Skip to main content
Log in

Treat herpes zoster with systemic antivirals and post-herpetic neuralgia with various agents depending on its severity

  • Disease Management
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Systemic antivirals are the mainstay treatment option for herpes zoster, although adequate pain relief should also be provided. For post-herpetic neuralgia (PHN), first-line treatment options include topical lidocaine or capsaicin for mild symptoms and systemic anticonvulsants (gabapentin and pregabalin) for more severe PHN. Other systemic agents, such as tricyclic antidepressants and opioids, can also provide benefit. Preventative measures, particularly vaccination, should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Gan EY, Tian EA, Tey HL. Management of herpes zoster and post-herpetic neuralgia. Am J Clin Dermatol. 2013;14(2):77–85.

    Article  PubMed  Google Scholar 

  2. Yawn BP, Saddier P, Wollan PC, et al. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341–9.

    Article  PubMed  Google Scholar 

  3. Bruxelle J, Pinchinat S. Effectiveness of antiviral treatment on acute phase of herpes zoster and development of post herpetic neuralgia: review of international publications. Med Mal Infect. 2012;42(2):53–8.

    Article  PubMed  CAS  Google Scholar 

  4. Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44(Suppl 1):S1–26.

    Article  PubMed  CAS  Google Scholar 

  5. Tyring SK, Beutner KR, Tucker BA, et al. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000;9(9):863–9.

    Article  PubMed  CAS  Google Scholar 

  6. British Medical Association and the Royal Pharmaceutical Society of Great Britain. British national formulary (March 2013). London: BMJ Group and the Royal Pharmaceutical Society; 2013.

    Google Scholar 

  7. Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113–23.

    Article  PubMed  CAS  Google Scholar 

  8. Khaliq W, Alam S, Puri N. Topical lidocaine for the treatment of postherpetic neuralgia. Cochrane Database Syst Rev. 2007(2):CD004846.

  9. Hempenstall K, Nurmikko TJ, Johnson RW, et al. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLoS Med. 2005;2(7):e164.

    Article  PubMed  Google Scholar 

  10. Derry S, Lloyd R, Moore RA, et al. Topical capsaicin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2009(4):CD007393.

  11. Moore RA, Straube S, Wiffen PJ, et al. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009(3):CD007076.

  12. Rowbotham MC, Reisner LA, Davies PS, et al. Treatment response in antidepressant-naive postherpetic neuralgia patients: double-blind, randomized trial. J Pain. 2005;6(11):741–6.

    Article  PubMed  CAS  Google Scholar 

  13. Rowbotham MC, Reisner-Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology. 1991;41(7):1024–8.

    Article  PubMed  CAS  Google Scholar 

  14. Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology. 1998;50(6):1837–41.

    Article  PubMed  CAS  Google Scholar 

  15. Bruera E, Palmer JL, Bosnjak S, et al. Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study. J Clin Oncol. 2004;22(1):185–92.

    Article  PubMed  CAS  Google Scholar 

  16. Bowsher D. The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trial. J Pain Symptom Manage. 1997;13(6):327–31.

    Article  PubMed  CAS  Google Scholar 

  17. Lapolla W, Digiorgio C, Haitz K, et al. Incidence of postherpetic neuralgia after combination treatment with gabapentin and valacyclovir in patients with acute herpes zoster: open-label study. Arch Dermatol. 2011;147(8):901–7.

    Article  PubMed  Google Scholar 

  18. Kolsek M. TENS: an alternative to antiviral drugs for acute herpes zoster treatment and postherpetic neuralgia prevention. Swiss Med Wkly. 2012;141:w13229.

    PubMed  Google Scholar 

  19. Li Q, Chen N, Yang J, et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2011(19):CD005451.

  20. Chen N, Yang M, He L, et al. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2010(12):CD005582.

  21. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271–84.

    Article  PubMed  CAS  Google Scholar 

  22. Schmader KE, Levin MJ, Gnann JW Jr, et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50–59 years. Clin Infect Dis. 2012;54(7):922–8.

    Article  PubMed  Google Scholar 

  23. Schmader KE, Oxman MN, Levin MJ, et al. Persistence of the efficacy of zoster vaccine in the Shingles Prevention Study and the Short-Term Persistence Substudy. Clin Infect Dis. 2012;55(10):1320–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

This article was adapted from the American Journal of Clinical Dermatology 2013;14(2):77–85 [1]. The preparation of these articles was not supported by any external funding.

Author information

Authors and Affiliations

Consortia

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adis Medical Writers. Treat herpes zoster with systemic antivirals and post-herpetic neuralgia with various agents depending on its severity. Drugs Ther Perspect 29, 348–352 (2013). https://doi.org/10.1007/s40267-013-0069-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-013-0069-1

Keywords

Navigation