Herpes Zoster Medication

  • Author: Joseph S Eastern, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 11, 2011
 

Medication Summary

The advent of oral antiviral agents has made the treatment of zoster possible, when effectively, none existed before. Acyclovir and its derivatives (famciclovir, penciclovir, valacyclovir) have been shown to be safe and effective in the treatment of active disease and the prevention of PHN. Usually, the earlier these medications are started, the more effective they are in shortening the duration of zoster and in preventing or decreasing the severity of PHN. Ideally, initiate therapy within 72 hours of onset of symptoms.

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Antivirals

Class Summary

Direct antiviral effect on varicella virus. Nucleoside analogs initially are phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50 times the potency of human alpha-DNA polymerase.

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Acyclovir (Zovirax)

 

Prototype antiviral agent and synthetic purine nucleoside analog with in vitro and in vivo inhibitory activity against human herpes viruses including herpes simplex type 1 (HSV-1), herpes simplex type 2 (HSV-2), VZV, Epstein-Barr virus (EBV), and cytomegalovirus (CMV). In cell cultures, acyclovir has the highest antiviral activity against HSV-1, followed in decreasing order of potency against HSV-2, VZV, EBV, and CMV.

Intravenous acyclovir is indicated for treatment of zoster infections in patients who are immunocompromised.

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Famciclovir (Famvir)

 

Prodrug that when biotransformed into active metabolite, penciclovir, may inhibit viral DNA synthesis/replication. Synthetic acyclic guanine derivative that has demonstrated activity against HSV-1, HSV-2, and VZV.

Initiate therapy promptly as soon as herpes zoster is diagnosed. No data are available on efficacy of treatment started 72 h after rash onset.

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Valacyclovir (Valtrex)

 

L-valyl ester of acyclovir. Rapidly converted to acyclovir, which has demonstrated antiviral activity against HSV-1, HSV-2, VZV, and other viruses.

Initiate therapy at earliest sign or symptom of herpes zoster; therapy is most effective when started within 48 h of onset of zoster rash. No data are available on efficacy of treatment started 72 h after rash onset.

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Vaccines

Class Summary

Elicit active immunization to increase resistance to infection. Vaccines consist of attenuated microorganisms or cellular components, which act as antigens. Administration stimulates antibody production with specific protective properties.

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Varicella zoster vaccine (Zostavax)

 

This is a lyophilized preparation of the Oka/Merck strain of live, attenuated VZV. It has been shown to boost immunity against herpes zoster virus (shingles) in older patients. It reduces the occurrence of shingles in individuals older than 60 years by about 50%. For individuals aged 60-69 years, it reduces the occurrence by 64%. In the ZEST trial, the vaccine significantly reduced the risk by 70% in subjects aged 50-59 years. It also slightly reduces pain compared with no vaccination in those who develop shingles. It is indicated for the prevention of herpes zoster.

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Contributor Information and Disclosures
Author

Joseph S Eastern, MD  Clinical Assistant Professor, Department of Internal Medicine, Section of Dermatology, University of Medicine and Dentistry of New Jersey

Joseph S Eastern, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, International Society for Dermatologic Surgery, and Medical Society of New Jersey

Disclosure: Abbott Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; Aqua Honoraria Consulting; Stiefel Honoraria Speaking and teaching; Medicis Honoraria Speaking and teaching; Quinnova Honoraria Consulting; Graceway Speaking and teaching; Abbott Grant/research funds Clinical Research; Amgen Grant/research funds Clinical Research

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Typical zoster in the vicinity of right popliteal fossa in a vertebral nerve L4 distribution.
Suspected zoster of the hand.
 
 
 
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