From the Guidelines
Adults 50 years and older should receive the Shingrix vaccine to prevent shingles, as it is over 90% effective in preventing the condition. Shingles is a painful rash caused by the varicella-zoster virus, the same virus that causes chickenpox. If you develop shingles, seek medical attention promptly for antiviral treatment, which works best when started within 72 hours of rash onset. Common antivirals include acyclovir (800mg five times daily), valacyclovir (1000mg three times daily), or famciclovir (500mg three times daily), typically for 7 days 1. Pain management is also important, using acetaminophen, NSAIDs, or in severe cases, prescription medications like gabapentin or pregabalin. Keep the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox. The condition usually resolves within 3-5 weeks.
The Shingrix vaccine, also known as the recombinant zoster vaccine (RZV), has been shown to be highly effective in preventing shingles, with a vaccine efficacy of 97.2% in individuals aged 50 years and 89.8% in those aged 70 years 1. The vaccine has also been shown to be safe, with no significant increase in serious adverse events or deaths compared to the placebo group 1. The Centers for Disease Control and Prevention (CDC) recommends 2 doses of RZV, 2 to 6 months apart, as the preferred vaccine over the live zoster vaccine (ZVL), also known as Zostavax 1.
Key points to consider:
- Shingles is a painful rash caused by the varicella-zoster virus
- Antiviral treatment should be started within 72 hours of rash onset
- Pain management is important, using acetaminophen, NSAIDs, or prescription medications
- The Shingrix vaccine is over 90% effective in preventing shingles
- The vaccine is safe, with no significant increase in serious adverse events or deaths
- The CDC recommends 2 doses of RZV, 2 to 6 months apart, as the preferred vaccine.
From the FDA Drug Label
VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The efficacy of VALTREX when initiated more than 72 hours after the onset of rash and the efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established.
Shingles Treatment: Valacyclovir is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults, as long as treatment is initiated within 72 hours of rash onset 2.
- Key Points:
- Initiation of treatment within 72 hours of rash onset
- Limited to immunocompetent adults
- Efficacy for treatment beyond 72 hours or for disseminated herpes zoster not established
Two randomized, double-blind trials, 1 placebo-controlled and 1 active-controlled, were conducted in 964 immunocompetent adults with uncomplicated herpes zoster. Treatment was initiated within 72 hours of first lesion appearance and was continued for 7 days The median time to full crusting was 5 days among famciclovir 500 mg-treated patients as compared to 7 days in placebo-treated patients
Alternative Treatment: Famciclovir is also an option for the treatment of herpes zoster (shingles) in immunocompetent adults, with treatment initiated within 72 hours of rash onset 3.
- Key Points:
- Initiation of treatment within 72 hours of rash onset
- Limited to immunocompetent adults with uncomplicated herpes zoster
- Median time to full crusting was shorter in famciclovir-treated patients compared to placebo-treated patients
From the Research
Overview of Shingles
- 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 4.
- The infection can affect individuals of any age, but it is more common among those aged 50 years and older, as well as those with immunocompromised status or taking immunosuppressant drugs 4.
Symptoms and Complications
- Common symptoms of shingles include fever, pain, and itch before the onset of a rash 4.
- Post-herpetic neuralgia (PHN) is the most common complication associated with shingles, which can result in months or years of pain 5, 4.
- Other complications may include cutaneous and visceral dissemination, which can be life-threatening in immunocompromised patients 6, 7.
Treatment and Management
- Antiviral drugs, such as acyclovir, valacyclovir, and famciclovir, are effective in reducing the severity and duration of shingles symptoms, including pain and PHN 6, 7, 5, 8.
- Valacyclovir has been shown to be more effective than acyclovir and equally effective as famciclovir in hastening the healing of zoster-associated pain and PHN 5, 8.
- Treatment with antiviral drugs and analgesics within 72 hours of rash onset can reduce the severity and complications associated with shingles and PHN 6, 7, 4.