From the Guidelines
Shingles treatment should begin with antiviral medications like acyclovir or famciclovir, as they have been shown to accelerate the rate of cutaneous healing and reduce the severity of acute pain when administered within 72 hours of rash onset. According to the study by 1, two nucleoside analogs, acyclovir and famciclovir, have been approved by FDA for treating HZ. The study found that if administered within 72 hours of rash onset, acyclovir has accelerated the rate of cutaneous healing and reduced the severity of acute pain in adults who have HZ. Some key points to consider in shingles treatment include:
- Starting antiviral medication within 72 hours of rash onset for optimal efficacy
- Using medications like acyclovir or famciclovir, which have similar efficacy in treating HZ
- Managing pain with options like acetaminophen, NSAIDs, or prescription medications like gabapentin or pregabalin
- Keeping the rash clean and covered to prevent spreading the virus to others
- Seeking immediate medical attention if the rash appears near the eyes, as this can lead to vision complications, as noted in the context of treating HZ 1. It's also important to note that treatment is particularly important for individuals over 50 or with a weakened immune system, as complications are more common in these populations.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Patients ... Herpes Zoster VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.
- Valacyclovir (PO) is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults 2.
- Acyclovir (PO) is indicated for the acute treatment of herpes zoster (shingles) 3.
- Famciclovir (PO) is indicated for the treatment of herpes zoster (shingles) in immunocompetent adult patients 4.
From the Research
Shingles Treatment Overview
- Shingles, also known as herpes zoster, is a viral infection characterized by a painful rash, typically affecting one side of the body 5.
- The primary risk factor for shingles is increasing age, with an estimated 1 million cases occurring in the United States each year 5.
Antiviral Treatment
- Antiviral medications such as acyclovir, famciclovir, and valacyclovir can decrease the duration of the rash and alleviate symptoms 5, 6.
- These medications are most effective when initiated within 72 hours of the onset of the rash 6, 7.
- Valacyclovir has been shown to be more effective than acyclovir and equally effective as famciclovir in hastening the healing of zoster-associated pain and postherpetic neuralgia 8.
Pain Management
- Adjunct medications, including opioid analgesics, tricyclic antidepressants, or corticosteroids, may be used to relieve pain associated with acute herpes zoster 5.
- For postherpetic neuralgia, treatments such as tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, or tramadol may be effective 5.
- Capsaicin cream or a lidocaine patch may also be used as a second-line agent for postherpetic neuralgia 5.