From the Guidelines
The treatment for Herpes Zoster (shingles) should include antiviral medications such as acyclovir or famciclovir, which have been shown to accelerate the rate of cutaneous healing and reduce the severity of acute pain when administered within 72 hours of rash onset 1.
Key Considerations
- The goal of treatment is to reduce morbidity, mortality, and improve quality of life by alleviating symptoms and preventing complications.
- Antiviral medications are most effective when started early, ideally within 72 hours of rash onset.
- Pain management is crucial, as it can significantly impact the patient's quality of life.
Treatment Options
- Acyclovir (800 mg five times daily) or famciclovir (500 mg three times daily) for 7-10 days are recommended antiviral medications 1.
- Pain management options include over-the-counter medications like acetaminophen or ibuprofen, as well as prescription medications such as gabapentin or tricyclic antidepressants for severe pain.
- Topical treatments like calamine lotion or colloidal oatmeal baths can help soothe the rash.
Special Considerations
- Patients over 50 or those with compromised immune systems require prompt treatment to reduce the risk of postherpetic neuralgia, a painful complication that can persist for months after the rash heals.
- Adequate rest and stress reduction support recovery, as stress can worsen symptoms and delay healing.
From the FDA Drug Label
Herpes Zoster VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. In the active-controlled trial, 545 patients were treated with 1 of 3 doses of famciclovir three times daily or with acyclovir 800 mg five times daily. Herpes Zoster Infections : Acyclovir tablets is indicated for the acute treatment of herpes zoster (shingles). The treatment for Herpes Zoster (shingles) includes:
- Valacyclovir (PO): indicated for the treatment of herpes zoster (shingles) in immunocompetent adults 2
- Famciclovir (PO): used to treat shingles (herpes zoster) in adults with a normal immune system 3
- Acyclovir (PO): indicated for the acute treatment of herpes zoster (shingles) 4
From the Research
Treatment Options for Herpes Zoster
The treatment for Herpes Zoster (shingles) includes:
- Antiviral medications such as aciclovir, famciclovir, and valaciclovir 5, 6, 7, 8, 9
- Corticosteroids, which may provide modest benefits in reducing pain and the incidence of postherpetic neuralgia 5, 6
- Pain management options, including narcotics, tricyclic antidepressants, anticonvulsants, capsaicin, lidocaine patches, and nerve blocks 6
Antiviral Medications
The antiviral medications are most effective when started within 72 hours after the onset of the rash 6, 8. The available options include:
- Aciclovir, taken 5 times daily for 7 days 5
- Famciclovir, taken 3 times daily for 7 days 5, 7
- Valaciclovir, taken 3 times daily for 7 days, which has been shown to be more effective than aciclovir in shortening the duration of postherpetic neuralgia 5, 8, 9
Postherpetic Neuralgia
Postherpetic neuralgia (PHN) is a common complication of herpes zoster, characterized by persistent pain after the rash has resolved 5, 6, 7. The antiviral medications, particularly valaciclovir and famciclovir, have been shown to reduce the duration of PHN 5, 7, 8, 9.