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Shingles - Management
Which antiviral drug should I prescribe?

  • If the person is severely immunocompromised or pregnant, seek specialist advice regarding choice of antiviral drug, dose, and duration of treatment.
  • For immunocompetent adults, if antiviral treatment is appropriate (see When to prescribe an antiviral drug), prescribe oral aciclovir, valaciclovir, or famciclovir:
    • Aciclovir: 800 mg five times a day for 7 days.
    • Valaciclovir: 1000 mg three times a day for 7 days.
    • Famciclovir: 250 mg three times a day for 7 days, or 750 mg once a day for 7 days.
  • For immunocompromised adults, if they are not systemically unwell and the rash is localised, prescribe oral aciclovir, valaciclovir, or famciclovir at full dose, and continue treatment until all the skin lesions have healed, which can be more than 10 days.
  • The decision on which antiviral drug to use should involve clinical judgement, taking into account cost and compliance issues for each individual.
    • Aciclovir is much cheaper than the other antivirals, but must be taken five times a day.
    • If compliance is likely to be a problem, consider valaciclovir or famciclovir.
  • Topical antivirals are not recommended.
  • For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk), or the British National Formulary (BNF) (www.bnf.org).

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