From the Guidelines
The best pain relief for uncomplicated herpes zoster (shingles) is antiviral therapy with oral acyclovir, famciclovir, or valacyclovir.
Key Points
- These medications are beneficial for reducing the severity and duration of herpes zoster in otherwise healthy hosts 1.
- Oral acyclovir, famciclovir, and valacyclovir are the preferred treatments for uncomplicated herpes zoster, as they have been shown to decrease viral shedding and lower the duration of lesions 1.
- The treatment should be started as soon as possible, ideally within 72 hours of the onset of symptoms, to maximize its effectiveness 1.
- High-dose IV acyclovir is typically reserved for immunocompromised patients or those with severe cases of herpes zoster 1.
- In addition to antiviral therapy, patients with herpes zoster may also require pain management, which can include over-the-counter pain medications, such as acetaminophen or ibuprofen, or prescription medications, such as gabapentin or pregabalin, for more severe cases 1.
From the Research
Treatment Options for Uncomplicated Herpes Zoster
- Oral antiviral agents, such as acyclovir, valacyclovir, and famciclovir, are the most important therapeutic keystone in the treatment of herpes zoster 2
- These agents have been shown to reduce the duration and intensity of zoster-associated pain (ZAP) and provide more rapid skin lesion healing when initiated within 72 hours of the onset of the acute HZ rash 2, 3
- Famciclovir has been proven to reduce the duration of postherpetic neuralgia (PHN) when administered during acute zoster infection 4
- Valacyclovir 1.5 g twice daily for 7 days is a safe and effective treatment for uncomplicated herpes zoster in immunocompetent patients 18 years of age or older 5
Benefits of Early Treatment
- Early treatment with oral antiviral agents can reduce the incidence and severity of complications, including PHN 3
- Treatment initiated within 72 hours of the onset of the acute HZ rash can significantly shorten the periods of acute pain, virus shedding, and rash 3
- Reducing the duration of PHN can improve quality of life and reduce healthcare costs 6