Worried you have shingles and looking for a shingles treatment? You’re not alone. According to the CDC, almost one out of every three people in the US will develop shingles in their lifetime, so many people experience the miserable shingles pain.
If you do have shingles pain and the shingles rash, what are the most common shingles treatments and how do they work? I’ll walk you through the 11 most common shingles treatments and discuss how they’ll help you.
First of all, if you think you have shingles, I urge you to see your doctor: they can determine what’s causing your symptoms and advise appropriate treatment. Shingles is the reactivation of the chickenpox virus, meaning you can only get shingles if you’ve contracted chickenpox before. If you’ve never had chickenpox, then you definitely don’t have shingles. If you’ve had chickenpox, then you might have shingles. In this article, I’ll discuss the normal course of untreated shingles. If your symptoms align with this course, then you likely have shingles.
By reading this article, you’ll be better prepared for your doctor’s appointment. If you’ve already been diagnosed with shingles, you’ll be able to review what your doctor told you and get some additional shingles pain relief tips.
Table of Contents
- Normal Course of Untreated Shingles: Shingles Pain and Shingles Rash
- Possible Complications: Abnormal Course of Shingles
- Major Shingles Treatment Types
- Antiviral Shingles Medications
- Which Is the Best Antiviral Shingles Medication?
- Shingles Pain Medications
- Home Remedies for Shingles
Normal Course of Untreated Shingles: Shingles Pain and Rash
First off, shingles will run the course outlined below whether or not you seek treatment. There is currently no cure for shingles.
According to the CDC, the current shingles medications only help to shorten the time period and severity of the illness. However, you should absolutely seek treatment. Treatment is essential to limit your shingles pain and also to decrease the risk for complications (which I’ll discuss in more depth below).
In order to understand how the treatment works and to know when to seek shingles treatment, you need to know how shingles normally progresses. How does shingles progress?
Day 1-5: Shingles Pain
The first symptom people with shingles experience is typically pain. The severity of this shingles pain varies—while some experience just a tingling or tickling, others experience very severe, sharp burning or numbness. This shingles pain is usually felt around the heart, lungs, or kidneys, which are the areas where the rash typically develops first, but the pain may also be felt on your face, neck, arms, stomach, or legs.
If you’re feeling pain without a rash, you might be developing shingles, but it’s really too soon to tell. At this stage, doctors are not usually able to say with certainty that you have shingles. Therefore, if you approached your doctor, you likely wouldn’t receive any shingles treatment yet.
Some people never progress any further—never develop the rash—but, for most, the pain continues, and a rash starts to develop one to five days following the shingles pain.
Day 2-8: Red Rash
A few days after the shingles pain starts most people with shingles develop a red rash on the side of their torso. If you develop a red rash such as the one in the image below, you very likely have shingles.
As soon as you start developing the rash, you should see your primary care physician or go to an urgent care clinic to confirm the diagnosis and seek shingles treatment. According to the CDC, for shingles medication to be effective it must be started as soon as possible after the rash appears (ideally within three days), so if you think you have shingles, don’t delay—go see your doctor.
The sooner you start treatment for shingles, the more effective it’ll be. You want your shingles medication to be effective because it’ll shorten the length of time you have shingles and will lessen the severity of your symptoms. According to the UK’s National Health Service, with medication, shingles typically clears up in 2-4 weeks.
Day 7-18+: Fluid Filled Blisters
A few days after the red rash develops, you’ll begin to develop fluid-filled blisters such as those in the image below.
This blister stage typically last about 1-2 weeks (though it can remain longer). You’re only contagious during this blister stage. You can’t pass on shingles, but you can give chickenpox to someone who’s never had chickenpox or the chickenpox vaccine. Make sure to cover your rash and stay away from those who’ve never had chickenpox or the chickenpox vaccine.
If you seek shingles treatments, then you shouldn’t have fluid-filled blisters quite as long. By treating shingles with shingles medication, you should be able to speed up your shingles (ensuring it only last 2-4 weeks as opposed to longer) and enter the next phase quicker.
Day: 14-30+: Scabbing/Crusting
In the final phase of shingles, the blisters burst and crust over. The scabbing/crusting typically last 1-2 weeks—though this time period can be shortened by shingles treatment. Be careful not to scratch your rash during this phase because it could lead to permanent scarring.
Possible Complications: Abnormal Course of Shingles Without Treatment
For most people, shingles, whether treated or untreated, progresses in the way outlined above.
However, some who don’t receive treatment for shingles experience serious complications. The most at risk groups are people over 60 and people with weakened immune systems (pregnant women, HIV patients, and chemotherapy patients).
According to the CDC, the most common complication is PHN or post-herpetic neuralgia. PHN causes people to have severe pain in the areas where they had the shingles rash, even after the rash clears up. This pain usually lasts a few weeks or months, but, for some people, it can last years.
While it’s rare for those under 40 to experience PHN, about a third of untreated shingles patients over 60 experience PHN. Therefore, it’s especially important to get shingles treatment if you’re older or have a weakened immune system. While PHN is the most common complication, there are some other more rare complications.
According to doctors at Mayo Clinic, if the shingles rash reaches your eye (such as in the picture below), it can cause eye infections that could lead to temporary or even permanent loss of vision.
It’s very important that you seek treatment as soon as you start developing the rash, so it doesn’t progress onto your face. If you have developed the rash on your forehead or eye, you must go see your doctor immediately abnd get immediate treatment.
Also, if the shingles rash develops in or on your ear, you could potentially develop hearing or balance problems. In rare instances, the virus might attack your brain or spinal cord, which, in even rarer cases, could lead to death. For these reasons, if you’re developing a shingles rash in or around your ear (such as in the image below), you should go see a doctor as soon as possible.
With shingles treatment, you should be able to avoid these nasty complications, but what are all the available treatments for shingles?
2 Major Shingles Treatment Types
There are two categories for shingles treatments: those that target the virus and those that target the shingles pain.
To help your body fight the virus, you’re likely to receive an antiviral medication. Unfortunately, antiviral medications are not a shingles cure. Unlike antibiotics, which kill illness-causing bacteria, antiviral shingles medications do not destroy the virus. They simply inhibit the virus from spreading further. Shingles medication won’t end your case of shingles, but, according to the CDC, it’ll help shorten the length and severity of the illness.
Nearly 100% of people with shingles who seek treatment will be prescribed an antiviral medication by their doctor, but not everyone will be prescribed a shingles pain relief medication. If your doctor doesn’t want to prescribe you an antiviral medication as a treatment for shingles, then I’d recommend you get a second opinion.
I’m going to focus primarily on the antiviral medications because these are the only medicines that are specifically targeted to fight shingles. As I said, not every shingles patient will receive pain medication; the pain medication is just general pain medication which might be used to combat shingles pain.
Antiviral Shingles Medications
There are three main antiviral shingles medications that doctors prescribe—acyclovir, valacyclovir, and famciclovir.
Acyclovir (Brand Name: Zovirax)
Acyclovir is given to help decrease shingles pain and to speed up the course of shingles (speed the healing of blisters, etc.). As I mentioned before, no shingles medication will be a shingles cure. However, acyclovir will prevent new sores from forming, decrease the risk of the shingles rash spreading to other parts of your body, and decrease the risk of the serious complications mentioned above.
According to the National Institute of Health, if you’re prescribed acyclovir as a shingles treatment, you’ll be given it in the form of either tablets, capsules or a liquid (suspension). It’s more likely you’ll be given it in tablet or capsule form unless you have issues swallowing pills. No matter which type you’re given, you’ll take it orally. Acyclovir can be taken with or without food.
It’s usually taken two to five times a day for five to ten days, but follow your doctor’s and/or pharmacist’s instructions. If they did not give you explicit instructions for your medication or if you’re confused, make sure to contact them. If you’re taking the liquid form, shake it well before each use.
Your shingles pain and rash should improve during your treatment with acyclovir. However, do not stop taking this shingles medication, even if you feel better, and your rash has disappeared. Take it until you finish your prescription unless otherwise instructed by your doctor/pharmacist. According to the NIH, if you stop taking acyclovir too soon or skip several doses, your shingles may not be completely treated and may become more difficult to treat.
If you miss a dose, don’t panic, just take the missed dose as soon as you remember and take any remaining doses for the day at evenly spaced intervals (i.e. every four hours). However, if you remembered right before it’s time to take the next dose, just skip the missed dose and continue your regular dosing schedule. Don’t take a double dose to make up for a missed one.
There are some potential side effects associated with the use of acyclovir as a shingles treatment. There is also the risk of overdose. For these reasons, it’s very important to tell your doctor what other medications—prescription or otherwise—that you’re taking. They won’t prescribe you acyclovir if they think they’ll be a bad interaction.
That being said, you can still experience negative side effects from taking this shingles medication. There are some non-emergency side effects you may experience such as:
|Upset stomach||Dizziness||Pain, especially in the joints|
|Diarrhea||Agitation||Changes in vision|
However, if these side effects worsen or do not go away, be sure to contact your doctor.
There are also some rarer, more worrisome potential side effects. If you experience one of these, contact your doctor right away:
|A new rash or hives (distinct from your shingles rash)||Fast heartbeat||Unusual bruising or bleeding||Headache||Numbness, burning, or tingling in the arms or legs|
|Additional itching (on top of your normal shingles itchiness)||Weakness||Blood in the urine||Hallucinations (seeing things or hearing voices that do not exist)||Temporary inability to move parts of your body|
|Difficulty breathing or swallowing||Pale skin||Stomach pain or cramps||Confusion||Shaking of a part of your body that you cannot control|
|Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs||Difficulty sleeping||Bloody diarrhea||Aggressive behavior||Seizures|
|Hoarseness||Fever, sore throat, chills, cough, and other signs of infection||Decreased urination||Difficulty speaking||Loss of consciousness|
As I mentioned, there is a risk of overdose. For this reason, it’s extremely important that you follow your doctor’s and pharmacist’s instruction regarding dosing your acyclovir. Some of the symptoms of overdose include:
|Agitation||Extreme tiredness||Swelling of the hands, feet, ankles, or lower legs|
|Seizures||Loss of consciousness||Decreased urination|
If you experience any of these overdose symptoms, call poison control (1-800-222-1222). If the victim has collapsed, is unconscious, or is not breathing, call 911.
Valacyclovir (Brand Name: Valtrex)
Valacyclovir, similarly to acyclovir, decreases shingles pain and itching, helps blisters to heal, and prevents new ones from forming. It won’t be a cure for shingles, but it’ll expedite the course of your illness.
According to the National Institute of Health, valacyclovir comes in tablet form and is taken by mouth. It’s usually taken three times per day (every eight hours) for one week. However, you should follow your doctor’s and/or pharmacist’s instructions. If you didn’t receive explicit instructions for your medication or if you’re confused, contact your doctor.
Even if your shingles pain and rash start to improve, don’t stop taking valacyclovir. Talk to your doctor before you discontinue use of the medication.
What should you do if you accidentally miss a dose? Don’t worry—take the missed pill as soon as you realize and take any remaining pills for the day at evenly spaced intervals (i.e. every eight hours). If you realized right before the time of your next dose, skip the missed dose and just continue your regular dosing schedule. It’s very important not to double dose to make up for a missed one because it is possible to overdose on this medication (I’ll explain this in more depth in the next section).
With valacyclovir, you might experience some undesirable side effects. There is also the risk of overdose from this medication, which is why it’s very important to tell your doctor what other medications—prescription or otherwise—that you’re taking before you start taking valacyclovir. That way, your doctor will ensure valacyclovir won’t interact negatively with your current medications.
However, you can still experience side effects from taking this valacyclovir. These are the most common side effects:
|Upset stomach||Vomiting||Diarrhea or loose stool||Headache||Constipation|
These are normal side effects and nothing to be concerned about. However, if these side effects worsen or do not go away, be sure to contact your doctor.
If you experience one of these rarer, more dangerous side effects, contact your doctor right away:
|A new rash (distinct from your shingles rash)||Confusion||Fever|
|Additional itching (on top of your normal shingles itchiness)||Yellowing of skin or eyes||Blood in the urine|
There is the potential for overdose, which is why you must follow your doctor’s and pharmacist’s instruction regarding dosing your valacyclovir. Some signs of overdose include:
|Aggression||Seizures or convulsions|
|Hallucinations||Swelling in your feet or ankles|
|Inability to speak||Inability to breathe or shortness of breath|
|Feeling shaky or unsteady||Little or no urination or pain or difficulty urinating|
Call poison control (1-800-222-1222) if you experience one of these symptoms. If the person has collapsed, is unconscious, or is not breathing, call 911 right away.
Famciclovir (Brand Name: Famvir)
Just like acyclovir and valacyclovir, famciclovir isn’t a cure for shingles. However, it’ll speed up the course of the virus—decreasing your pain and itchiness, helping blisters heal, and preventing new blisters from forming.
According to the National Institute of Health, famciclovir comes in tablet form only and is taken orally. It’s typically taken every eight hours (three times per day) for seven days. However, follow your doctor’s and/or pharmacist’s explicit instructions. If you didn’t receive instructions on how to take this shingles medication or if you’re confused, contact your doctor. Keep taking famciclovir even if you feel better. Don’t stop taking it without talking to your doctor first.
Just like acyclovir and valacyclovir, if you miss a dose, you take it as soon as you remember and take any remaining pills for the day at evenly spaced intervals (i.e. every eight hours). However, if you remembered the missed dose right before the time of your next dose, skip the missed dose and just continue your regular dosing schedule. Same as the other medications, don’t take a double dose to make up for a missed one. You can overdose on this medication (I’ll explain this in more depth in the next section).
Famciclovir can cause some unwanted side effects, and there’s a chance of overdosing. For this reason, you must tell your doctor what other prescription and nonprescription medicines you’re taking. They’ll pick a suitable shingles medication that won’t negatively interact with your current medications.
However, you still might experience some side effects. The following are non-emergency side effects, but if these symptoms seem severe and/or don’t go away, call your doctor:
|Drowsiness, dizziness, confusion, or disorientation||Don’t drive a car or operate machinery until you’ve tried the medication a few times and know how it affects you.||Gas||Rash|
|Headache||Diarrhea or loose stools||Tiredness||Painful menstrual periods|
If you experience one of these more concerning sensations, call your doctor immediately:
|pain burning, numbness, or tingling in the hands or feet|
Just as with the other two medications, you can overdose on famciclovir, so follow your doctor’s and pharmacist’s dosing instructions exactly. Overdose symptoms can include:
|Agitation||Extreme tiredness||Swelling of the hands, feet, ankles, or lower legs|
|Seizures or convulsions||Loss of consciousness||Decreased urination|
Don’t hesitate—if you experience an overdose symptom, call poison control (1-800-222-1222). If the victim has collapsed, is unconscious, or isn’t breathing, call 911 immediately.
Which Is the Best Antiviral Shingles Medication?
There really is no best medication—they’re fairly equal. As I’ve said there is no shingles cure, so the three antiviral shingles medications will only help speed up the course of your shingles and provide some pain relief. The three medications are about equally as good at clearing up shingles symptoms, so your doctor won’t prescribe one over the other for efficacy reasons.
The three medications have mostly similar, but some slightly different side effects. Your doctor might pick your medication based on avoiding certain side effects or interactions with your current medications. For example, your doctor might prescribe you acyclovir or valacyclovir over famciclovir if you drive for a living since famciclovir might make it unsafe for you to drive.
Your doctor also might choose based on your current life or medications schedule. Acyclovir needs to be taken every four hours, so valacyclovir or famciclovir might be better options for those who already take a lot of medications and may not be able to remember to take extra pills every few hours.
Shingles Pain Medications
For many people with shingles, the first priority is shingles pain relief. The three antiviral medications should help with some of the shingles pain, but some people may need additional medicines to help with shingles pain management.
Exactly what pain medication you’ll be prescribed will depend on the severity of your pain and on the other medications that you’re currently taking. I’ll discuss the nine most common pain medications your doctor might suggest taking.
If you’re just experiencing some moderate pain, your doctor might suggest trying over-the-counter medicines or shingles creams such as:
- Ibuprofen (Brand name: Advil)
- Acetaminophen (Brand name: Tylenol)
- Capsaicin cream
You can purchase these medications without a prescription from your local drug store. However, before purchasing, talk to your doctor. Make sure to follow the dosing instructions on the box for ibuprofen and acetaminophen, or if your doctor gave you dosing instructions, follow those. Generally, you can take two pills every six hours as needed for pain management.
Capsaicin cream works well as a shingles cream for temporary shingles pain relief. It’s applied directly to the skin in the areas that you’re experiencing pain. It won’t get rid of the rash or permanently eliminate your pain, but it will make you more comfortable in the short term. I’d suggest you start with a small amount for the first application as you may experience a brief heightening in pain when you apply the cream. Otherwise, follow the application instructions on the box or those given to you by your doctor (typically, you can apply three to four times per day).
For more severe shingles pain relief, you might receive:
- Anticonvulsants such as gabapentin
- Tricyclic antidepressants such as amitriptyline
- Numbing agents such as lidocaine
- Opioid pain medications such as codeine
- Steroid injections including corticosteroids
Your doctor will prescribe one of these to you if they think it’s necessary. They will choose based on your symptoms. For example, if you’re experiencing seizures or convulsions from your shingles, you would likely be a candidate for an anticonvulsant.
NOTE: these medications can have severe side effects, and some are addictive. For example, codeine is highly addictive if you overuse it. Only take these medications if told to do so by your doctor, and follow their dosing instructions explicitly.
Home Remedies for Shingles
I want to start by saying you must go see your doctor for shingles treatment. You should absolutely take one of the antiviral shingles medications in order to prevent your case of shingles from getting worse.
That being said, if you’ve already seen your doctor and are looking for additional shingles pain relief or itch relief, there are some home remedies for shingles to try. I’d suggest you talk to your doctor before adding any of these home remedies for shingles to your routine.
According to the CDC, wet compresses, colloidal oatmeal baths, and calamine lotion may help relieve some of the itchiness.
To make a wet compress, simply wet a clean towel with water (cold or hot) and press the towel against your shingles rash. Do not use the towel to scratch or itch your rash. Simply press it against the rash without any movement. You can potentially cause scarring by scratching your rash.
Colloidal Oatmeal Bath
For a colloidal oatmeal bath, you’ll need to purchase colloidal oatmeal, which is simply oats that have been ground into a very fine powder. Don’t try to make this yourself with your oatmeal mix—your oatmeal mix has additives that won’t work in the bath.
Disperse the colloidal oatmeal into your bath, and take a bath. It should temporarily relieve some of the itching sensation.
You might be familiar with calamine lotion from when you had bug bites or poison oak. You can buy it at your local drug store. You can apply it to the itchy area for some temporary itch relief. Follow the application instructions on the bottle.
Summary: What You Need to Know About Shingles Treatment
- Go see your doctor as soon as the shingles rash begins to develop (which is usually a few days after you experience shingles pain).
- The sooner you start a shingles antiviral medication, the more effective it’ll be.
- There are three main medications—acyclovir, valacyclovir, and famciclovir.
- There is no shingles cure, but these antiviral shingles treatments will help speed up your shingles, will help blisters heal, and will help prevent new blisters from forming.
- There is no best shingles medication; your doctor will suggest one that’ll work for your lifestyle.
- If you’re suffering from shingles pain, your doctor might suggest a shingles pain medication.
- There are many different shingles pain medications; your doctor will suggest one that is appropriate for your symptoms.
- If you have shingles, you must go see your doctor, but there are some home remedies for shingles such as wet compresses, colloidal oatmeal baths, and calamine lotion.