Table 4.

Medications commonly used for treatment of acute pain associated with herpes zoster^*

Medication	Dose	Titration	Maximum Dose	Side Effects
Analgesics-opioid and non-opioid
Oxycodone	5 mg every 4 hrs as needed	Increase by 5 mg 4 times daily every 2 days as tolerated	None specified, but do not exceed 120 mg daily without pain specialist	Drowsiness, dizziness, constipation, nausea, vomiting
Tramadol	50 mg once or twice daily	Increase by 50–100 mg daily in divided doses every 2 days as tolerated	400 mg daily; 300 mg dailyif >75 years old	Drowsiness, dizziness, constipation, nausea, vomiting
Corticosteroids^
Prednisone	60 mg daily for 7 days, then decrease to 30 mg daily for 7 days, then decrease to 15 mg daily for 7 days	None	60 mg	Gastrointestinal distress, nausea, vomiting, mood changes, edema, glucose intolerance, increased blood pressure
Anticonvulsants
Gabapentin	300 mg at bedtime or 100–300 mg 3 times daily	Increase by 100–300 mg 3 times daily every 2 days as tolerated	3600 mg daily	Drowsiness, dizziness, ataxia, peripheral edema
Pregabalin	75 mg at bedtime or 75 mg twice daily	Increase by 75 mg twice daily every 3 days as tolerated	600 mg daily	Drowsiness, dizziness, ataxia, peripheral edema
Tricyclic antidepressants
Nortriptyline	25 mg at bedtime	Increase by 25 mg daily every 2–3 days as tolerated	150 mg daily	Drowsiness, dry mouth, blurred vision, weight gain, urinary retention
Topical therapy
Lidocaine 5% patch	One patch topically for up to 12 hours to intact skin only	None	One patch for up to 12 hours within a 24-hour period	Local irritation; if systemic absorption can cause drowsiness, dizziness

^*Modified from Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44 Suppl 1:S1–26, by permission of Oxford University Press.

This list provides examples and is not meant to be comprehensive

^{^}The use of corticosteroids is controversial as they are often poorly tolerated in older patients.