Shingles medication: what works, when to start

Shingles (herpes zoster) needs quick action. Start antiviral treatment within 72 hours of the rash when possible — that’s the window where medicine cuts the worst of the pain and lowers the chance of long-term nerve damage. Common oral antivirals are acyclovir, valacyclovir, and famciclovir. Typical adult doses: acyclovir 800 mg five times daily, valacyclovir 1 g three times daily, or famciclovir 500 mg three times daily for about 7 days. If you’re very sick or immunocompromised, IV acyclovir may be needed in the hospital.

Antiviral treatment: what to expect and precautions

Antivirals shorten the virus’s activity and help the rash heal faster. Side effects are usually mild — nausea, headache, or dizziness — but your kidneys matter. If you have reduced kidney function your doctor will cut doses down. Don’t use oral antivirals as a substitute for medical care if the rash hits the eye, face, or you have high fever or a weakened immune system; eye involvement needs urgent specialist care to avoid vision loss.

Managing pain now and later

Pain control starts with over-the-counter options: acetaminophen (up to 3,000–4,000 mg/day depending on guidance) or ibuprofen 400–600 mg every 4–6 hours as needed. For stronger pain, short courses of opioids may be prescribed. For nerve pain, doctors often use gabapentin (start 300 mg at night, then titrate) or pregabalin (75 mg twice daily), which target the nerve signals causing burning or shooting pain. Tricyclic antidepressants like amitriptyline (low dose at night) are another option, but watch for dry mouth, dizziness, and other side effects in older adults.

Topical choices help too: 5% lidocaine patches give localized relief, and capsaicin cream or an 8% capsaicin patch can reduce nerve pain over weeks. These are useful for people with lingering postherpetic neuralgia (PHN), the long-term pain that sometimes follows shingles.

If pain stays severe beyond the acute phase, talk to your doctor about nerve blocks or referral to a pain specialist. Early treatment lowers the chance of PHN, but if nerve pain develops, a mix of oral meds, topical treatments, and sometimes procedures gives the best chance of relief.

Vaccine matters: the Shingrix vaccine (two doses, 2–6 months apart) cuts the risk of shingles and PHN dramatically. It’s recommended for adults 50 and older and for some younger people with weakened immunity. Don’t get the vaccine while you have active shingles; wait until you’ve recovered.

When to call your doctor? If the rash involves your eye, if you have high fever, spreading rash without blisters, or you’re immunocompromised — seek care fast. Also call if medications cause worrying side effects like severe dizziness, confusion, or signs of kidney trouble (reduced urine, swelling). Proper meds, started early and adjusted for your health, make the biggest difference in recovery.