Paracetamol is the first-line pain management option for shingles, as it is well-tolerated and effective for mild to moderate pain. NSAIDs, like ibuprofen, can be used if paracetamol is insufficient. Opioids and Gabapentinoids are reserved for more severe, refractory pain.
Aciclovir is the first-line antiviral treatment for shingles in immunocompetent individuals aged over 50 years when started within 72 hours of rash onset.
The presence of shingles in the ophthalmic dermatome, even without any symptoms affecting vision, warrants referral for urgent assessment to prevent potential eye complications.
Immunocompromised patients with widespread, disseminated shingles and systemic symptoms require immediate referral to emergency services for intravenous antiviral therapy and close monitoring.
Valaciclovir is the preferred antiviral for immunocompromised patients and can be managed under the NHS Pharmacy First Clinical Pathway, providing the patient is not severely immunosuppressed. The NHS Pharmacy First service PGD for the supply of Valaciclovir in shingles indicates that a person is classed as being ‘severely immunosuppressed’ when taking a dose of Methotrexate of 20mg or above, or where lower doses are taken in combination with other immunosuppressive therapies.
Valaciclovir is the preferred antiviral for patients with adherence concerns, because it has a simpler dosing regimen (three times daily) than aciclovir (five times daily).
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