From the Guidelines
Shingles treatment should begin as soon as possible with antiviral medications like acyclovir (800mg five times daily), valacyclovir (1000mg three times daily), or famciclovir (500mg three times daily) for 7-10 days, as these medications are most effective when started within 72 hours of rash appearance and work by inhibiting viral replication 1. The goal of treatment is to reduce the severity and duration of symptoms, as well as prevent complications.
- Antiviral medications are the mainstay of treatment, and they should be started promptly to maximize their effectiveness.
- Pain management is also crucial, and may include over-the-counter options like acetaminophen or ibuprofen, or prescription medications such as gabapentin (starting at 300mg daily and increasing as needed) for more severe pain.
- Topical treatments like calamine lotion or colloidal oatmeal baths can help soothe the rash, while keeping the affected area clean and covered prevents secondary infection and transmission.
- For patients over 50 or immunocompromised individuals experiencing severe symptoms, corticosteroids might be prescribed alongside antivirals 1.
- Adequate rest and hydration support recovery, and patients should avoid contact with pregnant women, newborns, and immunocompromised individuals until lesions crust over.
- If eye involvement occurs, immediate ophthalmological consultation is necessary to prevent vision complications. The treatment approach may vary depending on the patient's immune status, with high-dose IV acyclovir being the treatment of choice for VZV infections in compromised hosts 1.
- Oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts, but oral therapy should be reserved for mild cases of VZV disease in patients with transient immune suppression or as treatment to complete therapy once the patient has shown a clinical response to IV acyclovir 1.
From the FDA Drug Label
Herpes Zoster (Shingles) There are no data on treatment initiated more than 72 hours after onset of zoster rash Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster. VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The efficacy of VALTREX when initiated more than 72 hours after the onset of rash and the efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established. Herpes Zoster Infections : Acyclovir tablets is indicated for the acute treatment of herpes zoster (shingles).
Treatment for Shingles:
- Famciclovir, valacyclovir, and acyclovir are indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.
- Treatment should be initiated as soon as possible after a diagnosis of herpes zoster, with no data supporting treatment initiated more than 72 hours after onset of zoster rash 2, 3.
- The efficacy and safety of these medications for treatment of disseminated herpes zoster have not been established 3.
From the Research
Treatment Options for Shingles
- Antiviral therapy is the primary treatment for shingles, with three main options: aciclovir, famciclovir, and valaciclovir 4, 5, 6, 7, 8
- These medications can shorten the duration of post-herpetic neuralgia (PHN) and reduce the severity of symptoms, but may not prevent PHN 4, 5, 6, 7, 8
Antiviral Medications
- Aciclovir is taken 5 times daily for 7 days, while famciclovir is taken 3 times daily for 7 days 4
- Valaciclovir is taken 3 times daily for 7 days and has been shown to be more efficient and effective than aciclovir in shortening the duration of PHN 4, 6
- Famciclovir and valaciclovir have similar efficacy to aciclovir, but require less frequent administration 5, 8
Effectiveness of Antiviral Therapy
- Oral antiviral therapy, when initiated within 72 hours of the onset of the acute shingles rash, can significantly shorten the periods of acute pain, virus shedding, and rash 5, 7
- Antiviral therapy can also reduce the incidence and severity of PHN, but may not prevent it 4, 5, 6, 7, 8
Comparison of Antiviral Medications
- Valaciclovir and famciclovir have been compared in several studies, with similar efficacy and safety profiles 6, 8
- Valaciclovir may be more cost-effective than famciclovir, with a lower wholesale price 8