Online Canadian Pharmacy Blog

Treatment of herpes zoster

Antiviral agents have been shown to decrease the duration of herpes zoster rash and the severity of pain associated with the rash. Benefits have been demonstrated in patients who received antiviral agents within 72 hours after the onset of rash.

Acyclovir Zovirax therapy appears to produce a moderate reduction in the development of postherpetic neuralgia. Other antiviral agents, specifically valacyclovir (Valtrex) and famciclovir (Famvir), appear to be at least as effective as acyclovir.

Valtrex, a prodrug of acyclovir, is administered three times daily. Compared with acyclovir, valacyclovir may be slightly better at decreasing the severity of pain associated with herpes zoster, as well as the duration of postherpetic neuralgia.

Famvir The advantages of famciclovir are its dosing schedule (three times daily), its longer intracellular half-life compared with acyclovir and its better bioavailability compared with acyclovir and valacyclovir.

All three antiviral agents are generally well tolerated. The most common adverse effects are nausea, headache, vomiting, dizziness and abdominal pain.

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Prednisone used in conjunction with acyclovir has been shown to reduce the pain associated with herpes zoster. Some studies with prednisone therapy have shown decreased postherpetic neuralgia pain at three and 12 months. Other studies have demonstrated no benefit.

Analgesics. Patients with mild-to-moderate pain may respond to over-the-counter analgesics. Patients with more severe pain may require the addition of a narcotic medication. Lotions containing calamine (eg, Caladryl) may be used on open lesions to reduce pain and pruritus. Once the lesions have crusted over, capsaicin cream (Zostrix) may be applied. The lidocaine (Xylocaine) patch (q4-12h) and nerve blocks have also been reported to be effective in reducing pain.

Ocular involvement. Ocular herpes zoster is treated with orally administered antiviral agents and corticosteroids.