Shingles
If hypo-immune considerations are involved discuss with medical team before making management decisions.
NOTES:
- Early (< 48 hrs after onset of rash) oral acyclovir will shorten duration of herpes related pain [Bestbets]
- Acyclovir dosage for adults - 800 mg five times a day
- Suggested analgesia Paracetamol/Codeine (500/30mg) plus
- Amitriptyline 10 mg nocte (increasing to 20 mg if required)
- +/- Gabapentin
- Be frank with patients about the risk of Zoster Associated Pain (ZAP)
from the outset
- Risk factors for ZAP (pain > 120 days post rash) include.
- Older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity Ref
Links
- Beth F. Jung. Risk factors for post herpetic neuralgia in patients with herpes zoster. Neurology 2004;62:1545-1551 Link
