From the Research
Treatment Overview
The treatment for Herpes Zoster (shingles) primarily relies on antiviral drugs, with the goal of shortening the healing process, preventing or alleviating pain, and reducing the risk of complications 1, 2.
Antiviral Medications
- Aciclovir is considered a first-line agent for the treatment of herpes zoster, with its efficacy well established by many clinical studies 1.
- Other antiviral medications approved for the systemic treatment of herpes zoster include valaciclovir, famciclovir, and brivudine 2.
- Brivudine has shown greater effectiveness against the varicella-zoster virus than aciclovir and its derivatives, with the advantage of once-daily administration for seven days 2.
Pain Management
- The treatment of herpes zoster to reduce pain should be combined with analgesics and neuroactive agents, such as amitriptyline and gabapentin 2.
- Topical treatments, including capsaicin and lidocaine patches, can also help reduce the intensity and duration of pain 2, 3.
- For patients with post-herpetic neuralgia (PHN), evidence-based pharmacotherapy using topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, or opiates can reduce pain burden 3.
Special Considerations
- Early antiviral therapy and careful pain management are crucial for optimal treatment of herpes zoster 3.
- The live attenuated zoster vaccine is effective in reducing pain burden and preventing herpes zoster and PHN in older adults 3.
- Treatment guidelines may vary for special locations, such as cranial nerves, and different subpopulations, including children, pregnant women, and immunodepressed patients 2, 4.