Oral antiviral therapy for shingles (herpes zoster)

If oral antiviral therapy is indicated for shingles, useSchmader, 2018:

1valaciclovir 1 g (child 2 years or older: 20 mg/kg up to 1 g) orally, 8-hourly for 7 days12. For dosage adjustment in adults with kidney impairment, see valaciclovir dosage adjustment valaciclovir valaciclovir valaciclovir

OR

1famciclovir 500 mg orally, 8-hourly for 7 days. For patients with immune compromise, the duration of therapy is 10 days34. For dosage adjustment in adults with kidney impairment, see famciclovir dosage adjustment famciclovir famciclovir famciclovir

OR

2aciclovir 800 mg (child: 20 mg/kg up to 800 mg) orally, 5 times daily for 7 days5. For dosage adjustment in adults with kidney impairment, see aciclovir oral dosage adjustment. aciclovir aciclovir aciclovir

There is evidence that famciclovir and valaciclovir are more effective than oral aciclovir in reducing acute pain in patients with shinglesMcDonald, 2012.

Limited data suggest that valaciclovir (a prodrug of aciclovir) is safe in pregnancy, and some prescribers prefer it because it has a more convenient (8-hourly) dosing regimen. There are insufficient data to support use of famciclovir in pregnancyAustralian Society for Infectious Diseases (ASID), 2022.

1 An oral liquid formulation of valaciclovir is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplusReturn
2 Valaciclovir is not licensed in Australia for use in children younger than 12 years; however, it is licensed internationally for use in children older than 2 years.Return
3 At the time of writing, the quantity of famciclovir required for a course of treatment for patients who do not have immune compromise is not available on the Pharmaceutical Benefits Scheme (PBS). See the PBS website for current information.Return
4 Famciclovir is not used in children.Return
5 Aciclovir dosing in obesity is poorly defined; however, limited data support dosing based on ideal body weight in children.Return