, except for certain immunosuppressed patients 6

Management of Ocular Involvement

• Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist 3