From the Guidelines
The fastest treatment for herpes zoster is antiviral medication started within 72 hours of rash onset, with options including valacyclovir, famciclovir, or acyclovir. When considering the treatment options, it's essential to prioritize those that can be administered orally and have a high efficacy rate.
- Valacyclovir (1,000 mg three times daily for 7 days) and famciclovir (500 mg three times daily for 7 days) are generally preferred due to less frequent dosing and better absorption, as noted in studies such as 1.
- Acyclovir (800 mg five times daily for 7-10 days) is also an effective option, although it may require more frequent dosing. For pain management, initial treatment with acetaminophen or NSAIDs is recommended, with possible addition of gabapentin, pregabalin, or tricyclic antidepressants for more severe pain, as suggested by guidelines such as 1. Additional relief may be provided by topical lidocaine patches or capsaicin cream. It's crucial to keep the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox. Antiviral medications work by inhibiting viral DNA synthesis, reducing viral replication, shortening the duration of viral shedding, and accelerating rash healing, which is supported by studies like 1. Early treatment not only speeds recovery but also reduces the risk of developing postherpetic neuralgia, a painful complication that can persist for months or years after the rash resolves, highlighting the importance of prompt initiation of antiviral therapy, as recommended in guidelines such as 1.
From the FDA Drug Label
In subjects aged less than 50 years, the median time to cessation of new lesion formation was 2 days for those treated with VALTREX compared with 3 days for those treated with placebo. The fastest treatment for herpes zoster is valacyclovir (VALTREX), with a median time to cessation of new lesion formation of 2 days in subjects aged less than 50 years 2.
- Key points:
- Median time to cessation of new lesion formation: 2 days for VALTREX vs 3 days for placebo
- Age group: less than 50 years
- Treatment: valacyclovir (VALTREX) 2
From the Research
Fastest Treatment for Herpes Zoster
The fastest treatment for herpes zoster is a subject of several studies, with various antiviral medications being compared for their efficacy.
- Valaciclovir has been shown to be effective in shortening the duration of post-herpetic neuralgia (PHN) and is considered a well-tolerated first-line therapy 3, 4, 5.
- Aciclovir, famciclovir, and valaciclovir are three well-tolerated and effective antiviral drugs available for the therapy of acute herpes zoster, with valaciclovir being more efficient than aciclovir in shortening the duration of PHN 3.
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends the varicella zoster virus vaccine for adults 60 years and older, except for certain immunosuppressed patients, to decrease the incidence of herpes zoster 6.
Comparison of Antiviral Medications
- Valaciclovir (1000 mg 3 times daily for 7 days) was at least as effective as aciclovir (800 mg 5 times daily for 7 days) in controlling the symptoms of acute herpes zoster, and alleviated zoster-associated pain and postherpetic neuralgia significantly faster than aciclovir 4.
- A study comparing valaciclovir and famciclovir found that they were of similar efficacy in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia 4.
- Valaciclovir given at 1,000 mg three times daily for 7 days accelerated the resolution of pain and offered simpler dosing, while maintaining the favorable safety profile of acyclovir 5.
Treatment Duration and Corticosteroids
- A randomized trial found that treatment with acyclovir for 21 days or the addition of prednisolone to acyclovir therapy confers only slight benefits over standard 7-day treatment with acyclovir, and neither additional treatment reduces the frequency of postherpetic neuralgia 7.
- Corticosteroids have been used to treat herpes zoster, but their effect on PHN does not appear to be consistent, and they may not provide an added benefit over acyclovir alone 3, 7.