From the Guidelines
Herpes Zoster (Shingles) treatment typically involves antiviral medications, with the goal of reducing the severity and duration of symptoms.
Treatment Options
- Acyclovir and famciclovir are two nucleoside analogs approved by the FDA for treating Herpes Zoster (HZ) 1.
- Valacyclovir is also beneficial for VZV infections in otherwise healthy hosts 1.
- High-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts 1.
- Treatment should be continued at least until all lesions have scabbed 1.
Specific Treatment Recommendations
- Uncomplicated herpes zoster (shingles) can be treated with oral acyclovir or valacyclovir 1.
- Disseminated or invasive herpes zoster should be treated with intravenous acyclovir and a temporary reduction in immunosuppressive medication 1.
- Oral acyclovir, famciclovir, and valacyclovir can be used 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 intravenous acyclovir 1.
From the Research
Treatment Options for Herpes Zoster (Shingles)
The treatment for Herpes Zoster (Shingles) primarily relies on:
- Antiviral drugs, such as aciclovir, valaciclovir, and famciclovir 2, 3, 4
- Immunomodulating agents, specific immunoglobulins, antimicrobial agents, antiviral enzymes, and corticosteroids 2
- Analgesic therapy to reduce the incidence and severity of acute zoster pain and post-herpetic neuralgia 4, 5
- Alternative therapies, such as transcutaneous electrical nerve stimulation (TENS), which may be a safe adjunct or alternative to antiviral drugs for treatment of acute HZ 6
Antiviral Drugs
Antiviral drugs are the most important therapeutic keystone in the treatment of herpes zoster, with:
- Aciclovir being a first-line agent, with its efficacy well established by many clinical studies 2
- Valaciclovir and famciclovir exhibiting better oral bioavailability than acyclovir and demonstrating similar efficacy in reducing zoster-associated pain (ZAP) 3
- Newer molecules, such as penciclovir, showing improved activity against VZV 2, 5
Treatment Approaches
Treatment approaches for herpes zoster include:
- Oral antiviral therapy, which is beneficial in selected, elderly immunocompetent patients, reducing the duration and intensity of ZAP and providing more rapid skin lesion healing 3
- Intravenous antiviral therapy, which is reserved for patients with disseminated varicella zoster virus infection, ophthalmic involvement, very severe immunosuppression, or the inability to take oral medications 4
- Combination therapy, which may include antiviral drugs, analgesic agents, anticonvulsants, tricyclic antidepressants, and topical therapies 5