From the FDA Drug Label
Varicella Zoster and Measles Viral Infections Varicella and measles can have a serious or even fatal course in non-immune patients taking corticosteroids, including prednisone tablets In corticosteroid-treated patients who have not had these diseases or are non-immune, particular care should be taken to avoid exposure to varicella and measles
The use of prednisone for shingles (varicella zoster) treatment is not directly supported by the provided drug label. However, it does mention that varicella can have a serious or even fatal course in non-immune patients taking corticosteroids, including prednisone.
- The label does not provide guidance on the use of prednisone for treating shingles.
- It emphasizes the importance of avoiding exposure to varicella in non-immune patients taking corticosteroids.
- If a prednisone-treated patient is exposed to varicella, prophylaxis with varicella zoster immune globulin may be indicated, and if varicella develops, treatment with antiviral agents may be considered 1.
From the Research
Steroids are not routinely recommended as a first-line treatment for uncomplicated shingles (herpes zoster), but may be considered in specific cases, such as moderate to severe pain or high risk for postherpetic neuralgia, alongside antiviral medications. The standard treatment for shingles consists of antiviral medications such as acyclovir (800 mg five times daily), valacyclovir (1000 mg three times daily), or famciclovir (500 mg three times daily) for 7-10 days, which work best when started within 72 hours of rash onset 2.
Key Considerations
- Antiviral medications are the primary treatment for shingles, with corticosteroids considered in specific cases to reduce inflammation and potentially decrease the risk of postherpetic neuralgia 3.
- When used, prednisone is typically prescribed at 40-60 mg daily for the first week, followed by a taper over the next 2-3 weeks, but should be avoided in patients with contraindications such as uncontrolled diabetes, immunosuppression, or active peptic ulcer disease 4, 5.
- Pain management with acetaminophen, NSAIDs, or in severe cases, gabapentin or pregabalin, is also an important component of shingles treatment, as it can help alleviate symptoms and improve quality of life 2, 6.
Evidence Summary
The most recent and highest quality study, published in 1996, found that combined acyclovir and prednisone therapy can improve quality of life in relatively healthy persons older than 50 years of age with localized herpes zoster 3. However, other studies have found that corticosteroids do not prevent the development of postherpetic neuralgia, and their use should be carefully considered in patients with comorbidities or contraindications 4, 5.
Clinical Implications
In clinical practice, the decision to use corticosteroids in the treatment of shingles should be made on a case-by-case basis, taking into account the individual patient's risk factors, symptoms, and medical history. The potential benefits of corticosteroids, including reduced inflammation and improved quality of life, must be weighed against the potential risks, such as increased risk of complications in patients with contraindications.