From the Guidelines
Shingles treatment should start with antiviral therapy within 72 hours of rash onset using medications like acyclovir or famciclovir to reduce the severity of acute pain and accelerate cutaneous healing. When considering treatment options, it's essential to prioritize medications that have been proven to be effective in managing shingles. According to the study by 1, two nucleoside analogs, acyclovir and famciclovir, have been approved by the FDA for treating HZ. Some key points to consider when treating shingles include:
- Starting antiviral therapy within 72 hours of rash onset to maximize efficacy
- Using medications like acyclovir or famciclovir, which have similar efficacy in reducing the severity of acute pain and accelerating cutaneous healing 1
- Managing pain with over-the-counter options like acetaminophen or ibuprofen, or prescription medications like gabapentin or pregabalin for more severe cases
- Applying cool compresses to blisters and keeping them clean to prevent infection
- Avoiding touching or scratching the rash to prevent virus transmission to vulnerable individuals
- Staying well-hydrated and rested during recovery to support the immune system. It's also important to note that the shingles vaccine is recommended for adults over 50 to prevent future outbreaks.
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.
- Shingles treatment: Valacyclovir (PO) is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults 2.
- Alternative options: Acyclovir (PO) is also indicated for the acute treatment of herpes zoster (shingles) 3, and famciclovir (PO) is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults 4.
From the Research
Shingles Treatment Overview
- Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox 5.
- The treatment of shingles typically involves antiviral medications, such as acyclovir, valacyclovir, or famciclovir, which can help reduce the duration and severity of the rash and pain 6, 7, 8.
Antiviral Medications
- Valacyclovir has been shown to be at least as effective as acyclovir in controlling the symptoms of acute herpes zoster, and it alleviates zoster-associated pain and postherpetic neuralgia significantly faster than acyclovir 6.
- Famciclovir has also been shown to be effective in treating shingles, with a similar efficacy to valacyclovir 6, 9.
- Acyclovir, while effective in reducing the duration and intensity of zoster-associated pain, does not significantly reduce the incidence of postherpetic neuralgia 9.
Treatment Guidelines
- The recommended treatment for shingles is to start antiviral therapy within 72 hours of the onset of the rash, ideally with valacyclovir or famciclovir 6, 5.
- Treatment with antiviral medications can help reduce the duration and severity of the rash and pain, but it may not prevent postherpetic neuralgia 9, 7.
- Adjunct medications, such as opioid analgesics, tricyclic antidepressants, or corticosteroids, may be used to relieve pain associated with acute herpes zoster 7.