What are the discharge instructions for a patient diagnosed with shingles?

From the Guidelines

Discharge instructions for shingles should prioritize taking prescribed antiviral medications, such as acyclovir or valacyclovir, for at least 7-10 days as directed, to reduce the severity and duration of the outbreak, as recommended by the most recent guidelines 1. The goal of discharge instructions is to manage symptoms, prevent complications, and improve quality of life. Key components of discharge instructions for shingles include:

• Taking prescribed antiviral medications, such as acyclovir or valacyclovir, for at least 7-10 days as directed to reduce the severity and duration of the outbreak
• Using acetaminophen or NSAIDs as recommended for pain management
• Applying cool, wet compresses to affected areas to relieve discomfort
• Keeping the rash clean and dry, avoiding tight clothing over the affected area
• Avoiding scratching the blisters to prevent infection and scarring
• Covering the rash when around people with weakened immune systems, pregnant women who haven't had chickenpox, and infants
• Resting and limiting activities until feeling better, and staying home from work or school until the blisters scab over
• Contacting the healthcare provider if experiencing increased pain, spreading of the rash, signs of infection, high fever, dizziness, confusion, or if the rash involves the eye It is essential to note that shingles is caused by reactivation of the varicella-zoster virus that causes chickenpox and can be contagious to those who haven't had chickenpox, so limiting contact during the blister phase is crucial 1.

From the FDA Drug Label

The recommended dosage of VALTREX for treatment of herpes zoster is 1 gram 3 times daily for 7 days Therapy should be initiated at the earliest sign or symptom of herpes zoster and is most effective when started within 48 hours of the onset of rash.

Discharge Instructions for Shingles:

• Initiate valacyclovir 1 gram 3 times daily for 7 days
• Start therapy at the earliest sign or symptom of herpes zoster
• Therapy is most effective when started within 48 hours of the onset of rash
• No specific discharge instructions are provided in the drug label beyond the treatment regimen 2

From the Research

Discharge Instructions for Shingles

• The patient should be advised to take their prescribed antiviral medication as directed, such as famciclovir 500 mg three times daily for 7 days 3 or valaciclovir 1000 mg three times daily for 7 days 4, 5.
• The patient should be informed that antiviral therapy is most effective when started within 72 hours of rash onset, but may still be beneficial when started later 4.
• The patient should be advised to manage their pain with over-the-counter pain medications such as ibuprofen, as prescribed by their doctor 6.
• The patient should be informed that they are contagious and should avoid contact with individuals who have not had chickenpox or have weakened immune systems until their rash has crusted over.
• The patient should be advised to keep their rash clean and dry to promote healing and reduce the risk of infection.
• The patient should be informed that they may experience postherpetic neuralgia (PHN), a complication of shingles characterized by persistent pain after the rash has resolved, and that their doctor may prescribe additional medication to manage this condition 3, 4, 5.
• The patient should be advised to follow up with their doctor as scheduled to monitor their condition and adjust their treatment plan as needed.

Wound Care and Prevention of Complications

• The patient should be advised to keep their rash clean and dry to promote healing and reduce the risk of infection.
• The patient should be informed that they should avoid scratching or rubbing their rash, as this can lead to infection or scarring.
• The patient should be advised to wear loose, comfortable clothing to reduce irritation to the affected area.

Follow-up Care

• The patient should be advised to follow up with their doctor as scheduled to monitor their condition and adjust their treatment plan as needed.
• The patient should be informed that they may need to follow up with their doctor for several months after their initial diagnosis to monitor for complications such as PHN.