Famciclovir for the Treatment of Acute Herpes Zoster: Effects on Acute Disease and Postherpetic Neuralgia: A Randomized, Double-Blind, Placebo-Controlled Trial

  title={Famciclovir for the Treatment of Acute Herpes Zoster: Effects on Acute Disease and Postherpetic Neuralgia: A Randomized, Double-Blind, Placebo-Controlled Trial},
  author={Stephen K. Tyring and Rick Barbarash and James Nahlik and Anthony Cunningham and John Marley and Madalene Heng and Terry M. Jones and T L Rea and Ron J Boon and Robin L. Saltzman},
  journal={Annals of Internal Medicine},
Herpes zoster (shingles) develops in as many as 20% of all persons [1]. The characteristic zoster rash is often accompanied by substantial pain, dysesthesias, and skin hypersensitivity. The unmet challenge in the management of patients with acute zoster is the alleviation of chronic pain. In many patients, pain resolves once the affected area of skin returns to normal. However, some patients continue to experience pain long after the lesions have healed; this pain is commonly called… 

Tolerability of Treatments for Postherpetic Neuralgia

Treatment of established PHN is difficult and may require a holistic approach, although tricyclic antidepressants and gabapentin are the systemic agents with the most proven benefit, although opioids such as oxycodone and NMDA receptor antagonists such as ketamine may be useful in some people.

Acyclovir with and without Prednisone for the Treatment of Herpes Zoster

A clinical trial to determine the effect of adding corticosteroids to acyclovir for the treatment of herpes zoster and key study end points were measurements of pain and quality of life.

Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations.

  • M. Roxas
  • Medicine
    Alternative medicine review : a journal of clinical therapeutic
  • 2006
The most effective conventional treatment options currently available are presented, as well as select botanical, nutritional, and other considerations that may be beneficial in the management of this condition.

Management of herpes zoster and postherpetic neuralgia.

  • S. Tyring
  • Medicine
    Journal of the American Academy of Dermatology
  • 2007

The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis.

Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults.

Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients.

The results indicated that greater age, rash severity, and acute pain severity are risk factors for prolonged PHN and demonstrated that treatment of acute herpes zoster patients with famciclovir significantly reduces both the duration and prevalence of PHN.

The management of post-herpetic neuralgia

This total duration of pain and pain at a single time point (3 months after onset) is suggested to be used as endpoints in clinical studies.

Current and Future Management of Herpes Zoster

Preventive antiviral therapy early in the course of herpes zoster is recommended for all elderly patients since they have a high risk of developing severe postherpetic neuralgia (PHN).



Effect of oral acyclovir on pain resolution in herpes zoster: A reanalysis

It is found that the median duration of pain in acyclovir recipients was 20 days vs. 62 days for their placebo counterparts and the absence of pain at the onset of cutaneous herpes zoster did not preclude its later development.

Acute herpetic and postherpetic neuralgia: Clinical review and current management

This review summarizes current information on the epidemiology, clinical features, and pathology of herpes zoster and postherpetic neuralgia, and critically examines the accumulated experience with the various treatments.

Oral acyclovir in the treatment of herpes zoster in general practice.

Acyclovir reduced the extent and duration of the rash, the spread of the Rash to adjacent dermatomes and the incidence of disseminated lesions, and it shortened the period of new lesion formation and reduced the occurrence of ulceration in acute herpes zoster and postherpetic neuralgia.

Oral acyclovir in the treatment of acute herpes zoster ophthalmicus.

Human Infection with Herpes Zoster: Etiology, Pathophysiology, Diagnosis, Clinical Course, and Treatment

Clinical features of herpes zoster may follow a progression through 3 stages, prodromal, acute, and chronic, and acyclovir is considered the drug of choice by most clinicians.

The outcome of patients with herpes zoster.

There is a continuous stream of publications, in the medical literature, devoted to the study of the results obtained in the treatment of herpes zoster, and no single method of treatment has produced more than temporary enthusiasm.

Postherpetic neuralgia. A review.

It is reasonable to hope for a reduction in pain from severe to mild in two of three cases, and there is evidence to support the use of low doses of tricyclic antidepressants, especially amitriptyline hydrochloride, with gradual small increments, and also theUse of phenothiazines.

Herpes zoster and postherpetic neuralgia

Efficacy of oral acyclovir treatment of acute herpes zoster.

No significant hastening of rash healing was seen in those who started therapy later than 48 hours after the onset of rash, and acyclovir produced no effects on the frequency or severity of post-herpetic neuralgia.