Table 1.
Pharmacologic therapies used in the treatment of Herpes Zoster and Postherpetic neuralgia
| Antiviral agents | HZ | PHN | Recommended dose |
|---|---|---|---|
|
| |||
| Acyclovir (oral) | + | − | 800 mg 5 times daily for 7–10 days. |
|
| |||
| Famiciclovir (oral) | + | − | 500 mg every 8 hours for 7 days. |
|
| |||
| Valacyclovir (oral) | + | − | 1 gm every 8 hours for 7 days. |
|
| |||
| Brivudine (oral) | + | − | 125 mg once daily for 7 days. |
| Product licensed in various countries; not currently available in the United States | |||
|
| |||
| Acyclovir (IV) | + | − | 10 to 15 mg/kg every 8 hours until clinical improvement; switch to oral regimen to complete a 10 to 14 day course when formation of new lesions has ceased and signs/ symptoms of visceral infection areimproving. |
|
| |||
| Foscarnet (IV) | + | − | 40 mg/kg every 8 hours for 7–10 days.24 |
| Not approved for this indication by the FDA | |||
|
| |||
| Cidofovir (IV) | + | − | 5 mg/kg every week for 2 weeks, followed by or 5mg/kg every other week.76 |
| To be used if patient fails or relapses aftertherapy with foscarnet. Not approved for this indication by the FDA | |||
|
| |||
| Anti-inflammatory agents | |||
|
| |||
| Prednisone (PO) | + | − | 60 mg daily for 7 days, followed by 30 mgdaily for 7 days, then 15 mg daily for 7 days. |
|
| |||
| Intrathecal methylprednisone | - | ± | Reserved for intractable PHN due to risk profile. Not currently available in the United States. |
|
| |||
| Analgesic agents | |||
|
| |||
| Acetaminophen | + | − | Used for mild pain |
|
| |||
| NSAIDS | + | − | Used for mild pain |
|
| |||
| Oxycodone | 1st line | 3rd line | 5 mg every 4 hours as needed, carefully titrate upwards by 5 mg 4 times daily every 2 days for pain control. Dosage needs to be converted to a long-acting opioid analgesic and combined with a short acting medicationfor breakthrough pain. |
|
| |||
| Tramadol | ± | 3rd line | 50 mg once or twice daily, increase by 50–100 mg daily in divided doses every 2 days as tolerated. Maximum dose of 400 mg daily or 300 mg daily if older than 75 years. |
|
| |||
| Gabapentin | 2nd line | 2nd line | 300 mg at bedtime or 100–300 mg 3 times daily, increase by 100–300 mg 3 times daily every 2 days as tolerated. Maximum dose of 3,600 mg daily. |
|
| |||
| Pregabalin | 2nd line | 2nd line | 75 mg at bedtime or 75 mg twice daily, increase by 75 mg twice daily every 3 days astolerated. Maximum dose is 600 mg daily. |
|
| |||
| Nortryptyline | 3rd line | 2nd line | 25 mg at bedtime, increase by 25 mg daily every 2–3 days as tolerated. Maximum dose 150 mg daily. |
| * TCAs have similar efficacy to gabapentin orpregabalin, but cause more serious adverse events.31 | |||
|
| |||
| Venlafaxine | ± | ± | 37.5 mg daily, titrate upwards by 75 mg each week over a 4–6 week period. Maximum dose of 225 mg/day |
| * Used if unable to tolerate TCA side effect profile, however not as well studied as TCAs. Not approved for this indication by the FDA54 | |||
|
| |||
| Duloxetine | ± | ± | 20 mg at bedtime, increase dose by 20 mg every 5 days. Maximum dose 60 mg daily |
| * Used if unable to tolerate TCA side effect profile, however not as well studied as TCAs. Not approved for this indication by the FDA54 | |||
|
| |||
| Topical analgesic agents | |||
|
| |||
| Lidocaine 5% patch | ± | 1st line | One patch can be applied to the location ofpain. Up to 3 patches can be used at the same time for a maximum of 12 hours. |
|
| |||
| Capsaicin 0.075% cream | − | ± | Apply 4 times per day |
|
| |||
| Capsaicin 8% patch | − | ± | Application time of 30–90 minutes. |
+
Definitely can be used for this indication.
±
May be used for this indication if no other alternative is present, minimal supportive data present.
−
Avoid using for this indication, no supportive data present.