From the FDA Drug Label
The recommended dosage of valacyclovir hydrochloride 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.
The recommended dosing for valacyclovir (Valtrex) for treating shingles infection is 1 gram 3 times daily for 7 days.
- Therapy should be initiated at the earliest sign or symptom of herpes zoster.
- The treatment is most effective when started within 48 hours of the onset of rash. However, the FDA drug label does not provide information on the recommended steroid regimen for treating shingles infection 1.
From the Research
For treating shingles (herpes zoster), the recommended dosing of valacyclovir (Valtrex) is 1.5 g twice daily for 7 days, as this regimen has been shown to be safe and effective in immunocompetent patients over 18 years of age 2.
Key Considerations
- Treatment should be started within 72 hours of rash onset for maximum effectiveness.
- A short course of oral prednisone (typically 60 mg daily for the first week, followed by a taper over the second week) may be used alongside antiviral therapy in selected patients, particularly those over 50 years old with moderate to severe pain.
- However, steroids are not routinely recommended for all patients and should be avoided in those who are immunocompromised.
- The antiviral medication works by inhibiting viral DNA replication, while steroids help reduce inflammation and potentially decrease the risk of postherpetic neuralgia (persistent pain after the rash heals).
Patient Management
- Patients should take the full course of medication even if symptoms improve.
- Staying well-hydrated and keeping the rash clean and dry are also important aspects of patient care.
- Those with eye involvement, immunocompromised status, or severe disease may require different dosing or treatment approaches, so medical evaluation is essential for proper management.
Evidence Summary
- The study by 2 demonstrated that twice-daily dosing of valacyclovir was as safe and effective as three times daily dosing for the reduction of zoster-associated pain and zoster-associated abnormal sensations.
- Other studies, such as 3 and 4, have also shown the efficacy of valacyclovir in treating herpes zoster, but the most recent and highest quality study 2 supports the use of 1.5 g twice daily for 7 days.