From the Guidelines
Acyclovir and famciclovir are the primary medications used to treat herpes zoster (shingles), with the most effective treatment outcomes when administered within 72 hours of rash onset. The treatment of herpes zoster involves the use of antiviral medications to reduce the severity and duration of the outbreak. Some key points to consider when treating herpes zoster include:
- Starting treatment within 72 hours of rash onset to maximize efficacy, as seen with acyclovir and famciclovir 1
- The use of oral antiviral medications, such as acyclovir and famciclovir, which have been shown to accelerate cutaneous healing and reduce acute pain in adults with herpes zoster 1
- The importance of pain management, which may involve the use of over-the-counter pain relievers, prescription medications, or topical treatments The goal of treatment is to reduce the severity and duration of the outbreak, as well as prevent complications such as postherpetic neuralgia. In terms of specific medication regimens, acyclovir and famciclovir have been approved by the FDA for the treatment of herpes zoster, with similar efficacy when administered within 72 hours of rash onset 1. It is essential to note that the treatment of herpes zoster should be individualized based on the patient's specific needs and medical history. Overall, the use of antiviral medications, such as acyclovir and famciclovir, is a crucial component of the treatment of herpes zoster, and prompt treatment is essential to reduce the risk of complications and improve treatment outcomes.
From the FDA Drug Label
VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The medication used to treat herpes zoster (shingles) is valacyclovir (PO), also known by the brand name VALTREX 2.
- The efficacy of VALTREX when initiated more than 72 hours after the onset of rash has not been established.
- The efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established.
From the Research
Medications for Herpes Zoster
The following medications are used to treat herpes zoster (shingles):
- Aciclovir: taken 5 times daily for 7 days 3
- Famciclovir: taken 3 times daily for 7 days 3, 4, 5, 6
- Valaciclovir: taken 3 times daily, with a study also showing effectiveness with a twice-daily dosing regimen of 1.5 g 3, 7
- Sorivudine: being compared with aciclovir for the therapy of acute herpes zoster in older patients, but data from these trials are not yet available 3
Administration and Efficacy
- Antiviral medications are most effective when started within 72 hours after the onset of the rash 4, 5, 6, 7
- The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 4
- Famciclovir and valaciclovir have been shown to be as effective as aciclovir in treating herpes zoster, with some studies suggesting that valaciclovir may be more effective in shortening the duration of postherpetic neuralgia 3, 5, 6, 7
Treatment Considerations
- Treatment should be initiated within 72 hours of symptom onset for optimal efficacy 4, 5, 6, 7
- Patients with ocular involvement may require referral to an ophthalmologist 4
- Patients with postherpetic neuralgia may require additional pain management, such as narcotics, tricyclic antidepressants, or anticonvulsants 4