From the Guidelines
For the treatment of shingles, the recommended dosage of acyclovir is 800 mg taken orally five times daily for 7-10 days. This dosage is based on the most recent and highest quality studies available, which prioritize morbidity, mortality, and quality of life as the primary outcomes. Treatment should begin as soon as possible after shingles symptoms appear, ideally within 72 hours of rash onset, as early intervention significantly improves outcomes 1. Patients should space doses evenly throughout waking hours (approximately every 4-5 hours while awake) and maintain adequate hydration while taking the medication. For patients with kidney impairment, dosage adjustments are necessary. Acyclovir works by inhibiting viral DNA synthesis, preventing the herpes zoster virus from replicating. While taking acyclovir, patients should complete the full course even if symptoms improve, avoid alcohol, and report any concerning side effects like severe headache, confusion, or signs of kidney problems. Alternative antiviral medications for shingles include valacyclovir (1,000 mg three times daily for 7 days) and famciclovir (500 mg three times daily for 7 days), which may offer more convenient dosing schedules.
Some key points to consider when treating shingles with acyclovir include:
- Starting treatment within 72 hours of rash onset to maximize efficacy
- Maintaining adequate hydration to prevent kidney problems
- Completing the full course of treatment even if symptoms improve
- Monitoring for potential side effects and reporting them to a healthcare provider
- Considering alternative antiviral medications for patients with kidney impairment or other contraindications to acyclovir.
It's worth noting that the provided evidence includes various studies with different recommendations for acyclovir dosage, but the most recent and highest quality study supports the recommended dosage of 800 mg taken orally five times daily for 7-10 days 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Acute Treatment of Herpes Zoster: 800 mg every 4 hours orally, 5 times daily for 7 to 10 days. The recommended dosage of Acyclovir for the treatment of shingles is 800 mg every 4 hours orally, 5 times daily for 7 to 10 days 2.
- The dosage is administered orally.
- The treatment duration is 7 to 10 days.
- The dosage frequency is 5 times daily.
From the Research
Treatment of Shingles
The treatment of shingles typically involves the use of antiviral medications, such as Acyclovir, to help manage symptoms and reduce the risk of complications.
Acyclovir Dosage
- The recommended dosage of Acyclovir for the treatment of shingles is 800 mg, five times daily for 7-10 days 3, 4, 5.
- Studies have shown that this dosage can help shorten the duration of viral shedding, accelerate lesion resolution, and reduce the severity of acute pain 4, 5.
- However, it's worth noting that the efficacy of Acyclovir in preventing postherpetic neuralgia (PHN) is still a topic of debate, with some studies suggesting that it may not have a significant impact on the incidence of PHN 3, 4.
Comparison with Other Antiviral Medications
- Other antiviral medications, such as Famciclovir and Valaciclovir, have also been shown to be effective in the treatment of shingles 6, 7.
- Famciclovir has been shown to reduce the duration of PHN, while Valaciclovir has been shown to accelerate the resolution of herpes zoster-associated pain 6, 7.
- The choice of antiviral medication may depend on individual patient factors, such as age, immune status, and severity of symptoms.