Shingles - Treatment 

Treating shingles 

There is no cure for shingles, but treatment can help ease your symptoms.

The symptoms of shingles are often mild. However, see your GP as soon as possible if you recognise the symptoms of shingles. Early treatment may help reduce the severity of your symptoms and the risk of developing complications.

Treating the rash

If you develop the shingles rash:

  • keep the rash as clean and dry as possible – this will reduce the risk of the rash becoming infected with bacteria
  • wear loose-fitting clothing – this may help you feel more comfortable
  • do not use topical (rub-on) antibiotics or plasters (adhesive dressings) as this can slow down the healing process
  • use a non-adherent dressing (a dressing that will not stick to the rash) if you need to cover the blisters, for example to prevent passing the virus to anyone else

Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching. An antihistamine (a medicine often used to treat allergies) may also be useful for preventing itching at night. Before you use an antihistamine, read the manufacturer’s instructions or ask your pharmacist for advice.

Painkilling medication

To ease the pain caused by shingles, your GP may prescribe a painkilling medicine. Several different painkilling medicines may be used, including:

These are described in more detail below. You can also read the NICE guidelines on drug treatments for neuropathic pain (PDF 148kb).

Paracetamol

The most commonly used painkiller is paracetamol, which is available over-the-counter without a prescription. Always read the manufacturer’s instructions to make sure the medicine is suitable and you are taking the correct dose.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are an alternative type of painkilling medicine, also available over-the-counter. However, NSAIDs may not be suitable if you:

  • have stomach or kidney problems, such as a peptic ulcer (an open sore on the inside lining of your stomach)
  • have had stomach or kidney problems in the past
  • have liver problems 
  • have asthma, a condition that causes the airways of the lungs to become inflamed (swollen)
  • are pregnant or breastfeeding

Ask your GP or pharmacist if you are unsure about whether you should take NSAIDs. 

Opioids

For more severe pain in adults, your GP may prescribe a weak opioid, such as codeine. This is a stronger type of painkiller likely to be prescribed with paracetamol.

Antidepressants

If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine.

Antidepressants are commonly used to treat depression, but can also be useful in managing pain caused by shingles. Antidepressants may be particularly useful if you have experienced severe or prolonged pain.

The antidepressants used to treat shingles pain are known as tricyclic antidepressants. Tricyclic antidepressants affect the levels of certain chemicals in your body. The most commonly prescribed tricyclic antidepressants are:

  • amitriptyline
  • imipramine 
  • nortriptyline

Side effects of tricyclic antidepressants may include:

  • constipation (an inability to empty your bowels)
  • difficulty urinating
  • blurred vision
  • dry mouth
  • weight gain
  • drowsiness

If you have shingles, you will usually be prescribed a much lower dose of tricyclic antidepressants than if you were being treated for depression. This will usually be a tablet to take at night. Your dose may be increased until your pain settles down. It may take several weeks before you start to feel the antidepressants working, although this is not always the case. 

Anticonvulsants

As with antidepressants, anticonvulsants are most commonly associated with treating another condition. Anticonvulsants are often used to control seizures (fits) caused by epilepsy.

However, anticonvulsants can also help manage nerve pain. They work by stabilising electrical nerve activity within your brain. Gabapentin is the most commonly prescribed anticonvulsant for shingles pain.

Side effects of gabapentin may include:

  • headache
  • dizziness
  • diarrhoea (loose, runny stools)
  • dry mouth
  • swollen ankles

As with antidepressants, you will have to take gabapentin for several weeks before you notice it working. If your pain does not improve, your dose may be gradually increased until your symptoms are effectively managed.

Antiviral medication

As well as painkilling medication, some people with shingles may also be prescribed an antiviral medicine.

This type of medicine cannot kill the shingles virus, but can help stop it multiplying. Antiviral medicine may:

  • reduce the severity of your shingles, particularly if you take it in the early stages of the condition
  • reduce how long your shingles lasts
  • prevent complications of shingles from developing, such as postherpetic neuralgia, although the evidence for this is uncertain

Antiviral medicines are most effective when taken within 72 hours (three days) of your rash appearing. However, they may be started up to a week after your rash appears if you are at risk of severe shingles or developing complications.

Commonly prescribed antiviral medicines include:

  • aciclovir
  • valaciclovir
  • famciclovir

You will usually have to take this type of medicine for seven days.

Who is prescribed antiviral medication? 

If you are over 50 years of age and have the symptoms of shingles, it is likely you will be prescribed an antiviral medication. You may also be prescribed antiviral medication if you have:

  • symptoms of shingles that affect your eyes (ophthalmic shingles)
  • a weakened immune system (the body’s natural defence system)
  • a rash on parts of your body other than your torso (the upper part of your body, excluding your head), such as your neck, arms or legs
  • moderate to severe pain
  • a moderate to severe rash

Pregnancy and antiviral medication

If you are pregnant and have shingles, it is likely your GP will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks. Shingles will not harm your unborn baby.

If you are under 50 years of age, you are at less risk of developing complications from shingles. If this is the case, you may not need antiviral medication.

Children and antiviral medication

Antiviral medication is not usually necessary for children because they:

  • usually only experience mild symptoms of shingles
  • only have a small risk of developing complications

If your child is otherwise healthy, antiviral medicines are not likely to be of significant benefit, so may not be prescribed.


Page last reviewed: 21/06/2012

Next review due: 21/06/2014

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Staying off work or school

If you or your child has shingles, only stay away from work or keep your child off school if:

  • the rash is weeping (oozing fluid) and cannot be covered 
  • you or your child are feeling unwell

If the rash is only on your body and can be covered by clothing, there is little risk of passing on the infection to others.

You can return to work and your child can return to school as soon as you or they feel well enough and:

  • the rash can be covered  
  • the blisters have dried up

Which painkiller?

The drugs you should take to treat pain depend on what type of pain you have