From the Guidelines
The current treatment for an acute shingles flareup primarily involves antiviral medications started within 72 hours of rash onset, with options including acyclovir and famciclovir, as they have been shown to accelerate the rate of cutaneous healing and reduce the severity of acute pain in adults with shingles 1. When managing an acute shingles flareup, it is essential to consider the following key points:
- Antiviral therapy should be initiated as soon as possible, ideally within 72 hours of rash onset, to maximize its effectiveness.
- Acyclovir and famciclovir are two nucleoside analogs approved by the FDA for treating shingles, with similar efficacy when administered during the same period 1.
- The treatment regimen for acyclovir is typically 800 mg five times daily for 7-10 days, while famciclovir is usually administered at 500 mg three times daily for 7 days.
- In addition to antiviral therapy, pain management is crucial, and options may include acetaminophen, NSAIDs, gabapentin, pregabalin, or tricyclic antidepressants like amitriptyline.
- Topical treatments, such as lidocaine patches or capsaicin cream, can provide additional relief, and patients should keep the rash clean and dry, avoid scratching, and consider loose-fitting clothing to minimize irritation.
- Early treatment is crucial, as antivirals can reduce viral shedding, promote faster healing, decrease pain severity, and may reduce the risk of postherpetic neuralgia, a common complication, especially in older adults.
From the FDA Drug Label
Herpes Zoster 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.
The current treatment guidelines for an acute shingles flareup is 1 gram of valacyclovir three 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 2.
- Key points:
- Dosage: 1 gram three times daily
- Duration: 7 days
- Initiation: at the earliest sign or symptom of herpes zoster
- Timing: most effective when started within 48 hours of the onset of rash
From the Research
Current Treatment Guidelines for Acute Shingles Flareup
- The current treatment guidelines for acute shingles flareup involve the use of antiviral drugs, such as aciclovir, famciclovir, and valaciclovir, to shorten the duration of post-herpetic neuralgia (PHN) and reduce the severity of the disease 3, 4, 5.
- Valaciclovir has been shown to be more effective than aciclovir in shortening the duration of PHN and is considered a first-line treatment for acute shingles 3, 4, 5.
- Famciclovir is also an effective treatment for acute shingles, but valaciclovir has been shown to be more efficacious in some studies 5.
- Corticosteroids may be used in combination with antiviral drugs to improve the quality of life of older patients, but their effect on PHN is not consistent 3.
- Treatment with antiviral drugs and analgesics within 72 hours of rash onset has been shown to reduce the severity and complications associated with herpes zoster and post-herpetic neuralgia 6.
Antiviral Drug Regimens
- Aciclovir: 800 mg five times daily for 7 days 3, 4.
- Famciclovir: 500 mg three times daily for 7 days 5.
- Valaciclovir: 1000 mg three times daily for 7 days 4, 5.
Prevention
- Routine vaccination for individuals over 60 years has been shown to reduce the incidence of herpes zoster and post-herpetic neuralgia 6.