Table 1.

 Treatment of acute herpes zoster in immunocompetent adults

Drug	Dose/frequency	Treatment duration	Efficacy	Notes
Aciclovir	800 mg five times daily*	7-10 days	Reduces acute pain and development of PHN	Most effective if started within 72 hours of onset of rash
Famciclovir	750 mg daily* or 250 mg three times daily	7 days	Reduces acute pain and development of PHN	Most effective if started within 72 hours of onset of rash
Valaciclovir	1 g three times daily*	7 days	Reduces acute pain and development of PHN	Most effective if started within 72 hours of onset of rash
Brivudin	125 mg daily	7 days	Reduces acute pain and development of PHN	Licensed for treatment in Austria, Belgium, Germany, Greece, Italy, Luxembourg, and Spain
Prednisolone	60 mg daily initially, then taper dose	21 days	Reduces acute pain	Use only in combination with antivirals. Reduce dose to 30 mg after 7 days and to 15 mg after a further 7 days, then stop
Amitriptyline	25 mg daily	3 months	Reduces incidence of PHN; effect on acute pain uncertain	Use with care in elderly patients. An electrocardiogram should be done before treatment

PHN=postherpetic neuralgia.

*Dose given in British National Formulary.