Prescription for shingles
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Prescription for Shingles: Effective Antiviral Therapies
Valaciclovir for Shingles Treatment
Valaciclovir is a commonly prescribed antiviral medication for the management of shingles (herpes zoster). The recommended dosage for treating shingles is 1 gram three times daily for 7 days. This regimen has been shown to be effective in managing the symptoms and reducing the duration of the condition1. In a case where a patient was initially prescribed a lower dose, the prescription was corrected to the recommended dosage upon consultation with the prescriber1.
Alternative Antiviral Medications
Acyclovir
Acyclovir is another antiviral agent frequently used in the treatment of shingles. It is effective in inhibiting varicella-zoster virus (VZV) replication and alleviating zoster-associated pain. However, due to its moderate bioavailability, it requires five oral doses per day4. For patients over 50, topical idoxuridine or intravenous acyclovir is recommended to reduce the risk of post-herpetic neuralgia, while younger patients may require high-dose intravenous acyclovir only for complications or if they are immunosuppressed5.
Famciclovir and Valaciclovir
Famciclovir and valaciclovir are oral prodrugs of penciclovir and acyclovir, respectively. These medications have been developed to improve oral bioavailability and are effective in treating shingles. They offer a more convenient dosing schedule compared to acyclovir, making them preferable options for many patients4.
Experimental Antiviral Agents
Research is ongoing to develop new antiviral agents with improved efficacy and bioavailability. Experimental drugs such as sorivudine, brovavir, H2G, HPMPC, mappicine ketone, and A-73209 are being investigated for their potential in treating VZV infections, including shingles4.
Case Study: Comprehensive Shingles Management
A case study of a 75-year-old female with shingles affecting the vaginal, vulva, anal, and buttock areas highlights a comprehensive treatment approach. The prescribed therapy included Zovirax (acyclovir) 800 mg five times daily for 7 days, along with additional medications to manage symptoms and prevent secondary infections2. This case underscores the importance of a multifaceted treatment plan in managing severe shingles cases.
Impact of Vaccination Programs
The introduction of the Australian National Shingles Vaccination Program, which provides free herpes zoster vaccination for eligible adults aged 70 years and a catch-up program for those aged 71-79 years, has significantly impacted shingles management. The program has led to a substantial decline in herpes zoster antiviral prescription rates, indicating a decrease in the incidence of shingles among vaccinated individuals3. This highlights the effectiveness of vaccination in preventing shingles and reducing the need for antiviral medications.
Conclusion
Effective management of shingles primarily involves antiviral therapy, with valaciclovir, acyclovir, and famciclovir being the most commonly used medications. The appropriate dosing and timely administration of these antivirals are crucial in alleviating symptoms and preventing complications. Additionally, vaccination programs have proven to be highly effective in reducing the incidence of shingles, thereby decreasing the reliance on antiviral prescriptions. Ongoing research into new antiviral agents holds promise for even more effective treatments in the future.
Sources and full results
Most relevant research papers on this topic
What are clinical interventions
The prescriber adjusts the prescription to 1 g three times daily for 7 days, and you dispense the new prescription to Mr G.
Case ReportShingles Case Study
On 17/1/93, a 75 year old female presented with shingles of the vaginal, vulva, anal and buttock area. The therapy prescribed consisted of a) Zovirax 800m9 Sx/day for 7 days b) Noroxin 400 mg bd for 3 days c) Urispas 2tds for 3 days d) Citro Soda 20ml QID
Case ReportEarly impact of the Australian national shingles vaccination program with the herpes zoster live attenuated vaccine
The Australian National Shingles Vaccination Program has successfully vaccinated a significant proportion of adults aged 70-79 against herpes zoster, suggesting decreased incidence of herpes zoster.
Observational StudySection Review: Anti-infectives: Current therapies for shingles
Current shingles treatment relies on oral antiviral therapy, with acyclovir being effective and new agents like sorivudine and brovavir showing potential.
Shingles in general practice.
Topical idoxuridine or intravenous acyclovir is recommended for patients over 50 with shingles to reduce post-herpetic neuralgia.
996. The Potential for Reducing Opioid and Analgesic Prescriptions Via Herpes Zoster Vaccination
Herpes zoster vaccination could potentially reduce opioid and analgesic prescription exposure, as it is associated with high levels of opioid, benzodiazepine, and other analgesic use.
Rigorous JournalDo herpes zoster patients receive antivirals? A Dutch National Survey in General Practice.
Antiviral treatment for herpes zoster is more likely to be prescribed when patients are older, have ophthalmic shingles, have asthma/COPD, or adhere to professional guidelines.
Observational StudyNotes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020
Gabapentin-related overdose deaths in 23 states and the District of Columbia increased by 5% from 2018 to 2019, with a higher incidence in unintentional or undetermined cases compared to the previous year.
Shingles Occurs in Only 0.5% of Myeloma Patients on Any Dose of Antiviral Prophylaxis
A less than 1% failure rate can be achieved using acyclovir 400 mg twice daily in patients with normal renal function, and patients with shingles have a significantly lower ALC/AMC ratio than those without shingles.
Observational StudyTransforaminal vs Interlaminar Epidural Steroid Injection for Acute-Phase Shingles: A Randomized, Prospective Trial.
Both interlaminar and transforaminal epidural steroid injections improve pain relief in acute-phase shingles patients, with no significant difference in analgesic effects at 1 and 3 months.
RCT