Herpes zoster medical therapy: Difference between revisions
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[[Aciclovir|Acyclovir]] (an [[antiviral drug]]) inhibits replication of the viral DNA, and is used both as [[prophylaxis]] (''e.g.'', in patients with [[AIDS]]) and as therapy for herpes zoster. Other antivirals are [[valacyclovir]] and [[famciclovir]]. During the [[Acute (medical)|acute phase]], oral acyclovir should be given. Use of acylovir is most effective in moderating the progress of the symptoms, and in preventing post-herpetic neuralgia, if started within 24 to 72 hours of the onset of symptoms, so medical care should be obtained as soon as the condition is recognized. [[Immunocompromised]] patients may respond best to intravenous acyclovir. In patients who are at high risk for recurrences, an oral dose of acyclovir, taken twice daily, is usually effective. It is also reported that the [[amino acid]] [[lysine]] inhibits the replication of herpes zoster.<ref>{{cite journal|last=Griffith|first=RS|coauthors=Walsh DE, Myrmel KH, Thmpson RW, and Behforooz A|title=Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis|journal=Dermatologica|date=1987|volume=175|issue=4|pages=183-190|id=PMID 3115841}}</ref> | [[Aciclovir|Acyclovir]] (an [[antiviral drug]]) inhibits replication of the viral DNA, and is used both as [[prophylaxis]] (''e.g.'', in patients with [[AIDS]]) and as therapy for herpes zoster. Other antivirals are [[valacyclovir]] and [[famciclovir]]. During the [[Acute (medical)|acute phase]], oral acyclovir should be given. Use of acylovir is most effective in moderating the progress of the symptoms, and in preventing post-herpetic neuralgia, if started within 24 to 72 hours of the onset of symptoms, so medical care should be obtained as soon as the condition is recognized. [[Immunocompromised]] patients may respond best to intravenous acyclovir. In patients who are at high risk for recurrences, an oral dose of acyclovir, taken twice daily, is usually effective. It is also reported that the [[amino acid]] [[lysine]] inhibits the replication of herpes zoster.<ref>{{cite journal|last=Griffith|first=RS|coauthors=Walsh DE, Myrmel KH, Thmpson RW, and Behforooz A|title=Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis|journal=Dermatologica|date=1987|volume=175|issue=4|pages=183-190|id=PMID 3115841}}</ref> | ||
===Analgesics=== | ===Analgesics=== | ||
People with mild to moderate pain can be treated with [[Over-the-counter drug|over-the-counter]] [[analgesics]]. Topical lotions containing [[calamine]] can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as [[morphine]]. Once the lesions have crusted over, [[capsaicin]] cream (Zostrix) can be used. Topical [[lidocaine]] and nerve blocks may also reduce pain.<ref name=pmid15061819>{{cite journal| author=Baron R| title=Post-herpetic neuralgia case study: optimizing pain control| journal=Eur. J. Neurol| volume=11 Suppl 1| pages=3–11| year=2004| pmid=15061819| doi=10.1111/j.1471-0552.2004.00794.x}}</ref> Administering [[gabapentin]] along with antivirals may offer relief of postherpetic neuralgia | People with mild to moderate pain can be treated with [[Over-the-counter drug|over-the-counter]] [[analgesics]]. Topical lotions containing [[calamine]] can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as [[morphine]]. Once the lesions have crusted over, [[capsaicin]] cream (Zostrix) can be used. Topical [[lidocaine]] and nerve blocks may also reduce pain.<ref name=pmid15061819>{{cite journal| author=Baron R| title=Post-herpetic neuralgia case study: optimizing pain control| journal=Eur. J. Neurol| volume=11 Suppl 1| pages=3–11| year=2004| pmid=15061819| doi=10.1111/j.1471-0552.2004.00794.x}}</ref> Administering [[gabapentin]] along with antivirals may offer relief of postherpetic neuralgia<ref name="pmid18021865">{{cite journal| author=Tyring SK| title=Management of herpes zoster and postherpetic neuralgia. | journal=J Am Acad Dermatol | year= 2007 | volume= 57 | issue= 6 Suppl | pages= S136-42 | pmid=18021865 | doi=10.1016/j.jaad.2007.09.016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18021865 }} </ref>. | ||
===Other Drugs=== | ===Other Drugs=== | ||
Revision as of 19:51, 2 January 2013
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Herpes zoster Microchapters |
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Herpes zoster medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Several antiviral medicines—acyclovir, valacyclovir, and famciclovir—are available to treat shingles. These medicines will help shorten the length and severity of the illness. But to be effective, they must be started as soon as possible after the rash appears. Thus, people who have or think they might have shingles should call their healthcare provider as soon as possible to discuss treatment options. Analgesics (pain medicine) may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the itching.
Medical Therapy
Currently, there is no cure available for Herpes zoster, nor a treatment to effectively eliminate the virus from the body. However, there are some treatments that can mitigate the length of the disease and alleviate certain side effects.
Antiviral Drugs
Acyclovir (an antiviral drug) inhibits replication of the viral DNA, and is used both as prophylaxis (e.g., in patients with AIDS) and as therapy for herpes zoster. Other antivirals are valacyclovir and famciclovir. During the acute phase, oral acyclovir should be given. Use of acylovir is most effective in moderating the progress of the symptoms, and in preventing post-herpetic neuralgia, if started within 24 to 72 hours of the onset of symptoms, so medical care should be obtained as soon as the condition is recognized. Immunocompromised patients may respond best to intravenous acyclovir. In patients who are at high risk for recurrences, an oral dose of acyclovir, taken twice daily, is usually effective. It is also reported that the amino acid lysine inhibits the replication of herpes zoster.[1]
Analgesics
People with mild to moderate pain can be treated with over-the-counter analgesics. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as morphine. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Topical lidocaine and nerve blocks may also reduce pain.[2] Administering gabapentin along with antivirals may offer relief of postherpetic neuralgia[3].
Other Drugs
Cimetidine, a common component of over-the-counter heartburn medication, has been shown to lessen the severity of herpes zoster outbreaks in several different instances.[4][5][6] This usage is considered an off-label use of the drug. In addition, cimetidine and probenecid have been shown to reduce the renal clearance of aciclovir. [7] The study showed these compounds reduce the rate, but not the extent, at which valaciclovir is converted into aciclovir. Renal clearance of aciclovir was reduced by approximately 24% and 33% respectively. In addition, respective increases in the peak plasma concentration of acyclovir of 8% and 22% were observed. The authors concluded that these effects were "not expected to have clinical consequences regarding the safety of valaciclovir". Due to the tendency of aciclovir to precipitate in renal tubules, combining these drugs should only occur under the supervision of a physician.
Complementary Therapies
Digestive Enzymes are available on prescription and in some over the counter preparations. Before the availability of antivirals, oral pancreatic enzyme therapy in shingles was used in some countries and later subjected to clinical and scientific research. A large scale multi-centre clinical study, using an oral preparation of such enzymes, has shown promising results.[8] [9] The results of another clinical study support the concept that oral enzyme therapy is beneficial in diseases characterized in part by TGF-beta overproduction that included shingles patients. [10] TGF-β has also been found to be elevated in instances of VZV infection. [11] [12]
References
- ↑ Griffith, RS (1987). "Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis". Dermatologica. 175 (4): 183–190. PMID 3115841. Unknown parameter
|coauthors=ignored (help) - ↑ Baron R (2004). "Post-herpetic neuralgia case study: optimizing pain control". Eur. J. Neurol. 11 Suppl 1: 3–11. doi:10.1111/j.1471-0552.2004.00794.x. PMID 15061819.
- ↑ Tyring SK (2007). "Management of herpes zoster and postherpetic neuralgia". J Am Acad Dermatol. 57 (6 Suppl): S136–42. doi:10.1016/j.jaad.2007.09.016. PMID 18021865.
- ↑ Kapinska-Mrowiecka M, &Toruwski G (1996.). "Efficacy of cimetidine in treatment of herpes zoster in the first 5 days from the moment of disease manifestation". Pol Tyg Lek. 51 (23–26): 338–339. PMID 9273526. Check date values in:
|year=(help) - ↑ Hayne ST, & Mercer JB (1983). "Herpes zoster: treatment with cemetidine". Canadian Medical Association Journal. 129 (12): 1284–1285. PMID 6652595.
- ↑ Notmann J, Arieli J, Hart J, Levinsky H, Halbrecht I, & Sendovsky U (1994). "In vitro cell-mediated immune reactions in herpes zoster patients treated with cimetidine". Asian Pacific Journal Allergy and Immunology. 12 (1): 51–58. PMID 7872992.
- ↑ De Bony F, Tod M, Bidault R, On NT, Posner J, & Rolan P (2002). "Multiple interactions of cimetidine and probenecid with valaciclovir and its metabolite acyclovir". Antimicrobial Agents and Chemotherapy. 46 (2): 458–463. PMID 11796358.
- ↑ Billigmann P (1995). "[Enzyme therapy--an alternative in treatment of herpes zoster. A controlled study of 192 patients]". Fortschr. Med. (in German). 113 (4): 43–8. PMID 7713467.
- ↑ Roxas M (2006). "Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations". Alternative medicine review : a journal of clinical therapeutic. 11 (2): 102–13. PMID 16813460.
- ↑ Desser L, Holomanova D, Zavadova E, Pavelka K, Mohr T, Herbacek I (2001). "Oral therapy with proteolytic enzymes decreases excessive TGF-beta levels in human blood". Cancer Chemother. Pharmacol. 47 Suppl: S10–5. PMID 11561866.
- ↑ Kaygusuz I, Gödekmerdan A, Keleş E; et al. (2004). "The role of viruses in idiopathic peripheral facial palsy and cellular immune response". American journal of otolaryngology. 25 (6): 401–6. PMID 15547808.
- ↑ Sato M, Abe T, Tamai M (2000). "Expression of the Varicella Zoster Virus Thymidine Kinase and Cytokines in Patients with Acute Retinal Necrosis Syndrome". 44 (6): 693. PMID 11094200.