From the Guidelines
Valacyclovir can be given twice daily (BID) for shingles treatment, with a recommended dosage of 1,000 mg three times daily for 7 days in immunocompetent adults, but a simplified twice-daily regimen may also be effective. The treatment of shingles, also known as herpes zoster, typically involves antiviral medications such as valacyclovir, which works by converting to acyclovir in the body, inhibiting viral DNA synthesis and replication, making it effective against varicella-zoster virus 1.
Key Considerations
- Treatment should be started as soon as possible after shingles diagnosis, ideally within 72 hours of rash onset, as early treatment leads to better outcomes.
- For immunocompromised patients, higher doses or longer treatment duration may be necessary, and high-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts 1.
- Common side effects of valacyclovir include headache, nausea, and abdominal pain, and patients should maintain adequate hydration while taking the medication and report any unusual neurological symptoms.
- The dosage of valacyclovir for shingles treatment may vary, but a twice-daily regimen of 1,500 mg BID for 7 days is also effective and may improve medication adherence, although the most recent and highest quality study recommends 1,000 mg three times daily for 7 days in immunocompetent adults 1.
Patient Management
- Patients with shingles should be closely monitored for signs of complications, such as disseminated infection or secondary bacterial or fungal superinfections.
- Recipients of allogeneic blood and bone marrow transplants may take acyclovir (800 mg bid) or valacyclovir (500 mg bid) during the first year following transplant for the prevention of VZV and HSV reactivation 1.
- Valacyclovir is beneficial for VZV infections in otherwise healthy hosts, but oral therapy should be reserved for mild cases of VZV disease in patients with transient immune suppression or as treatment to complete therapy once the patient has shown a clinical response to IV acyclovir 1.
From the Research
Dosage of Valacyclovir for Shingles
- The recommended dosage of valacyclovir for the treatment of herpes zoster (shingles) is 1000 mg three times daily for 7 days 2, 3, 4.
- This dosage has been shown to be effective in accelerating the resolution of herpes zoster-associated pain and reducing the duration of postherpetic neuralgia 2, 3, 4.
- There is no evidence to suggest that a twice-daily (BID) dosage of valacyclovir is effective for the treatment of shingles, as all studies have used a three-times-daily regimen 2, 3, 4, 5, 6.
Efficacy of Valacyclovir
- Valacyclovir has been shown to be at least as effective as acyclovir in the treatment of herpes zoster, with some studies suggesting that it may be more effective in reducing the duration of pain and postherpetic neuralgia 2, 3, 4, 6.
- Valacyclovir has also been compared to famciclovir, with both drugs showing similar efficacy in the treatment of herpes zoster 4, 5, 6.