Shingles Treatment and Prevention: Medication and Vaccination

“People with shingles almost always have a rash around [either] the left or right side of the body,” though both sides may be affected in immunocompromised people, says Dushyantha T. Jayaweera, MD, an infectious disease specialist and professor at the University of Miami’s Miller Medical School in Miami, Florida. “[It] is usually painful, itchy, or tingly.”

But shingles and its potential complications are almost always avoidable. “Do not wait for [an infection] to happen,” says Jayaweera. “This is almost always preventable [if you] vaccinate early.”

• acyclovir
• famciclovir
• valacyclovir (Valtrex)

“This is an emergency, because if it progresses, it can involve the eye itself and threaten sight,” says Andrew Tout, MD, an internal medicine specialist at Northwestern Medicine in Chicago.

“Treatment is initially with high-dose [oral] antiviral medication that is reduced slowly over the course of weeks to months under the close supervision of an ophthalmologist. Anti-inflammatory eye drops may also be used.”

Treating herpes zoster ophthalmicus promptly — within 72 hours — can reduce the chances of eye-related complications by about 50 percent compared with no treatment, Dr. Tout says, but there’s still a small chance of significant vision loss.

Before taking any medication for shingles, be sure to talk to your doctor about possible side effects.

“Shingles can be very, very painful,” says Tout. “The pain is related to inflammation of the nerves and is often described as burning, throbbing, stabbing, or an electric-shock sensation.”

• Acetaminophen (Tylenol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
• Capsaicin topical patch (Qutenza)
• Anticonvulsant drugs such as gabapentin (Neurontin, Gralise) and pregabalin (Lyrica)
• Tricyclic antidepressants such as amitriptyline and nortriptyline (Pamelor)
• Numbing medications such as lidocaine
• Opioids such as tramadol, oxycodone, or morphine
• An injection of corticosteroids and local anesthetic
• Oral corticosteroids

“[W]hile [pain medications] can be somewhat helpful, they often have drawbacks, especially in older adults or individuals with certain health conditions like diabetes,” Tout says. “Starting antiviral medication promptly has been shown to reduce the severity and duration of time with shingles-related pain, but it doesn't make the pain medications themselves work better.”

“Like the pain-relieving treatments for shingles itself, the medications we use for treating postherpetic neuralgia are less effective than we would like and can often come with side effects,” Tout says.

“It is expected [you’ll] need less and less pain medications over time, and most people experience resolution by three months. However some [people], most commonly older individuals, can experience pain for up to two years or even longer.”

• Shingles (herpes zoster), a viral infection that causes a painful rash, can be prevented by getting vaccinated, or treated within 72 hours with antivirals and other medications, to prevent complications.
• In addition to antivirals, shingles symptoms like pain are treated using over-the-counter or prescription pain medications, antidepressant and anticonvulsant drugs that alter pain signaling or responses, corticosteroids (steroids), and antibiotics, if needed.
• Most of the same medications are used to treat complications of shingles, such as eye involvement and lingering nerve pain.

Additional reporting by Carlene Bauer and Laura Casey.