From the Guidelines
For patients diagnosed with shingles, prompt antiviral therapy and precautions are essential to prevent complications and transmission to non-immune individuals. The recommended medications include valacyclovir, famciclovir, or acyclovir, and pain management may include acetaminophen, NSAIDs, or in more severe cases, gabapentin, pregabalin, tricyclic antidepressants, or short-term opioids 1. Patients should keep the rash clean and dry, avoid scratching to prevent secondary infection, and cover the rash when around vulnerable individuals. Those with shingles can transmit chickenpox to non-immune individuals through direct contact with fluid from blisters. Isolation is recommended until lesions crust over, typically 7-10 days. The shingles vaccine (Shingrix) is recommended for prevention in adults 50 and older, even for those who have previously had shingles, as it reduces the risk of recurrence and complications 1. Precautions such as avoiding close contact with others, especially those with weakened immune systems, and frequent handwashing can help prevent the spread of the virus 1. It is also important to note that individuals who do not have evidence of immunity to varicella should receive postexposure prophylaxis with VariZIG as soon as possible (but within 96 h) after exposure to a person with varicella or shingles 1. Overall, a comprehensive approach to managing shingles includes prompt antiviral therapy, pain management, precautions to prevent transmission, and vaccination to prevent recurrence and complications. Key precautions include:
- Keeping the rash clean and dry
- Avoiding scratching to prevent secondary infection
- Covering the rash when around vulnerable individuals
- Isolating until lesions crust over
- Avoiding close contact with others, especially those with weakened immune systems
- Frequent handwashing
- Postexposure prophylaxis with VariZIG for individuals who do not have evidence of immunity to varicella.
From the FDA Drug Label
Famciclovir tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: Immunocompetent Adult Patients • Herpes zoster (shingles)
DOSAGE AND ADMINISTRATION Immunocompetent Adult Patients ( 2.1) Herpes Zoster (shingles) 500 mg every 8 hours for 7 days
WARNINGS AND PRECAUTIONS Acute renal failure: May occur in patients with underlying renal disease who receive higher than recommended doses of famciclovir for their level of renal function. Reduce dosage in patients with renal impairment. ( 2.3,8. 6)
Precautions for Shingles:
- The patient should take 500 mg of famciclovir every 8 hours for 7 days.
- Patients with underlying renal disease should have their dosage reduced to prevent acute renal failure 2.
- Patients should be advised to practice safer sex to lower the chances of spreading genital herpes to others, although this is more relevant for genital herpes than shingles 2.
- It is not known if famciclovir can stop the spread of herpes to others 2.
From the Research
Precautions for Shingles
- Avoid touching the rash or blisters, as this can spread the virus to other parts of the body or to other people 3, 4
- Keep the rash covered to prevent spreading the virus to others 4
- Avoid contact with people who have weakened immune systems, such as those with cancer or HIV/AIDS, as they may be more susceptible to infection 3, 4
- Avoid contact with pregnant women who have not had chickenpox, as they may be at risk of infection 4
Treatment for Shingles
- Antiviral medications, such as acyclovir, valacyclovir, or famciclovir, can help reduce the severity and duration of the rash and pain 3, 5, 4, 6
- These medications are most effective when started within 72 hours of the onset of the rash 3, 4
- Pain management medications, such as narcotics, tricyclic antidepressants, or anticonvulsants, may be prescribed to control pain 3, 4
- Topical treatments, such as lidocaine or capsaicin, may be used to relieve pain and itching 3, 4