If possible, antivirals should be administered within 24-72 hours of feeling pain/burning and preferably before blisters appear.  Antiviral drugs inhibit herpes zoster replication, reducing severity, but typically do not prevent post-herpetic neuralgia.

 

The following antiviral drugs are the most commonly used for herpes zoster:

-Acyclovir (brand names: Zovirax, Cyclovir, Herpex, Acivir, Acivirax, Aciclovir, Zovir)
-Famciclovir (brand name: Famvir) prodrug of penciclovir with improved oral bioavailability
-Valacyclovir (brand names: Valtrex, Zelitrex) prodrug, being converted in vivo to acyclovir

 

The following several analgesics are used to treat herpes zoster and PHN pain:

 

Anticonvulsants (manage severe muscle spasms and provide sedation in neuralgia):

-Phenytoin (brand names: Dilantin, Phenytek, Eptoin, Epanutin, Phydum) antiepileptic
-Carbamazepine (brand names: Carbatrol, Tegretol) anticonvulsant used for epilepsy
-Gabapentin (brand name: Neurontin) developed for epilepsy and commonly used for pain
-Lamotrigine (brand name: Lamictal) anticonvulsant used for epilepsy and bi-polar disorder

 

Corticosteroids such as prednisone are common prescriptions despite clinical trials showing unreliable effects.  It has been recommended that using acyclovir and prednisone together only be used in people over 55 because of their greater risk of developing post-herpetic neuralgia.

 

Anti-depressants (affect brain chemicals, altering mood and interpretation of pain):

-Amitriptylie
-Venlafaxine (brand name: Effexor)
-Bupropion (brand names: Wellbutrin, Zyban)

 

Opiates, NSAIDs etc:

-Paracetamol (acetaminophen, Tylenol)
-Ibuprofen (Advil)
-Tramadol
-Fentanyl

-Codeine
-Morphine
-Oxycodone

 

Topical analgesics:

-Lidocaine patches (brand name: Lidoderm)
-Capsaicin cream (brand name: Zostrix)

 

An FDA approved zoster virus vaccine was made available in 2006 called Zostavax. It is for people over 60 who have had chickenpox.  This vaccine is a preventive therapy only and is not a treatment for those who currently have shingles or post-herpetic neuralgia.  Zostavax is not recommended for women who are pregnant, people with active untreated tuberculosis, or those with weakened immune systems. It is also not recommended for anyone who has had a life-threatening allergic reaction to gelatin or to the antibiotic neomycin, which are components of the vaccine formula.

Please note this list is based on commonly used drugs and not necessarily the only conventional treatment options available. Used as a guide, this page may aid you in determining conventional treatment options provided by your doctor.

 

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