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Varicella Zoster Virus Varicella Zoster Virus

Management of herpes zoster (HZ) and post-herpetic neuralgia (PHN):

Treatment of acute herpes zoster

  • Antivirals should be considered for treatment of acute HZ, ideally given within 72 hours of rash onset.1,2
  • Delayed presentation/diagnosis may lead to delays in treatment so early recognition of the symptoms and signs is important.1,4
  • Specialist referral and/or hospital admission may be required in some patients, such as those suspected of having serious complications such as disseminated disease, ophthalmic involvement or patients who are severely immunocompromised.2

Information to the patient should include advice to avoid contact with individuals who have not had chickenpox, especially those at greater risk, such as immunocompromised people, pregnant women and babies under 1 month of age. Individuals should be informed that they will remain infectious until all the rash vesicles have crusted over (generally 5-7 days following rash onset).2

Pain management in HZ and PHN

Medication icon
  • A range of analgesics including neuropathic pain medications are used to manage HZ and PHN pain.2,3
  • The choice of drug should be assessed for each patient based on contraindications, adverse events and potential drug interactions2
  • HZ and PHN pain can be challenging to manage.1,4
  • Treatment options may have limited efficacy in some patients.1,4
  • Side effects from analgesic medications mean that tolerability is an important consideration.1,3,4
  • Regular review of dosing and side effects is recommended.3
  • Specialist input or referral to the pain team may be required.2,3

Click on a section below to learn more


  1. Johnson RW, et al. Ther Adv Vaccines. 2015, Vol. 3(4) 109–120
  2. UK NICE Clinical Knowledge Summary. Shingles June 2022
  3. UK NICE Clinical Knowledge Summary. PHN April 2022
  4. Johnson RW, et al. BMC Med 2010;8:37

Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.

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February 2023 | NX-GB-GVX-WCNT-220004 (V1.0)