Bell Palsy Medication

Updated: May 04, 2021
  • Author: Danette C Taylor, DO, MS, FACN; Chief Editor: Selim R Benbadis, MD  more...
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Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Agents used in cases of Bell palsy include corticosteroids and antiviral agents. Early treatment with corticosteroids is the most widely accepted treatment, but it remains controversial because most patients recover without treatment. The literature offers less support for the use of antiviral agents in either monotherapy or combination therapy, although treatment with combinations of corticosteroids and antiviral agents is somewhat better supported.



Class Summary

Prednisone can be used in the treatment of Bell palsy but has many adverse effects, including the following:

- Fluid retention

- Hypokalemia

- Myopathy

- Peptic ulcer

- Headache (pseudotumor)

- Menstrual irregularities

- Cataracts

- Glaucoma

- Manifestation of latent diabetes mellitus

In addition, signs of infection may be masked in patients taking prednisone. Physicians should use caution when using prednisone in patients with the aforementioned conditions.

Prednisone (Deltasone, Orasone, Sterapred)

Prednisone, the standard drug used in Bell palsy, is a glucocorticoid that is absorbed readily from the gastrointestinal tract. It has anti-inflammatory and immune-modulating effects, as well as profound and varied metabolic effects. For best outcome, prednisone treatment should be initiated within 72 hours of symptom onset.



Class Summary

Acyclovir and valacyclovir have been administered in the treatment of Bell palsy in combination with prednisone or have been used alone in patients who cannot take prednisone. The use of antivirals has proved most beneficial in patients with severe to complete facial palsy. [58]

Acyclovir (Zovirax)

Acyclovir is a prodrug activated by phosphorylation, by way of virus-specific thymidine kinase (TK), that inhibits viral replication. Herpes virus TK, but not host cell TK, uses acyclovir as a purine nucleoside, converting it into acyclovir monophosphate, a nucleotide analogue. Guanylate kinase converts the monophosphate form into diphosphate and triphosphate analogues that inhibit viral DNA replication.

Acyclovir has an affinity for viral TK and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase.

The drug inhibits the activity of HSV-1 and HSV-2. Patients experience less pain and faster resolution of cutaneous lesions when acyclovir is used within 48 hours after rash onset. Acyclovir may also prevent recurrent outbreaks. Early initiation of therapy is imperative.

Valacyclovir (Valtrex)

Valacyclovir is a prodrug that is rapidly converted to acyclovir. It is more expensive than acyclovir, but it has a more convenient dosing regimen.