From the Guidelines
Valtrex (valacyclovir) should be started within 72 hours of rash onset for the treatment of shingles in immunocompromised patients. The recommended treatment for uncomplicated shingles is oral valacyclovir or famcyclovir in higher doses appropriate for VZV, and treatment should continue for a minimum of 7–10 days 1.
- Key points to consider when treating shingles with valtrex include:
- Starting treatment as soon as possible after symptoms appear to reduce viral replication, shorten the duration of the outbreak, decrease pain severity, and lower the risk of postherpetic neuralgia
- Completing the full course of treatment, even if symptoms improve before finishing the medication
- Considering intravenous acyclovir for complicated cases, such as multi-dermatomal, ophthalmic, visceral, or disseminated shingles
- Withholding immunosuppressive therapy in severe cases of varicella infection, disseminated HSV and VZV, symptomatic infectious mononucleosis, EBV-related mucocutaneous ulceration, and severe influenza, and restarting it after the patient has commenced anti-VZV therapy and the skin vesicles have resolved 1.
- It is essential to note that the 72-hour window is considered optimal for starting treatment, but some benefit may still be gained by starting treatment later, especially if new lesions are still forming or in patients with compromised immune systems.
From the Research
Treatment Window for Valtrex in Shingles
- The treatment window for valtrex (valaciclovir) in shingles is ideally within 72 hours after the onset of the rash 2, 3, 4, 5, 6
- Starting treatment later than 72 hours after rash onset did not significantly reduce the beneficial effect of valaciclovir on duration of zoster-associated pain, but it is still recommended to start treatment as soon as possible after symptoms appear 2
- Valaciclovir is usually given for 7 days, with a dosage of 1000 mg three times daily 2, 4
Efficacy of Valtrex in Shingles
- Valaciclovir has been shown to be at least as effective as aciclovir in controlling the symptoms of acute herpes zoster 2
- Valaciclovir alleviated zoster-associated pain and postherpetic neuralgia significantly faster than aciclovir 2
- A 14-day regimen of valaciclovir showed no significant advantage over the 7-day regimen 2