Antiviral treatment for acute shingles
What is the antiviral regimen used to treat acute shingles?
Individuals with normal renal function can receive any of the following:
- Acyclovir 800 mg orally five times a day or IV 10 mg/kg every 8 hours for 7 to 10 days
- Famciclovir 500 mg three times daily for 7 days
- Valacyclovir 1 g three times daily for 7 days
If early intervention with the above treatment was given, but the patient still crossed over into postherpetic neuralgia, what are the treatment options for such a patient?
The interventional pain management community argues that either sympathetic blockade or epidural blockage with anesthetic and steroids during the acute phase of the disease lessens the likelihood of getting postherpetic neuralgia.
They extend this approach into the early phase of postherpetic neuralgia. Other interventions, later in the course of the disease, such as epidural spinal stimulation, receive mixed reviews.
Pharmacologic measures such as topical lidocaine, IV lidocaine infusions during acute crises, and various formulations of gabapentin (topical compounding, or oral gabapentin, Gralise ® or Horizant ® ) are often employed in this form of neuropathic pain.
Regardless, in many instances successful treatment of postherpetic neuralgia is a daunting challenge.