May 2019

Pharmacist Letter

A hot topic with some recent changes in care is Shingles. Shingles has been on the rise in the United States for the last few decades, according to the Centers for Disease Control and Prevention (CDC). About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.

Shingles, also known as zoster or herpes zoster, is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox. Anyone who's had chickenpox can get shingles. After you've been infected with chickenpox, the varicella-zoster virus lies inactive in your body — mostly in spinal or cranial nerves — usually for many decades. If the virus reactivates, it can travel along nerve pathways to your skin and cause a rash to erupt. For one in three adults, the virus will become active again.

Shingles usually appears as a single row of blisters that may wrap around one side of your torso, one side of your face or neck, or around one eye. It almost always involves only one side of the body. Pain is usually the first sign of shingles, and you can experience the pain anywhere from one to five days before the rash develops.

Because the pain of shingles originates in the nerves, it is different quality than any other pain you might have experienced before. Neuropathic pain is burning, it’s both numb and painful at the same time, and can be provoked by touching the skin. Your skin may be so sensitive that even sunlight can bring on a stabbing sensation.

Even if you aren’t sure that you have shingles, you should still see a doctor right away, because immediate treatment can prevent nerve damage.

While the rash is present, you may experience symptom relief by taking cool showers, avoiding direct sunlight, and limiting your scratching. Scratching can create the ideal condition for a bacterial skin infection.

As this is a viral infection, anti-viral medication is the first-line therapy (acyclovir, valacyclovir, or famciclovir). Taking these drugs within 72 hours of the eruption of the rash will help prevent postherpetic neuralgia, a condition in which nerve fibers, inflamed or damaged by shingles, continue to send pain signals to your brain months, or even years, after the blisters have gone away. The best over-the-counter options for pain are nonsteroidal anti-inflammatory drugs (NSAIDs) (i.e. ibuprofen or naproxen). As described, at the root, shingles is a nerve disorder, so drugs that work in different ways to calm overactive nerves are ideal for neuropathic pain (i.e. gabapentin, pregablin, amitriptyline, or duloxetine)

Getting a shingles vaccine is the only way to reduce the risk of developing shingles and to lessen the risk of postherpetic neuralgia. There are now two shingles vaccines available: Zostavax and Shingrix. Zostavax has been in use since 2006, and Shingrix was introduced in 2017.

Shingrix is given as two shots that are two to six months apart, researchers found that Shingrix was 97.2 effective at preventing shingles. Zostavax is given as one shot, studies on Zostavax have shown that it’s 51.3 percent effective in preventing shingles and 66.5 percent effective at preventing postherpetic neuralgia. You can get either vaccine even if you’ve had shingles before, and you can receive the Shingrix vaccine if you’ve already been treated with Zostavax. But it’s important to note that Zostavax is a live virus vaccine and cannot be given to patients with compromised immune systems. According to the CDC, you should let eight weeks elapse from the time of your Zostavax dosage to the time of your first Shingrix shot.

Together we can be a healthier community.

God Bless – Joe Flynn, PharmD