Post-Herpetic Neuralgia

ASPE Post-Herpetic Neuralgia

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Table 1. Prevention Drug (Brand) Immunization Live Varicella Vaccine Varivax® Live Zoster Vaccine Zostavax® Anti-virals* Acyclovir Zovirax® Valacyclovir Valtrex® Famciclovir Famvir® Drug* (Brand) Dose Topicals Topical lidocaine 5% Lidoderm® 1-3 patches 1-3 patches for ≤ 12 h q24h Skin erythema, rash Possible systemic absorption in patients taking oral therapy with Class 1 antiarrhythmic drugs Capsaicin 8% Patch Qutenza™ Gabapentin Neurontin® 1-4 patches for 60 minutes Repeat q3mos prn Anticonvulsants 300-900 mg/d, in divided doses q8h; increase dose daily by 300 mg/d Pregabalin Lyrica® Initial: 150 mg/d, in divided doses q8-12h; May increase to 300 mg/day within 1 week * See PI for details. 300-600 mg tid (maximum 600 mg tid) 150-300 mg/d (maximum 600 mg/d) Sedation, ataxia, edema, weight gain, diplopia, nystagmus Sedation, ataxia, edema, diplopia, weight gain, dry mouth Simple antacids reduce bioavailability None documented to date • Dose adjustment in patients with renal dysfunction • Dose adjustment in patients with renal dysfunction Max: 4 patches q3mos Application site erythema, pain, pruritus and papules • Patch must be applied to painful area and only to intact skin • Pretreat with topical anesthetic 800 mg q4h (5 times a day) x 7-10 days 1 g tid x 7 days 500 mg q8h x 7 days Table 2. Neuropathic Pain Medications FDA-Approved for PHN Usual Effect Dose (and Maximum) Adverse Effects Drug Interactions Comments Nausea/vomiting, headache, diarrhea , Proquad® Single subcut dose Not recommended for use in immunocompromised individuals or persons under 60 years old Dosage 2 subcut doses Adverse Effects Comments

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