Antiviral drugs used on shingles

DEAR DOCTOR K: I’ve been diagnosed with shingles. What can I take for the pain?

DEAR READER: Shingles, also known as herpes zoster or just zoster, is caused by the varicella-zoster virus. It is the same virus that causes chickenpox. Once you have had chickenpox, the varicella-zoster virus remains in your body’s nerve tissues. It is inactive, but it can be reactivated later in life. This causes shingles.

When the virus reactivates, it causes a burning or tingling sensation in the affected areas. A few days later, the virus causes a blistery rash. (I’ve put an illustration of this process on my website, AskDoctorK.com.)

If you’re older than age 50 and have had shingles pain for less than three days, the current recommendations call for doctors to prescribe antiviral medicine to kill the virus that causes shingles. (If you are younger than 50 and very uncomfortable from shingles that began in the last three days, your doctor may still prescribe antiviral therapy.)

The two medicines recommended most often are famciclovir (Famvir) and valacyclovir (Valtrex). These antiviral medications not only help shorten the days of pain that you have, they also help reduce the risk of long-lasting shingles pain, or post-herpetic neuralgia.

If the antiviral medicine does not provide enough relief, you can take additional pain medicines. Start with nonsteroidal anti-inflammatory drugs and acetaminophen. If necessary, your doctor will prescribe more potent pain medicines; these include codeine, tramadol and (when the pain is very severe) oxycodone.

You should also gently rinse your skin rash and blisters once or twice daily with cool water. Your doctor may suggest that you use antibiotic ointment on open areas.

If post-herpetic neuralgia presents severe pain, then oxycodone, morphine and methadone may be helpful.

A shingles vaccine is recommended for most adults age 60 and older. Even though treatment is effective, nothing beats preventing the condition in the first place.