What is the recommended treatment for shingles?

From the Guidelines

The most effective treatment for shingles involves administering antiviral medications such as acyclovir or famciclovir within 72 hours of rash onset to accelerate cutaneous healing and reduce acute pain severity. When treating shingles, the primary goal is to reduce the severity and duration of the illness, as well as manage pain and prevent complications. According to the study by 1, two nucleoside analogs, acyclovir and famciclovir, have been approved by the FDA for treating herpes zoster (HZ), also known as shingles. Some key points to consider when treating shingles include:

• Starting antiviral medication within 72 hours of rash onset to maximize efficacy
• Using medications such as acyclovir or famciclovir, which have similar efficacy in reducing the severity of acute pain and accelerating cutaneous healing
• Managing pain effectively, which may involve a range of options from over-the-counter medications to prescription drugs
• Implementing supportive care measures, such as keeping the rash clean and covered, to prevent secondary infections and transmission to others. It is essential to prioritize the initiation of antiviral therapy promptly, as this has been shown to improve outcomes in patients with shingles, as indicated by the findings of 1.

From the Research

Treatment Options for Shingles

• The recommended treatment for shingles includes antiviral medications such as acyclovir, famciclovir, and valacyclovir 2, 3, 4, 5, 6
• These medications are most effective when started within 72 hours after the onset of the rash 2, 4, 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 2

Antiviral Medications

• Acyclovir is typically taken 5 times daily for 7 days 5
• Famciclovir is taken 3 times daily for 7 days 3, 5
• Valacyclovir is taken 3 times daily for 7 days, with a dose of 1000 mg 6 or 1.5 g twice daily 4

Management of Postherpetic Neuralgia

• Patients with postherpetic neuralgia may require narcotics for adequate pain control 2
• Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain 2
• Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients 2

Special Considerations

• Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist 2
• The varicella zoster vaccine may help prevent shingles and its complications 5