Herpes zoster (shingles)
The regional formulary will not cover all eventualities for infections medicines choices. As with any condition; patient specific factors and sensitivities need to be considered. Please consider this regional formulary advice alongside any relevant local Board guidelines.
Treatment of herpes zoster
Treatment is usually only required in specific patient groups, see prescribing notes below for further detail.
Treatment needs to be started within 72 hours of onset of rash.
Aciclovir
Aciclovir 800mg tablets
800mg 5 times daily for 7 days started within 72 hours of onset of rash.
Treatment needs to be started within 72 hours of onset of rash.
Valaciclovir
Valaciclovir 500mg tablets
1g every 8 hours for 7 days started within 72 hours of onset of rash.
Prescribing Notes:
- Aciclovir is available through Pharmacy First via PGD for patients over 18.
- Consider treatment for anyone aged 50 years and over, or aged less than 50 years with any of the following criteria:
- immunocompromised
- non-truncal involvement (such as shingles affecting the neck, face, limbs or perineum)
- involvement of multiple dermatomes
- eczema
- moderate or severe pain
- moderate or severe rash
- seek immediate specialist advice regarding antiviral treatment for people with ophthalmic involvement; severely immunocompromised people; immunocompromised people who are systemically unwell, or have a severe or widespread rash or multiple dermatomal involvement; or pregnant or breastfeeding women.
- Aciclovir reduces the symptoms of acute herpes zoster (duration of pain, time to healing of lesions), complications (especially serious eye complications) and may reduce progression to postherpetic neuralgia.
- Valaciclovir is substantially more expensive than aciclovir, therefore it should be used where aciclovir is ineffective or not tolerated.
History Notes
30/07/2026
Regional formulary chapter launched.