How to Treat Shingles: Medication, Pain Relief, Home Remedies and More

About 1 million people in the U.S. get shingles (herpes zoster) each year, according to the CDC. Anyone who has had chickenpox can get it, but it’s much more common in people over 50 years old. Shingles occurs when the chickenpox virus gets reactivated in the body. It causes a painful rash on one side of the face or body, which can last for several weeks. 

If you have shingles, early treatment is key. Antiviral medications can shorten how long shingles lasts. And early treatment can also decrease postherpetic neuralgia (PHN) — the most common complication of shingles. PHN is a type of nerve damage that causes ongoing pain long after the rash is gone. 

We’ll review the best prescription and over-the-counter (OTC) medication for shingles and shingles pain relief.

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What to do if you think you have shingles 

If you think you have shingles, see a healthcare professional as soon as possible. The best place to go is your primary care provider. But if you don’t have access to one, any of your doctors — or even an urgent care — can help. This is because it’s important to start antiviral medications less than 72 hours after you notice a shingles rash. This helps:

• Reduce how severe the infection is

• Shorten how long the skin rash lasts

• Decrease the associated pain

If it’s been more than 72 hours, you should still talk with a healthcare professional. Treatment will still help prevent progression of the rash and infection.

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• Can you get shingles more than once? Yes, but it’s more common if you have a weak immune system. Learn who is at risk, and how to prevent getting shingles a second time.

• Shingles vaccine: Adults older than 50 years can prevent shingles and its complications by getting vaccinated. Learn about who needs the shingles vaccine, and potential side effects.

Shingles treatment 

There’s no cure for shingles. But there are several different treatments that can help treat it and its symptoms.

Antiviral medications

There are three main antiviral medications used to treat shingles. They’re all effective at helping the shingles rash crust over and heal. They also help reduce pain during the healing process. 

You will need a prescription for these medications. And all three are prescribed for 7 days.The antiviral medications are:

• Valacyclovir: Research suggests that valacyclovir (Valtrex) worked faster than acyclovir at reducing pain. You take it 3 times a day.

• Famciclovir: This is just as effective as valacyclovir in healing the rash and reducing pain. You also take famciclovir (Famvir) 3 times a day.

• Acyclovir: This one may be a bit slower to work, but it’s still effective. You take acyclovir (Zovirax) 5 times a day. 

OTC medications for shingles pain 

Pain from shingles can be very distressing. But you don’t need a prescription to get relief from the pain. The following OTC medications can help: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These can be quite effective for many people. They include ibuprofen (Advil, Motrin) and naproxen (Aleve).

• Acetaminophen (Tylenol): Acetaminophen can also provide significant pain relief. And you can take it along with NSAIDs like ibuprofen to provide even more relief.

• Topical treatments: Lidocaine jelly or Lidoderm patches can numb the nerves that are causing the pain. 

Prescription medications for severe shingles pain 

If you’re not getting enough relief from these medications, talk with your healthcare professional about other options like prescription medications. These include:

• Antiviral ointments, like Zovirax

• Glucocorticoids (steroids) like prednisone, which can help with pain relief and speed up healing of the rash

• A short course of opioid pain medications if the pain is severe

• Gabapentin (neurontin), which is more often prescribed for postherpetic neuralgia (discussed below), but may help some people when the rash is still present 

Prescription medications for postherpetic neuralgia

Postherpetic neuralgia (PHN) is the most common complication of shingles. It occurs in up to 20% of people. PHN is pain that remains in the area of the rash after the rash has healed. It can last for months to even years, and it can be debilitating for many people. There are several options for different pain medications that can help.

The first-choice medications for pain from PHN include:

• Gabapentin (Neurontin, Horizant) 

• Pregabalin (Lyrica)

• Capsaicin patches (Qutenza)

• Lidocaine patches

But there are several additional pain medications that may also help with PHN pain: 

• Tricyclic antidepressants, such as nortriptyline and amitriptyline

• Anti-seizure medications, such as valproic acid, carbamazepine, oxcarbazepine, and lamotrigine

• Serotonin-norepinephrine reuptake inhibitors, such as duloxetine and venlafaxine

Researchers continue to search for new treatments, too. A recent study that reviewed data from four clinical trials showed that vitamin B12 injections reduced pain and the need for pain medications in people with PHN. It even worked better than lidocaine. 

Home remedies for shingles itching 

Shingles treatment starts with prescription antiviral medications to help the rash heal. As mentioned above, some OTC medications can be useful for the pain. If the rash is itching, you can try some at-home remedies, including:

• Wet compresses

• Calamine lotion

• Oatmeal baths (a lukewarm bath mixed with ground-up oatmeal)

How long does shingles last?

Shingles first develops as a rash that occurs on just one side of the body, sometimes on the face or chest area. The shingles rash typically scabs over in 7 to 10 days. In most people, the rash fully clears up in 2 to 4 weeks. 

You can pass the virus that causes shingles — VZV or varicella — to others only while the rash is in the form of blisters. Once the blisters scab or crust over, you’re no longer contagious. 

Can shingles go away without treatment?

Experts don’t recommend a “wait-and-see” approach with shingles. Although the rash may go away with time, untreated shingles leads to a higher risk of complications. These complications include:

• Postherpetic neuralgia (PHN)

• Blindness

• Pneumonia (infection of the lungs)

• Hearing problems

• Encephalitis (inflammation of the brain)

• Death, in rare cases

How to prevent shingles 

You can prevent shingles by getting the shingles vaccine, called Shingrix. Experts recommend it to anyone over the age of 50. Research shows that it’s 97% effective at preventing shingles in this age group. It’s not recommended for people younger than 50. 

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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