From the Guidelines
Shingles treatment should begin as soon as possible with antiviral medications like valacyclovir or famciclovir in higher doses appropriate for VZV, for a minimum of 7–10 days, as recommended by the most recent guidelines 1.
Treatment Overview
The goal of treatment is to reduce the severity and duration of symptoms, as well as prevent complications.
- Antiviral medications are most effective when started within 72 hours of rash appearance and work by inhibiting viral replication.
- For immunocompromised patients, antiviral therapy is recommended, and treatment for complicated HZ, including multi-dermatomal, ophthalmic, visceral, or disseminated HZ, is intravenous acyclovir 1.
Pain Management
- Options include acetaminophen, NSAIDs like ibuprofen, or in severe cases, prescription medications such as gabapentin or pregabalin.
- Topical treatments like calamine lotion or cool compresses can soothe the rash, while keeping the affected area clean and covered helps prevent secondary infections.
Special Considerations
- If you're over 50 or immunocompromised, seek medical attention promptly as complications can be more serious.
- While the rash is active, avoid contact with pregnant women, newborns, and immunocompromised individuals, as you can transmit chickenpox to those who haven't had it.
- Vaccination for shingles before initiating a JAK inhibitor, particularly for older patients, is recommended to prevent herpes zoster 1.
Additional Treatment
- Most shingles cases resolve within 3-5 weeks, but some patients develop postherpetic neuralgia, persistent pain that may require additional treatment.
- The persistence of lesions despite appropriately dosed antiviral therapy should raise suspicion of acyclovir resistance, and alternative treatments should be considered 1.
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.
INDICATIONS AND USAGE Famciclovir tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: ... Herpes zoster (shingles) INDICATIONS AND USAGE Herpes Zoster Infections : Acyclovir tablets is indicated for the acute treatment of herpes zoster (shingles).
To treat shingles, valacyclovir (PO), famciclovir (PO), and acyclovir (PO) can be used in immunocompetent adults 2, 3, and 4.
From the Research
Treatment Options for Shingles
- Antiviral medications such as aciclovir, famciclovir, and valaciclovir can be used to treat shingles 5, 6, 7, 8, 9
- These medications can help shorten the duration of the rash and reduce the risk of postherpetic neuralgia (PHN) 5, 6, 8
- Valaciclovir has been shown to be more effective than aciclovir in shortening the duration of PHN 5
- Famciclovir and valaciclovir have better oral bioavailability than acyclovir and require less frequent administration 6
- Corticosteroids may be used in combination with antiviral medications to relieve pain and improve quality of life 5
Management of Postherpetic Neuralgia
- Tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, and tramadol may be used to treat PHN 7
- Capsaicin cream or a lidocaine patch may be used as a second-line agent for PHN 7
- Immunization with the varicella zoster vaccine is recommended for most adults 60 years and older to prevent herpes zoster and PHN 7
Comparison of Antiviral Medications
- Valacyclovir has been shown to be more efficacious than famciclovir in managing herpes zoster, with significant decrease in pain scores and accelerated resolution of zoster-associated pain 9
- Valacyclovir and famciclovir have similar efficacy to acyclovir in reducing the duration and intensity of zoster-associated pain (ZAP) 6