valacyclovir and Herpes-Zoster

The most refractory symptom of herpes zoster (HZ) is pain. Approximately 90% of people who have HZ suffer from pain. Early use of antiviral medications has been found to reduce pain across all stages of the disease. Although many antiviral agents via oral or intravenous administration were recommended by clinical practice, the best approach to prevent HZ-associated pain remains uncertain.. The purpose of this study was to compare the efficacy and adverse events of various antiviral agents used for the treatment of HZ-associated pain through a network meta-analysis.. A systematic review and meta-analysis.. The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to Feb 2020.. Randomized clinical trials evaluating antiviral agents currently available for treating HZ-associated pain were included. We extracted data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted network meta-analyses with random-effects models. The primary outcome was the presence of acute pain at the end of anti-virus treatment, and the secondary outcomes included the presence of pain at 28-30 days after the onset of the acute herpetic rash, the presence of postherpetic neuralgia (PHN), and any other adverse events.. A total of 17 randomized control trials with 5,579 participants were included in this study. According to the results of the network meta-analysis, for the treatment of acute pain, there was no significant difference between oral acyclovir and intravenous acyclovir. Furthermore, oral famciclovir was the most effective treatment concerning both the odds ratio (OR) (superior to placebo OR = 0.25; 95% CI: 0.13~0.48) and the surface under the cumulative ranking curve (SUCRA) values of 0.84 for the treatment of acute pain among all the oral antiviral agents. For the presence of pain at 28-30 days, no significant difference was observed in efficacy between all antiviral treatments and placebo concerning the OR; however, oral valaciclovir ranked first (SUCRA values of 0.96). For the presence of NPH, oral famciclovir was determined to be the most effective (SUCRA values of 0.77) treatment with an efficacy of 0.42 (95% CI: 0.18~0.99) versus placebo. For adverse events, there was no significant difference between oral antivirals and placebo; however, intravenous acyclovir ranked last with a score of OR 4.31 (95% CI: 1.26~14.75) versus placebo.. The distribution of severity of pain was different in various studies; then, the lack of availability of individual data prevented us from analyzing the effects of the risk factors.. For the treatment of acute pain and PHN, oral famciclovir was the most effective treatment among all the oral antiviral agents. For alleviating pain after 28-30 days, oral valaciclovir appeared to be the most effective among all antiviral agents. Additionally, all oral antiviral agents were well tolerated.. PROSPERO under the identification CRD42020212834.

Topics: Acute Pain; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Network Meta-Analysis; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir

Topics: Acyclovir; Antiviral Agents; Blister; Famciclovir; Herpes Zoster; Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir

Acyclovir (ACV)-associated encephalopathy is related to an increase in plasma levels of 9-carboxymethoxymethylguanine, an ACV metabolite, and is often reported in patients with renal dysfunction. We report a case of ACV-associated encephalopathy with rapid progression of renal dysfunction after oral administration of valacyclovir (VACV) and review literature of previous ACV-associated encephalopathy cases.. An 88-year-old man was diagnosed with herpes zoster. VACV (3000 mg/day) treatment was initiated. Serum creatinine (Cr) level was 0.80 mg/dL. However, irritability, memory impairment, and decreased responsiveness occurred after 3 days. The Cr level was 6.76 mg/dL on admission.. He was diagnosed with ACV-associated encephalopathy with acute kidney injury.. VACV was discontinued, hemodialysis was initiated on the day of admission, and then the signs and symptoms improved approximately 72 hours after the admission.. Worsening of renal function and encephalopathy should be a focus when using VACV or ACV, regardless of age and original renal function. Acute kidney injury and ACV-associated encephalopathy may particularly occur in the elderly even when renal function is normal. Therefore, regular monitoring of renal function and consciousness is necessary during VACV treatment.

Topics: Acute Kidney Injury; Aged, 80 and over; Antiviral Agents; Brain Diseases; Creatinine; Guanine; Herpes Zoster; Humans; Kidney; Male; Reference Values; Renal Dialysis; Valacyclovir

Herpes zoster classically presents as a vesicular eruption along a single dermatome that correlates with the dorsal root ganglion in which varicella zoster virus (VZV) reactivates. Such cases most commonly involve a single thoracic dermatome, but other rare presentations of herpes zoster have been reported including multidermatomal herpes zoster. This letter reports a case of multidermatomal herpes zoster affecting cervical dermatomes C2-C5 and presents all previously published cases of multidermatomal herpes zoster in which involved dermatomes were reported to determine if this condition has a predilection for cervical dermatomes. A total of eight other cases were reviewed and involvement of cervical dermatomes was observed in 6 of 9 cases (66.7%). This suggests a propensity for multidermatomal involvement to affect cervical dermatomes beyond that encountered in classic herpes zoster. Clinicians should be aware of this presentation of herpes zoster especially in the head and neck region where the classic vesicular eruption may not be confined to a single dermatome.

Topics: Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neck; Valacyclovir

The optimal duration of prophylaxis for the varicella-zoster virus following hematopoietic stem cell transplantation (HSCT) remains unclear. The purpose of this study was to systematically review the available literature to determine the optimal duration of antiviral prophylaxis for preventing herpes zoster (HZ) in allogeneic and autologous HSCT recipients. The MEDLINE and EMBASE databases were searched to identify relevant studies. The relative risk (RR) of HZ was calculated using fixed effects or random effects models depending on heterogeneity across the included studies. We analyzed six observational studies comprising a total of 3420 patients. In all HSCT recipients, the overall incidence of HZ in the prophylaxis group and the control group was 7.8% and 25.6%, respectively, with a pooled RR of 0.31 (95% CI, 0.26-0.37). The incidence of HZ in the subgroup wherein prophylaxis was given for at least 1 year and in the subgroup wherein prophylaxis was given for less than 1 year was 2.1% and 15.4%, respectively, with a pooled RR of 0.23 (95% CI, 0.04-1.39). Taken together, our results demonstrate that antiviral prophylaxis can significantly reduce HZ in HSCT recipients, and suggests that long-term prophylaxis given for at least 1 year may be recommended for better preventive effects.

Topics: Acyclovir; Antiviral Agents; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Observational Studies as Topic; Pre-Exposure Prophylaxis; Risk; Time Factors; Transplant Recipients; Valacyclovir; Valine; Virus Activation

A 75-year-old woman presented with edema of the left leg in December 2012. On examination, there was a palpable 5-cm tumor in the left lower abdomen, and PET/CT showed lymphadenopathy of the tracheal, para-aortic, left iliac and inguinal regions with increased FDG uptake. We performed histopathological examination of the iliac lymph node and diagnosed diffuse large B-cell lymphoma (DLBCL), stage IIIA. The patient received 8 courses of R-CHOP chemotherapy and achieved a complete response. In April 2014, she noticed seven new painful erythematous vesicles <1 cm in size on the skin of the left lower abdominal region. Herpes zoster was suspected and valacyclovir was administered. However, this medication had no effect, and the vesicles enlarged and became nodular. Histopathological examination of one of the skin lesions revealed the infiltration of DLBCL and the diagnosis of zosteriform cutaneous recurrence of DLBCL was thus made. Skin lesions mimicking herpes zoster have been reported in certain types of hematological malignancies, and histopathological diagnosis should be performed in such cases.

Topics: Acyclovir; Aged; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cyclophosphamide; Diagnosis, Differential; Doxorubicin; Female; Herpes Zoster; Humans; Lymphoma, Large B-Cell, Diffuse; Prednisone; Recurrence; Rituximab; Skin Neoplasms; Treatment Outcome; Valacyclovir; Valine; Vincristine

Herpes zoster (HZ) infections rarely affect the mandibular branches of the trigeminal nerve. When the mandibular branches are involved, lesions may appear on the face, in the mouth, in the eye, or on the tongue. Additionally, this condition may be associated with devitalized teeth, internal resorption and spontaneous exfoliation of the teeth, and osteomyelitis of the alveolar bone. In this paper, the treatment of a case HZ of the mandibular branch of the trigeminal nerve is reported, and 22 articles on HZ cases with involvement of the mandibular branch are reviewed. This is the first literature review of HZ cases involving only the mandibular branch of the trigeminal nerve.

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Humans; Male; Mandibular Diseases; Pain Management; Radiography, Panoramic; Trigeminal Nerve; Trigeminal Nerve Diseases; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Arm; Autonomic Fibers, Preganglionic; Eyelids; Female; Ganglia, Sympathetic; Herpes Zoster; Herpesvirus 3, Human; Horner Syndrome; Humans; Neck; Spinal Cord; Thorax; Valacyclovir; Valine

Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.

Topics: Acyclovir; Adalimumab; Adrenal Cortex Hormones; Adult; Antibodies, Monoclonal, Humanized; Antiviral Agents; Crohn Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Meningitis, Viral; Opportunistic Infections; Prednisone; Treatment Outcome; Tumor Necrosis Factor-alpha; Valacyclovir; Valine; Virus Activation

Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pregabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Cohort Studies; Famciclovir; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Incidence; Lidocaine; Male; Middle Aged; Neuralgia, Postherpetic; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; United States; Valacyclovir; Valine

INTRODUCTION. Infection by the Epstein-Barr virus (EBV) -either as a primary infection, a reactivation or an active chronic infection- can give rise to several clinical forms of involvement of the central nervous system. We report a case of encephalitis due to EBV produced by viral reactivation in an immunocompetent patient which initially mimicked, from the clinical and electroencephalographic point of view, encephalitis due to type 1 herpes simplex virus (HSV-1). CASE REPORT. A 51-year-old male who had reported the presence of dorsal herpes zoster some days earlier. The patient visited the emergency department after suffering a holocranial oppressive headache and febricula for seven days; 24 hours before admission to hospital, he was suffering from drowsiness and language disorder. The neurological examination revealed stiffness in the back of the neck and dysphasia. An analysis of the cerebrospinal fluid revealed pleocytosis (422 cells/mm(3)) with 98% of mononuclear cells and normal protein and glucose concentration levels in cerebrospinal fluid. Magnetic resonance imaging of the brain and electroencephalogram readings were normal with periodic lateralised epileptiform discharges in the left temporal region. Intravenous acyclovir treatment was initiated, but renal failure meant it had to be changed to oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests were negative. CONCLUSIONS. EBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum. Clinical pictures mimicking HSV-1 are less frequent. When encephalitis is related to viral reactivation, precipitating factors can be detected, as in our case.. Encefalitis por el virus de Epstein-Barr: descripcion de un caso clinico y revision de la bibliografia.. Introduccion. La infeccion por el virus de Epstein-Barr (VEB) puede dar lugar –tanto como primoinfeccion, reactivacion o infeccion cronica activa– a varias formas clinicas de afectacion del sistema nervioso central. Presentamos un caso de encefalitis por VEB producido por reactivacion virica en un paciente inmunocompetente, que inicialmente simulaba, desde el punto de vista clinico y electroencefalografico, una encefalitis por virus herpes simple tipo 1 (VHS-1). Caso clinico. Varon de 51 años con antecedente de herpes zoster dorsal en los dias previos. Acudio a urgencias por un cuadro de siete dias de duracion de cefalea opresiva holocraneal y febricula; 24 horas antes de su ingreso, padecia somnolencia y alteracion del lenguaje. En la exploracion neurologica presentaba rigidez nucal y disfasia. En el liquido cefalorraquideo se evidencio pleocitosis (422 celulas/mm3) con un 98% de mononucleares, y proteinorraquia y glucorraquia normales. Resonancia magnetica cerebral normal y electroencefalograma con descargas epileptiformes lateralizadas periodicas en la region temporal izquierda. Se trato con aciclovir intravenoso; una insuficiencia renal motivo su cambio a valaciclovir oral con resolucion clinica y mejoria de los parametros licuorales. La reaccion en cadena de la polimerasa en el liquido cefalorraquideo fue positiva para VEB y negativa para el resto de virus neurotropos. En sangre, la serologia para VEB con IgG resulto positiva, y negativa con IgM y anticuerpos heterofilos. Conclusiones. La infeccion por VEB puede dar lugar a una encefalitis aguda diseminada o afectar a varias localizaciones del sistema nervioso central, principalmente el cerebelo. Menos frecuentes son los cuadros imitadores de VHS-1. Cuando la encefalitis se relaciona con reactivacion viral pueden detectarse, como en nuestro caso, factores precipitantes.

Topics: Acute Kidney Injury; Acyclovir; Antibodies, Viral; Antiviral Agents; Cerebrospinal Fluid; Drug Substitution; Electroencephalography; Encephalomyelitis, Acute Disseminated; Epilepsy; Epstein-Barr Virus Infections; Herpes Zoster; Herpesvirus 4, Human; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Imaging; Male; Middle Aged; Valacyclovir; Valine

Herpes zoster is due to the reactivation of the virus causing varicella, called varicella-zoster virus. It affects peripheral nerves and causes painful skin and nerve lesions. This pain may last for months, or years after the initial lesions have resolved: post-herpetic neuralgia is the most frequent complication. Antiviral drugs, acting directly on the infectious agent are prescribed to reduce or block viral replication, relieve pain, and shorten symptom duration, especially for people of 50 years of age or more. However, there is currently no systematic collection of data concerning the effectiveness of antiviral drugs administered outside of clinical trials. This review evaluates the effectiveness of antiviral drugs on: (a) the intensity of pain and progression of the rash during the acute phase of herpes zoster, and (b) the frequency, intensity, and duration of post-herpetic neuralgia. During the acute phase, antiviral drugs (acyclovir, valacyclovir and famcyclovir) significantly reduce the intensity of acute pain, accelerate the healing of the vesicular rash, and reduce the duration of viral excretion. According to some authors, these drugs taken at an early stage of the disease would help to prevent the development of post herpetic neuralgia. But for others, there is no convincing evidence that antiviral drugs reduce the risk of painful complications.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Age Factors; Aged; Antiviral Agents; Drug Administration Schedule; Drug Evaluation; Early Diagnosis; Famciclovir; Global Health; Herpes Zoster; Humans; Meta-Analysis as Topic; Middle Aged; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir; Valine

There is lack of consensus from randomized controlled trials on the efficacy of antivirals in the management of herpes zoster. Therefore, a systematic review and meta-analysis was undertaken to provide better understanding of effectiveness of antivirals in management of herpes zoster.. A total of 12 randomized controlled trials with 7,277 patients were included in the review. Trials compared one antiviral to another (aciclovir, valaciclovir, famciclovir or brivudin) for a minimum of 7 days in immunocompetent patients presenting with herpes zoster diagnosed within 72 h of symptom onset. Primary outcome was reduction in pain.. Compared with aciclovir, valaciclovir showed significant reduction in herpes-zoster-associated pain up to 112 days. The largest risk reduction in pain (36%) was seen at 21-30 days (relative risk [RR] 0.64, 95% CI 0.59, 0.70) with number needed to treat to benefit (NNT) of 3 (95% CI 2.7, 3.8). Famciclovir was also superior to aciclovir with a 46% reduction in risk of pain at 28-30 days (RR 0.54, 95% CI 0.48, 0.68) with NNT of 3 (95% CI 2, 5). Time to lesion healing and adverse effect profile was comparable.. Evidence from quality trials have shown significant reduction in risk of pain with valaciclovir and famciclovir for management of herpes zoster including ophthalmicus. Valaciclovir or famciclovir should be preferred treatment options in patients with herpes zoster as they both provide significant reduction in risk of herpes-zoster-associated pain. Furthermore, the superior pharmacokinetics and more convenient dosing regimens with the use of valaciclovir and famciclovir clearly make them the preferred treatment option.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Bromodeoxyuridine; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Pain Management; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Valacyclovir (VACV) is used increasingly to treat herpes zoster, although neuropsychiatric symptoms [VACV neurotoxicity (VAN) or acyclovir neurotoxicity], may accompany use of this drug. To promote awareness of this rare condition, we describe here two clinical cases of VAN we previously reported and review 20 cases from the literature. In all cases, chronic or acute renal failure preceded VAN. The symptoms of VAN varied, but disturbances of consciousness and hallucination occurred most commonly. When acute renal failure was due to the drug, recovery from both the disturbance of consciousness and renal failure followed within several days after discontinuation of VACV. Early recognition and diagnosis will ensure effective treatment of VAN.

Topics: Acute Kidney Injury; Acyclovir; Adult; Aged; Antiviral Agents; Consciousness Disorders; Female; Hallucinations; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Neurotoxicity Syndromes; Valacyclovir; Valine

Topics: Acetaminophen; Acyclovir; Administration, Oral; Adult; Aged; Analgesics, Non-Narcotic; Antiviral Agents; Chickenpox; Child, Preschool; Female; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Recurrence; Seroepidemiologic Studies; Valacyclovir; Valine

To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN).. The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence).. Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven.. Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Glucocorticoids; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Neuralgia, Postherpetic; Prednisolone; Time Factors; Valacyclovir; Valine

The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Anti-Inflammatory Agents; Antiviral Agents; Bromodeoxyuridine; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Immunocompromised Host; Valacyclovir; Valine

We have analysed zoster-associated pain treated with valaciclovir (VCV) in immunocompetent patients with acute herpes zoster over 6 months, and evaluated the safety of VCV. We know of no reports that evaluate postherpetic neuralgia (PHN) treated with VCV for 6 months. Predisposing factors that influence PHN were age (over 60 years), clustered vesicles, severity of eruption, sleep disturbance, and hypesthesia. Timing of the administration of VCV before or after the onset of rash did not influence the incidence of PHN. No serious adverse reactions were observed during the administration of VCV.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Immunocompetence; Kaplan-Meier Estimate; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Surveys and Questionnaires; Treatment Outcome; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Herpes Zoster Vaccine; Humans; United States; Valacyclovir; Valine

Viral skin infections are common findings in organ transplant recipients. The most important etiological agents are the group of human herpesviruses (HHV), human papillomaviruses (HPV), and molluscum contagiosum virus. HHV that are important in this group of patients are herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), HHV-6 and -7, and HHV-8, which causes Kaposi sarcoma (KS). HSV infections are characterized by their ability to establish latency and then reactivate at a later date. The most common manifestations of HSV infection in organ transplant recipients are mucocutaneous lesions of the oropharynx or genital regions. Treatment is usually with acyclovir, valaciclovir, or famciclovir. Acyclovir resistance may arise although the majority of acyclovir-resistant strains have been isolated from AIDS patients and not organ transplant recipients. In such cases, alternatives such as foscarnet, cidofovir, or trifluridine may have to be considered. VZV causes chickenpox as well as herpes zoster. In organ transplant recipients, recurrent herpes zoster can occur. Acute chickenpox in organ transplant patients should be treated with intravenous acyclovir. CMV infection occurs in 20-60% of all transplant recipients. Cutaneous manifestations, which include nonspecific macular rashes, ulcers, purpuric eruptions, and vesiculobullous lesions, are seen in 10-20% of patients with systemic infection and signify a poor prognosis. The present gold standard for treatment is ganciclovir, but newer drugs such as valganciclovir appear promising. EBV is responsible for some cases of post-transplant lymphoproliferative disorder, which represents the greatest risk of serious EBV disease in transplant recipients. HHV-6 and HHV-7 are two relatively newly discovered viruses and, at present, the body of information concerning these two agents is still fairly limited. KS is caused by HHV-8, which is the most recently discovered lymphotrophic HHV. Iatrogenic KS is seen in solid-organ transplant recipients, with a prevalence of 0.5-5% depending on the patient's country of origin. HPV is ubiquitous, and organ transplant recipients may never totally clear HPV infections, which are the most frequently recurring infections in renal transplant recipients. HPV infection in transplant recipients is important because of its link to the development of certain skin cancers, in particular, squamous cell carcinoma. Regular surve

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Cidofovir; Cytomegalovirus Infections; Cytosine; Drug Administration Schedule; Epstein-Barr Virus Infections; Famciclovir; Foscarnet; Herpes Zoster; Herpesviridae Infections; Humans; Immunocompromised Host; Molluscum Contagiosum; Organ Transplantation; Organophosphonates; Papillomavirus Infections; Skin Diseases, Viral; Trifluridine; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Secondary Prevention; Severity of Illness Index; Valacyclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Eye Infections, Viral; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine; Vitrectomy

Genital herpes is the most prevalent sexually transmitted infection in the USA. While sometimes mild in severity, it can be a distressing and painful chronic condition. Likewise, herpes labialis and herpes zoster can be both physically and psychologically painful. While there is no cure for these conditions, treatment to alleviate symptoms, suppress recurrences and reduce transmission has been drastically improved over the past 20 years with the use of guanine nucleoside antivirals, such as valacyclovir hydrochloride (Valtrex), GlaxoSmithKline) the highly bioavailable prodrug of acyclovir (Zovirax((R)), GlaxoSmithKline), and famciclovir (Famvir, Novartis), a highly bioavailable prodrug of penciclovir (Denavir, Novartis). Clinical trials involving approximately 10,000 patients (including patients from nongenital herpes studies, such as herpes zoster) have assessed the safety and efficacy of valacyclovir in the treatment of initial genital herpes outbreaks, episodic treatment of recurrent episodes and daily suppressive therapy. It was shown that valacyclovir has similar efficacy to acyclovir in the episodic and suppressive treatment of genital herpes. Valacyclovir is the only antiviral drug approved for a once-daily dose of suppressive therapy for genital herpes, as well as the only antiviral drug US FDA approved for a 3-day regimen of episodic treatment of recurrent genital herpes. In addition, valacyclovir is also indicated in the reduction of the sexual transmission of herpes simplex virus infection and for the treatment of herpes labialis. In herpes zoster, valacyclovir is more effective than acyclovir or placebo (and as equally effective as famciclovir) in shortening the length and severity of herpes zoster-associated pain and postherpetic neuralgia. Valacyclovir has an acceptable safety profile in patients with herpes simplex and herpes zoster. The less frequent dosing regimen makes it an attractive option in the treatment of genital herpes and other viral infections, and may contribute to increased patient adherence to therapy.

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Viral; Herpes Genitalis; Herpes Zoster; Humans; Recurrence; Valacyclovir; Valine

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Administration, Oral; Adult; Age Factors; Analgesics, Non-Narcotic; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Bromodeoxyuridine; Child; Drug Therapy, Combination; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Prodrugs; Risk Factors; Sex Factors; Time Factors; Vaccination; Valacyclovir; Valine

Antiviral agents play a key role in the prevention and treatment of varicella zoster virus (VZV) disease in immunosuppressed patients. Randomized trials show that aciclovir is effective in preventing VZV reactivation disease; however, no consensus exists on dose, duration and patient population for its use. The recent shortage of VZV-specific immunoglobulin has generated renewed interest in the use of antiviral agents as post-exposure prophylaxis. The use of antiviral agents for post-exposure prophylaxis is not supported by randomized trials, but uncontrolled experience suggests that it might be a reasonable alternative if varicella-specific immunoglobulin is not available. Current evidence on the use of antiviral agents in the prevention of reactivation disease and management of exposure to VZV is discussed.

Topics: Acyclovir; Antiviral Agents; Chemoprevention; Chickenpox; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Valacyclovir; Valine; Virus Activation

Topics: Acyclovir; Age Distribution; Antiviral Agents; Child; Diagnosis, Differential; Drug Therapy, Combination; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Morpholines; Primary Health Care; Prognosis; Risk Factors; Silver Sulfadiazine; Valacyclovir; Valine; Virus Activation; Virus Latency

Topics: Acetates; Acyclovir; Age Factors; Aged; Aged, 80 and over; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Earache; Fever; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Oxycodone; Pain; Patient Selection; Polymerase Chain Reaction; Risk Factors; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Amines; Antidepressive Agents, Tricyclic; Antiviral Agents; Arabinofuranosyluracil; Cyclohexanecarboxylic Acids; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Neuralgia; Valacyclovir; Valine

Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary infection varicella. Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with pain of varying intensity. Currently, several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of postherpetic neuralgia in elderly patients. The effects of all antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute herpes zoster pain. Valaciclovir (valacyclovir), famciclovir and brivudine (brivudin) are comparably effective in the reduction of the incidence and/or prevention of zoster-associated pain and postherpetic neuralgia. Brivudine 125mg once daily is as effective as famciclovir 250mg three times daily in reducing the prevalence and the duration of zoster-associated pain and postherpetic neuralgia, especially if therapy is combined with a structured-pain therapy. The intensity of the therapy for pain should depend on the intensity of the pain that it is treating. Famciclovir and brivudine offer an advantage over other antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore, antiviral therapy in combination with adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.

Topics: 2-Aminopurine; Acyclovir; Age Factors; Aged; Analgesics; Antiviral Agents; Bromodeoxyuridine; Drug Therapy, Combination; Famciclovir; Herpes Zoster; Humans; Neuralgia; Pain Measurement; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antifungal Agents; Antiprotozoal Agents; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Antiviral Agents; Atovaquone; Azithromycin; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Mycobacterium avium-intracellulare Infection; Mycoses; Naphthoquinones; Pneumonia, Pneumocystis; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Valacyclovir; Valine

After herpes zoster, immunocompetent persons frequently experience chronic pain and considerable suffering. Zoster-associated pain has a complex pathophysiology that begins with viral damage and increased sensitization of peripheral sensory neurons. The enhanced afferent barrage from these neurons sensitizes spinal neurons and leads to loss of synapses from descending inhibitory fibers, resulting in central neuropathic pain and allodynia. Antiviral therapy of acute zoster limits this sequence of pathophysiologic mechanisms. There is no clear consensus regarding the optimal means of determining the benefits of antiviral therapy in the management of pain of herpes zoster. A novel statistical approach utilizing rates of disappearance of pain of differing pathophysiologic mechanisms is proposed.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Antiviral Agents; Chronic Disease; Clinical Trials as Topic; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Meta-Analysis as Topic; Pain; Pain Measurement; Proportional Hazards Models; Treatment Outcome; Valacyclovir; Valine

Genital herpes is prevalent and sometimes debilitating. Likewise, herpes zoster ('shingles') can be painful and often disabling. The treatment of these conditions has been advanced over the past two decades by the introduction of guanosine nucleoside antivirals such as valacyclovir (Valtrex), Glaxo Wellcome), the highly bioavailable prodrug of acyclovir (Zovirax), Glaxo Wellcome). This review describes the pharmacology, pharmacokinetics, clinical efficacy and tolerability of valacyclovir and considers its clinical attributes in the context of those of the antivirals, acyclovir and famciclovir (Famvir), SmithKline Beecham). The data demonstrate that valacyclovir is more effective than placebo and as effective as other antivirals in the episodic and suppressive treatment of recurrent genital herpes. Valacyclovir is the only antiviral shown to be effective with a short (3-day) course in the episodic treatment of recurrent genital herpes, as well as with once-daily dosing for daily suppressive therapy. In herpes zoster, valacyclovir is as effective as famciclovir and more effective than either placebo or acyclovir at facilitating cutaneous healing and healing of zoster-associated pain and post-herpetic neuralgia. Valacyclovir is well tolerated, with convenient dosing frequencies for the treatment of genital herpes or herpes zoster, it also has the option for use as a short course therapy in the episodic treatment of recurrent genital herpes, all of which are important benefits in the management of these conditions.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Headache; Herpes Genitalis; Herpes Zoster; Humans; Nausea; Secondary Prevention; Tissue Distribution; Treatment Outcome; Valacyclovir; Valine

Varicella zoster virus (VZV), the pathogen responsible for herpes zoster, belongs to the herpesvirus family and is sensitive to the antiviral drug aciclovir. However, the low oral bioavailability of aciclovir has to some extent limited its efficacy in the treatment of herpes zoster and has prompted the development of the more readily absorbed oral prodrug valaciclovir. In a large comparative study valaciclovir, (1000 mg 3 times daily for 7 days) was at least as effective as aciclovir (800 mg 5 times daily for 7 days) in controlling the symptoms of acute herpes zoster. Importantly, valaciclovir alleviated zoster-associated pain and postherpetic neuralgia significantly faster than aciclovir. A 14-day regimen of valaciclovir showed no significant advantage over the 7-day regimen. A smaller trial in Japanese patients focusing primarily on the cutaneous (rash) signs of herpes zoster confirmed the similar efficacy of valaciclovir and aciclovir in the 7-day regimen. This study did not follow all patients for a formal analysis of postherpetic neuralgia. Valaciclovir and aciclovir demonstrated similar efficacy for the control of cutaneous lesions and ocular complications in patients with zoster ophthalmicus. Preliminary results of a large controlled trial indicate that valaciclovir 1000 mg 3 times daily and famciclovir (the prodrug of penciclovir) 500 mg 3 times daily are of similar efficacy in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia. Starting treatment later than 72 hours after rash onset did not significantly reduce the beneficial effect of valaciclovir on duration of zoster-associated pain (a continuum of pain that encompasses both acute pain and postherpetic neuralgia) in a large observational study, suggesting that valaciclovir might be effective when given later than previously thought. However, valaciclovir should ideally be given as soon as possible after symptoms appear. With the recommended regimen for the treatment of herpes zoster (1000 mg 3 times daily for 7 days) valaciclovir was well tolerated, with nausea and headache being the most commonly reported adverse events. The adverse events profile of the agent was similar to that seen with aciclovir or famciclovir.. The efficacy of valaciclovir for the treatment of herpes zoster has been confirmed and extended by follow-up studies in herpes zoster ophthalmicus, in Japanese patients, and in the wider primary care setting. Valaciclovir is at least equivalent to, and better in certain parameters than, aciclovir and appears to have similar efficacy to famciclovir 500 mg 3 times daily. Valaciclovir is a well tolerated first-line therapy with an established place in the treatment of immunocompetent patients with herpes zoster.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Valacyclovir; Valine

With the US population aging steadily, herpes zoster represents a growing contributor to diminished quality of life. Dermatologic manifestations appear as immunity declines with age but rarely pose a significant threat, except in instances when ocular structures are involved. Pain is of more concern, because it usually accompanies and may even precede and persist after acute eruptions. In most young patients, pain is transient and bearable. Unfortunately, in the elderly--who are at highest risk for herpes zoster--pain is often more prolonged and more intense. In spite of a wide spectrum of interventions, palliative efforts remain rather ineffectual. At present, intervening as early as possible, ideally within 48 to 72 hours of disease onset, offers the greatest chance of minimizing neurologic sequelae. Inoculation with varicella vaccine in patients between ages 55 and 65 may prove to boost cell-mediated immunity sufficiently so that recrudescence of the varicella virus can be relegated to the annals of history.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Antiviral Agents; Chronic Disease; Famciclovir; Herpes Zoster; Humans; Neuralgia; Risk Factors; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Herpes Genitalis; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

The past several years have provided exciting advances in the management of herpes zoster in the normal host. In spite of these advances, a significant portion of zoster patients still have persistent complications from this disease. Persistent pain is the most debilitating sequela and it occurs in at least 15% of individuals over 50 years of age. Future research efforts must embrace alternative approaches for pain control.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Pain; Prednisone; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Chickenpox; Famciclovir; Guanine; Herpes Zoster; Humans; Immunocompromised Host; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Child; Child, Preschool; Diagnosis, Differential; Famciclovir; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpes Zoster Oticus; Humans; Immunocompromised Host; Infant; Infant, Newborn; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Genitalis; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

Herpes simplex virus and varicella-zoster virus are common infections and are seen frequently in clinical practice. Infection with these viruses results in cutaneous lesions that may be diagnosed clinically, but widely available laboratory testing is useful for confirmation. Asymptomatic herpes simplex virus shedding, or "subclinical reactivation," likely occurs in all persons infected with herpes simplex virus and results in the transmission of virus despite the absence of signs or symptoms that suggest active infection. Oral and intravenous acyclovir are effective in treating initial and recurrent herpes simplex and varicella-zoster virus infections. The daily administration of oral acyclovir as suppressive therapy is effective in patients with frequently recurring genital infection with herpes simplex virus by reducing the number of symptomatic recurrences and the frequency of asymptomatic virus shedding. Two new antiviral agents, famciclovir and valacyclovir hydrochloride, have been approved for the short-term treatment of recurrent genital herpes simplex virus and recurrent zoster in nonimmunocompromised hosts. Famciclovir and valacyclovir demonstrate superior pharmacokinetics compared with acyclovir and allow for less frequent daily dosing with higher achievable serum drug concentrations. The attenuated live varicella virus vaccine is now available in the United States and prevents primary varicella-zoster virus infection in susceptible children and adults.

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Chickenpox; Child; Famciclovir; Female; Herpes Simplex; Herpes Zoster; Humans; Male; United States; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Biological Availability; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Valacyclovir; Valine

Antiviral treatment of herpesvirus infections is rapidly changing since the advent of new drugs with improved oral availability. The efficacy of valaciclovir, the prodrug of aciclovir, and famciclovir, the prodrug of penciclovir, in the treatment of herpes genitalis and acute herpes zoster has been well documented in large clinical trials. Both drugs are effective on zoster-associated pain. Brivudin and sorivudine which are the most active compounds against varicella-zoster virus (VZV) in cell culture have also been successful in the treatment of herpes zoster. Aciclovir is still the standard therapy of severe herpes simplex virus (HSV) and varicella virus infections. In patients treated with aciclovir, the mortality of herpes encephalitis has been reduced to about 25%. The development of resistance against aciclovir and the other nucleoside analogues has not been a problem to date in the treatment of immunocompetent individuals. However, in immunocompromised patients, aciclovir-resistant HSV strains often emerge. In such cases, intravenous foscarnet is the current treatment of choice.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Arabinofuranosyluracil; Bromodeoxyuridine; Chickenpox; Drug Resistance, Microbial; Encephalitis, Viral; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Prodrugs; Simplexvirus; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Genitalis; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: Acyclovir; Animals; Antiviral Agents; Herpes Zoster; Herpesviridae Infections; Humans; Prodrugs; Valacyclovir; Valine

Valaciclovir, the L-valyl ester of aciclovir (acyclovir), is an oral prodrug that undergoes rapid and extensive first-pass metabolism to yield aciclovir and the essential amino acid L-valine. Aciclovir, the active antiviral component of valaciclovir, shows good in vitro activity against the herpesviruses herpes simplex virus (HSV)-1, HSV-2 and varicella zoster virus. The bioavailability of aciclovir from oral valaciclovir is considerably greater than that achieved after oral aciclovir administration. Thus, valaciclovir delivers therapeutic aciclovir concentrations when administered in a less frequent oral dosage regimen than is required for aciclovir. Valaciclovir is an effective treatment for herpes zoster in immunocompetent adults. In a large comparative study that included patients > or = 50 years of age, valaciclovir (1000mg 3 times daily for 7 or 14 days) and oral aciclovir (800mg 5 times daily) were equally effective in achieving resolution of cutaneous zoster lesions. Importantly, valaciclovir was significantly more effective than aciclovir in reducing the duration of zoster-associated pain. Preliminary results of several studies indicate that valaciclovir (500 to 1000mg twice daily for 5 to 10 days) is as effective as aciclovir (200mg 5 times a day for 5 to 10 days) in the treatment of genital herpes. In patients with first or recurrent episodes of genital herpes, valaciclovir reduced the duration of viral shedding, hastened lesion healing and decreased lesion-associated pain. Valaciclovir was also effective in suppressing recurrent episodes of genital herpes and significantly prolonged the time to a recurrent episode of infection compared with placebo. Valaciclovir is a well tolerated drug; in herpes zoster and HSV studies its tolerability profile was similar to that of aciclovir or placebo. Valaciclovir represents and advance in antiherpes drug therapy and is a useful treatment option for patients with herpes zoster or genital herpes. It is at least as effective as aciclovir and is administered in a more convenient oral dosage regimen. Thus, valaciclovir may ultimately succeed aciclovir as a first-line treatment for genital herpes or herpes zoster.

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Drug Resistance, Microbial; Drug Tolerance; Herpes Genitalis; Herpes Zoster; Herpesviridae; Herpesviridae Infections; Humans; Middle Aged; Recurrence; Valacyclovir; Valine

Until recently aciclovir has been the only licensed drug for the treatment of herpes zoster. A number of new drugs have emerged over the past few years which offered the potential for improved efficacy or ease of administration. With the completion of the first efficacy trials for each of these agents it has become apparent that, whilst less frequent dosing can he accomplished, it is not easy to significantly improve on the efficacy of aciclovir. Increasing age, the presence of prodromal pain and more severe pain at presentation have, however, been found to predispose to a longer duration of pain. Taking cessation of pain as the single most important parameter, at least for the older immunocompetent population as a whole, only valaciclovir has, to date, been shown to be superior to standard therapy with aciclovir. This review utilises primarily intent-to-treat data to illustrate the relative efficacy of the different therapies.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Arabinofuranosyluracil; Controlled Clinical Trials as Topic; Drug Approval; Famciclovir; Herpes Zoster; Humans; Prodrugs; Treatment Outcome; United States; Valacyclovir; Valine

Oral administration of the prodrug valacyclovir results in enhanced bioavailability and significantly greater plasma concentrations of acyclovir than can be achieved with oral doses of acyclovir itself. The results of clinical trials with valacyclovir have demonstrated significant benefits in the resolution of pain associated with herpes zoster infection. Efficacy parameters were similar for valacyclovir and acyclovir in the treatment of herpes simplex; however the results were achieved with lower and less-frequent doses of valacyclovir. The cost of a course of therapy with valacyclovir is expected to be similar to that of other antivirals. The potential clinical benefits of valacyclovir will likely be apparent in the case of acyclovir-resistant herpesvirus infections, where high-dose intravenous treatment with acyclovir has been necessary. Most of these resistant viruses have been encountered in immunocompromised patients, and the resistance has been attributed to inadequate exposure to the drug. Because optimal levels of acyclovir are achieved with a simpler dosing regimen of valacyclovir, compliance may be improved in many patients, thus reducing the incidence of resistant virus.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Clinical Trials as Topic; Herpes Genitalis; Herpes Zoster; Humans; Male; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Arabinofuranosyluracil; Chickenpox; Drug Resistance, Microbial; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine

Herpes zoster is a serious medical problem, not only because of the discomfort associated with the acute rash, but also because of the potential for post-herpetic neuralgia. Acyclovir is currently the antiviral drug of choice for the treatment of herpes zoster. Efforts are underway to develop new drugs that have improved activity against varicella-zoster virus as well as more favorable pharmacokinetic properties. The goal of these efforts is to develop an orally administered antiviral drug that will accelerate the events of cutaneous healing as well as reduce the frequency and severity of post-herpetic neuralgia. Investigational drugs currently under evaluation include valaciclovir and famciclovir, the prodrugs of acyclovir and penciclovir, respectively. Two new uracil derivatives, sorivudine and BW882C87, with increased anti-varicella-zoster virus activity in vitro are also being studied.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Arabinofuranosyluracil; Drugs, Investigational; Famciclovir; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

The purpose of this study was to describe the rationale and design of the Zoster Eye Disease Study (ZEDS).. ZEDS is a National Eye Institute-supported randomized clinical trial designed to determine whether 1 year of suppressive valacyclovir in patients with herpes zoster ophthalmicus (HZO) reduces complications because there is currently no high-quality evidence to support its use. Eligible patients are 18 years and older, immunocompetent, have a history of a typical rash at disease onset, and have had a record of active epithelial or stromal keratitis or iritis within 1 year before enrollment. Exclusion criteria include estimated glomerular filtration rate less than 45 or pregnancy. The primary endpoint is the time to first occurrence of new or worsening dendriform epithelial keratitis, stromal keratitis without or with ulceration, endothelial keratitis, or iritis due to HZO during 12 months of study treatment requiring prespecified treatment changes. The study has 80% power to detect a 30% difference between treatment groups, with a 30% rate of endpoints by 1 year assumed among controls. Secondary and exploratory questions include whether there is a persistent treatment benefit during the 6 months after treatment, whether development of postherpetic neuralgia varies by treatment group, and whether vaccinations against herpes zoster affect study outcomes and coronavirus disease 19 status.. Over approximately 4 years, over 400 study participants have been enrolled.. ZEDS aims to provide scientific evidence on whether suppressive valacyclovir treatment improves outcomes in HZO and should become the standard of care.

Topics: Antiviral Agents; COVID-19; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Neuralgia, Postherpetic; Valacyclovir

Amenamevir is a potent helicase-primase inhibitor and a novel class of antiviral agent other than nucleoside compounds, such as aciclovir, valaciclovir and famciclovir. This study is the first randomized, double-blind, valaciclovir-controlled phase 3 study to evaluate the efficacy and safety of amenamevir in Japanese patients with herpes zoster when treated within 72 h after onset of rash. A total of 751 patients were randomly assigned to receive either amenamevir 400 mg or 200 mg p.o. once daily or valaciclovir 1000 mg three times daily (daily dose, 3000 mg) for 7 days. The primary efficacy end-point was the proportion of cessation of new lesion formation by day 4 ("day 4 cessation proportion"). The day 4 cessation proportions for amenamevir 400 and 200 mg and valaciclovir were 81.1% (197/243), 69.6% (172/247) and 75.1% (184/245), respectively. Non-inferiority of amenamevir 400 mg to valaciclovir was confirmed by a closed testing procedure. Days to cessation of new lesion formation, complete crusting, healing, pain resolution and virus disappearance were evaluated as secondary end-points. No significant differences were observed in any of the treatment groups. Amenamevir 400 and 200 mg were well tolerated as well as valaciclovir. The proportions of patients who experienced drug-related adverse events were 10.0% (25/249), 10.7% (27/252) and 12.0% (30/249) with amenamevir 400 and 200 mg and valaciclovir, respectively. In conclusion, amenamevir 400 mg appears to be effective and well tolerated for treatment of herpes zoster in immunocompetent Japanese patients.

Topics: Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Oxadiazoles; Treatment Outcome; Valacyclovir; Valine

This prospective, parallel-group, randomized, double-blind, multicenter study compared the efficacy and safety of FV-100 with valacyclovir for reducing pain associated with acute herpes zoster (HZ). Patients, ≥50 years of age, diagnosed with HZ within 72 h of lesion appearance who had HZ-associated pain, were randomized 1:1:1 to a 7-day course of either FV-100 200 mg QD (n = 117), FV-100 400 mg QD (n = 116), or valacyclovir 1000 mg TID (n =117). Efficacy was evaluated on the basis of the burden of illness (BOI; Zoster Brief Pain Inventory scores); incidence and duration of clinically significant pain (CSP); pain scores; incidence and severity of post-herpetic neuralgia (PHN); and times to full lesion crusting and to lesion healing. Safety was evaluated on the basis of adverse event (AE)/SAE profiles, changes in laboratory and vital signs values, and results of electrocardiograms. The burden of illness scores for pain through 30 days were 114.5, 110.3, and 118.0 for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg, respectively. The incidences of PHN at 90 days for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg were 17.8%, 12.4%, and 20.2%, respectively. Adverse event and SAE profiles of the two FV-100 and the valacyclovir groups were similar and no untoward signals or trends were evident. These results demonstrate a potential for FV-100 as an antiviral for the treatment of shingles that could both reduce the pain burden of the acute episode and reduce the incidence of PHN compared with available treatments.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Cost of Illness; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Pain Management; Prospective Studies; Pyrimidine Nucleosides; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition.. Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions).. Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons.. ISRCTN Registry identifier: ISRCTN79871784 . Registered on 2 May 2013.

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Clinical Protocols; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Quality of Life; Research Design; Sleep; Spain; Surveys and Questionnaires; Time Factors; Treatment Outcome; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is a sequela of herpes zoster that adversely affects quality of life seriously. The risk factors for PHN are well known but the effective interventions that reduce the incidence of PHN are less studied. The objective of this study is to evaluate the efficacy of treatment with gabapentin in patients with acute herpes zoster for preventing PHN. We performed a prospective randomized controlled study of 120 participants diagnosed with acute herpes zoster, aged 50 and over and complaining moderate to severe pain. All patients were treated with valacyclovir and acetaminophen. Half of the participants were assigned to the gabapentin group and received gabapentin 300 mg three times a day additionally. The intensity of pain at every visit and the incidence of PHN in both groups were measured. Total 52 and 49 patients in the gabapentin group and the control group, respectively, had completed 12 weeks of follow-up period. Although the incidence of PHN was higher in the control group, the difference was not statistically significant (6.1% vs. 3.8%, p = 0.67). Our results indicate that the use of low-dose gabapentin in acute herpes zoster seems not effective in the prevention of PHN.

Topics: Acetaminophen; Acyclovir; Aged; Aged, 80 and over; Amines; Analgesics; Analgesics, Non-Narcotic; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Quality of Life; Republic of Korea; Time Factors; Treatment Outcome; Valacyclovir; Valine

To evaluate the clinical efficacy of intradermal injection of methylene blue for treatment of moderate to severe acute thoracic herpes zoster and prevention of postherpetica neuralgia in elderly patients.. Sixty-four elderly patients with herpes zoster were randomized to receive a 10-day course of intradermal injection of methylene blue and lidocaine plus oral valaciclovir (group A, 32 cases) and intradermal injection of lidocaine plus oral valaciclovir (group B).Herpes evaluation index, pain rating index, incidence of postherpetic neuralgia, and comprehensive therapeutic effect were compared between the two groups at 11, 30 and 60 days after the treatment.. The baseline characteristics were comparable between the two groups (all P>0.05). Compared with that in group B, the time for no new blister formation, blister incrustation and decrustation, and pain relief was significantly shortened in group A (P<0.05) with also obviously lower pain intensity after the treatment. The incidence of postherpetic neuralgia was significantly lower in group A than in group B at 30 days (P<0.05), but not at 60 and 90 days after the treatment. The total clinical response rate was 93.8% in group A, much higher than that in group B (62.5%, P<0.05).. Intradermal injection of methylene blue can effectively shorten the disease course, reduce the pain intensity and prevent the development of postherpetic neuralgia in elderly patients with herpes zoster.

Topics: Acyclovir; Aged; Herpes Zoster; Humans; Incidence; Injections, Intradermal; Lidocaine; Methylene Blue; Neuralgia, Postherpetic; Pain Measurement; Valacyclovir; Valine

Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77 ± 4.88/mm vs. 13.29 ± 5.74/mm, p = 0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43 ± 2.35/mm and 2.8 ± 2.86/mm, p = 0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7 ± 2.05/mm vs. 14.72 ± 6.13/mm, p = 0.011) compared with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclusion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Biomarkers; Biopsy; Bromodeoxyuridine; Famciclovir; Female; Herpes Zoster; Humans; Immunohistochemistry; Male; Middle Aged; Nerve Fibers; Neuralgia, Postherpetic; Skin; Ubiquitin Thiolesterase; Valacyclovir; Valine

Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster-associated pain including post-herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2-3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3-4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.

Topics: 2-Aminopurine; Acute Pain; Acyclovir; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Asian People; Famciclovir; Female; Herpes Zoster; Humans; Immunocompetence; Japan; Male; Middle Aged; Pain Measurement; Valacyclovir; Valine

Herpes zoster is a common infectious disease that can result in significant acute and chronic morbidity. The safety and efficacy of once-daily oral valomaciclovir (EPB-348) was evaluated for non-inferiority to 3-times daily valacyclovir, an approved therapy. In this study, 373 immunocompetent adults with onset of a herpes zoster rash within the preceding 72 hr were randomly assigned to receive one of four treatments for 7 days: (1) EPB-348 1,000 mg once-daily; (2) EPB-348 2,000 mg once-daily; (3) EPB-348 3,000 mg once-daily; or (4) valacyclovir 1,000 mg 3-times daily. A 20% margin was the reference for non-inferiority assessment. For the primary efficacy measure of time to complete crusting of the zoster rash by Day 28, non-inferiority criteria were met for once-daily EPB-348 2,000 mg and once-daily EPB-348 3,000 mg compared to 3-times daily valacyclovir. Additionally, EPB-348 3,000 mg significantly shortened the time to complete rash crusting by Day 28 compared to valacyclovir. For secondary efficacy measures, non-inferiority was achieved for the EPB-348 1,000 and 2,000 mg groups compared to the valacyclovir group for time to rash resolution by Day 28. No EPB-348 group was non-inferior to valacyclovir for time to cessation of new lesion formation or time to cessation of pain by Day 120, though no significant differences occurred between treatment groups. Nausea, headache, and vomiting were the most common adverse events. Based on these results, additional studies are warranted to define further EPB-348's potential as an effective and safe therapy for acute herpes zoster.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Double-Blind Method; Female; Guanine; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Middle Aged; Treatment Outcome; Valacyclovir; Valine

Reactivation of latent VZV remains a significant cause of morbidity after SCT. Twenty-five percent or more of patients undergoing SCT will experience zoster within the first year after transplant. Short-course (<1 year) prophylaxis with acyclovir has been shown to be effective, but compliance with five times daily dosing may be problematic. We conducted a randomized, double-blind, placebo-controlled trial of valacyclovir (VACV) 1000 mg twice daily from 4 through 24 months after SCT for the prevention of VZV. Fifty-three VZV-seropositive transplant recipients (17 auto-SCT, 36 allo-SCT) were randomized at a median of 163 days after SCT. In a modified intent-to-treat analysis of 49 patients who took study drug, 0 of 22 in the VACV arm experienced zoster reactivation, compared with 6 of 26 (23%) in the placebo arm (P=0.025). Thirty-two subjects completed therapy through the second year post transplant or first episode of zoster. Adverse events resulting in discontinuation were more frequent in the placebo group (5 of 26 vs 3 of 27 for placebo and study drug, respectively). VACV at a dose of 1000 mg twice daily through 24 months after transplant is well tolerated and effective in suppressing shingles after SCT.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Double-Blind Method; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Male; Middle Aged; Recurrence; Time Factors; Valacyclovir; Valine

Varicella zoster virus (VZV) disease is a frequent complication after allogeneic hematopoietic stem cell transplantation (HSCT).  We carried out a trial of 1-year low-dose valacyclovir (VCV) prophylaxis against VZV disease to evaluate its efficacy and safety. Patients received oral acyclovir (ACV) 1000mg/day until day 35 after HSCT. Oral VCV 500mg/day, 3 times a week, was started on day 36 and continued until 1 year after HSCT. The development of VZV disease was monitored until 2 years after HSCT. A total of 40 patients with a median age of 43 years were enrolled. VCV was well tolerated in all but 1 patient who discontinued it on day 224 because of thrombocytopenia of unknown cause. Seven patients developed VZV disease at a median of 479 days (range 145-651) after HSCT, with a cumulative incidence of 18.5%. Two patients developed breakthrough disease during VCV prophylaxis. The other 5 patients developed VZV disease after the discontinuation of VCV, and 3 of these had developed extensive chronic graft-versus-host disease. Visceral involvement and serious complications were completely eliminated. All patients responded to the therapeutic dose of VCV or ACV. One-year low-dose VCV can be safely and effectively administered for the prevention of VZV disease after allogeneic HSCT.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Prospective Studies; Risk Factors; Transplantation, Homologous; Treatment Outcome; Valacyclovir; Valine

A phase 2 trial was conducted to evaluate the efficacy of a topical antiviral, sorivudine, as an adjuvant to valacyclovir for the treatment of acute herpes zoster.. In this randomized, placebo-controlled, double-blind trial, 25 patients were treated with either sorivudine or placebo cream. All patients began 7 days of valacyclovir treatment on day 3. Zoster lesion swab samples and samples of peripheral blood mononuclear cells were collected periodically throughout the study and were analyzed for varicella-zoster virus (VZV) DNA by use of both qualitative and real-time polymerase chain reaction. Serum samples collected periodically throughout the study were analyzed for VZV DNA by use of real-time polymerase chain reaction.. VZV DNA was detected in all 3 sample types, and the number of viral copies correlated with the progression of herpes zoster. No statistically significant differences were seen between the placebo- and sorivudine-treated groups with respect to clinical characteristics or laboratory test results.. The detection of VZV DNA in the serum and peripheral blood mononuclear cells of all 25 zoster patients documents that viremia is a common manifestation of herpes zoster. Sorivudine cream appears to be a safe and well-tolerated adjuvant therapy; however, further phase 2 studies are needed to determine its clinical efficacy for the treatment of herpes zoster. Trials registration. ClinicalTrials.gov identifier: NCT00652184.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; DNA, Viral; Double-Blind Method; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Patient Selection; Placebos; Valacyclovir; Valine; Viremia

To observe the clinical therapeutic effect of electroacupuncture (EA) of Jiaji (EX-B 2) plus focus-encircled needling for promoting the crust formation of herpes zoster and analgesia.. Eighty cases of herpes zoster patients were equally randomized into EA group [treated with EA of Ashi-point, Jiaji (EX-B 2), Zhigou (SJ 6) and Houxi (SI 3), once daily for 10 times] and medication group (treated with valaciclovir hydrochloride 300 mg/time, b. i. d. and vitamin B1 10 mg/time, t.i.d., 10 days). The pain severity was evaluated by using visual analogous scale (VAS) method. The time when the cutaneous scabbing area was equal or over 50% was recorded.. After the treatment, of the two 40 cases in EA and medication groups, 30 (75.0%) and 15 (37.5%) were cured, 7 (17.5%) and 12 (30.0%) improved, 3 (7.5%) and 13 (32.5%) failed, with the total effective rates being 92.5% and 67.5%, respectively. The therapeutic effect of EA was significantly superior to that of medication (P < 0.01). VAS scores of both groups reduced significantly (P < 0.01). Both the VAS score and the crust formation time of EA group were significantly lower than those of medication group (P < 0.01).. EA of Jiaji (EX-B 2) in combination with focus-encircled needling is effective in facilitating the crust formation and pain relief in the treatment of herpes zoster, and the effect of acupuncture is superior to that of medication.

Topics: Acupuncture Points; Acupuncture Therapy; Acyclovir; Adolescent; Adult; Aged; Electroacupuncture; Female; Herpes Zoster; Humans; Male; Middle Aged; Valacyclovir; Valine

To study the therapeutic effect of integrative medicinal therapy with Qinzhu Liangxue Mixture (QLM) in combined with valaciclovir on herpes zoster (HZ) in middle and old aged patients.. Ninety-seven HZ patients were randomly assigned to three groups and treated respectively with QLM alone (A), valaciclovir alone (B) and QLM plus valaciclovir (C). Times for stopping newly appeared blisters, scabbing relieving pain, and curing, as well as incidence rate of postherpetic neuralgia (PHN) after treatment were evaluated. Patients' symptoms and signs were scored before and after treatment.. Time for appeaed newly blister and scabbing was shorter in Group B than in Group A; time for relieving pain and curing was shorter in Group C than in Group A; and the PHN incidence rate in Group C was the lowest.. Valaciclovir can control the skin rash of HZ with quicker initiating time, and QLM can effectively relieve pain, the combined use with the two drugs can decrease the incidence rate of PHN availably.

Topics: Acyclovir; Aged; Analgesics; Antiviral Agents; Drug Therapy, Combination; Drugs, Chinese Herbal; Herpes Zoster; Humans; Integrative Medicine; Middle Aged; Valacyclovir; Valine

A dosage of 1 g of valacyclovir 3 times per day (TID) for 7 days has already been shown to be superior to an oral dosage of 800 mg acyclovir 5 times per day for 7 days in immunocompetent individuals. The objective of this study was to assess the safety and efficacy of an oral dosage of valacyclovir, 1 g TID versus 2 g TID, for the treatment of herpes zoster in immunocompromised patients > or =18 years of age. The oral dosage schedule of 2 g of valacyclovir TID reaches acyclovir plasma levels similar to those achieved with intravenous acyclovir therapy given to immunocompromised patients (10 mg/kg every 8 h for 7 days). In this double-blind study, 87 immunocompromised patients with clinical evidence of localized herpes zoster were randomized to receive oral valacyclovir therapy for 7 days, either 1 g TID or 2 g TID, within 72 h after onset of zoster rash. Patients were seen and assessed for cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated abnormal sensations (ZAAS), up to 24 weeks. Participants in both arms of the study demonstrated similar median times to full crusting of the rash (8 days), and both dosages were safe and effective therapies for reduction of ZAP and ZAAS in the immunocompromised patient population.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Middle Aged; Safety; Valacyclovir; Valine

Valacyclovir was administered to 28 immunocompromised children (ages 5-12 years) to obtain preliminary pharmacokinetic and safety information. Patients were randomized to valacyclovir regimens of 250 mg (9.4-13.3 mg/kg) or 500 mg (13.9-27.0 mg/kg) twice daily or 500 mg (13.2-21.7 mg/kg) 3 times a day. Acyclovir pharmacokinetics were evaluated at steady state. Valacyclovir was rapidly absorbed and converted to acyclovir. Mean (+/-SD) acyclovir peak concentrations from 250 mg and 500 mg valacyclovir were 4.11+/-1.41 and 5.19+/-1.96 microg/mL, respectively. Corresponding single dose area-under-curve values were 12.14+/-6.60 and 14.49+/-4.69h microg/mL. By using historical data for intravenous acyclovir as reference, the overall estimate of acyclovir bioavailability from valacyclovir was 48%, 2- to 4-fold greater than for oral acyclovir. In general, adverse events were not attributable to valacyclovir and were consistent with disease-related expectations and concomitant therapies. Dosage options for using valacyclovir in children are discussed.

Topics: Acyclovir; Administration, Oral; Analysis of Variance; Area Under Curve; Belgium; Biological Availability; Child; Child, Preschool; Female; France; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Male; Pilot Projects; Prodrugs; Switzerland; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Gastrointestinal Diseases; Headache; Herpes Zoster; Humans; Middle Aged; Nausea; Neuralgia; Pain; Prospective Studies; Time Factors; Treatment Outcome; Valacyclovir; Valine

Acyclovir, a specific and selective inhibitor of the replication of Herpesviridae family, has well-documented efficacy and tolerability in the treatment of herpes zoster. Its limited oral bioavailability and short half-life, however, necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, could be rapidly converted to acyclovir after oral administration, resulting in a three- to five-fold increase in acyclovir bioavailability compared with oral acyclovir in humans. Valaciclovir allows less frequent dosing and maintains the safety profiles of the parent drug. During the period from October 1996 through May 1998, a randomized, prospective study was performed in the Kaohsiung Veterans General Hospital to compare the safety and efficacy of valaciclovir with acyclovir in the treatment of herpes zoster in Taiwanese patients. Patients presenting with herpes zoster within 72 h after the onset of rash were enrolled and randomized to receive one of the following treatments: 1000 mg valaciclovir three times daily for 7 days or acyclovir 800 mg five times daily for 7 days. Patients were followed up for 29 days beginning with the start of therapy. A total of 57 patients were enrolled and randomized to receive valaciclovir (n = 32) or acyclovir (n = 25). Five patients in the valaciclovir group and three in the acyclovir group did not complete the study. The intent-to-treat analysis (57 patients) showed that valaciclovir significantly accelerated the resolution of herpes zoster-associated pain compared with acyclovir; on day 29, the valaciclovir group was 23% superior to the acyclovir group. There was no clinically significant difference in the nature, frequency or severity of adverse events between these two groups, although one and three adverse events were reported in the acyclovir and valaciclovir group, respectively. Thus, we conclude that in the management of herpes zoster, valaciclovir accelerates the resolution of pain and offers a simpler dosing, and maintains the favorable safety profile of acyclovir.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Prospective Studies; Valacyclovir; Valine

We examined the incidence of herpes varicella-zoster virus (VZV) infection in 151 patients undergoing allogeneic BMT between August 1990 and September 1997 and who survived at least 3 months. Median follow-up was 17 (range 3.3-80.7) months. Herpes simplex virus antibody positive (HSV+) patients received aciclovir 1200 mg p.o. daily or 750 mg i.v. daily, in divided doses from day 0 to engraftment. Ganciclovir (5 mg/kg i.v. three times per week) was given in CMV+ patients (or if the donor was CMV+) from engraftment to day 84. Ganciclovir was continued or recommenced if a dose of greater than 20 mg of prednisone was used for the treatment of GVHD otherwise aciclovir was recommenced. In HSV+ patients not receiving ganciclovir, aciclovir 600 mg p.o. daily in divided doses was given until at least 6 months after BMT. Thirty-two patients developed VZV infection from 4.1 to 28 months after transplant. The estimated cumulative incidence of VZV was 13% (95% confidence interval 6-19%) at 12 months, 32% (22-42%) at 24 months and 38% (27-50%) at 28 months, with no further cases beyond that time. No patient developed VZV whilst receiving aciclovir or ganciclovir (P < 0.0001). However, there was a rapid onset of VZV following cessation of antiviral therapy (33% (20-46%) at 1 year post cessation). The presence of GVHD and the prior duration of antiviral prophylaxis were significant and independent risk factors for the development of VZV. Age, underlying disease, conditioning therapy or donor type were not. We conclude that 3-6 months of low-dose aciclovir and ganciclovir are effective at delaying the onset of VZV after allogeneic BMT, but may not affect the overall incidence of infection. Prolonged prophylaxis may be warranted in patients at high risk of infection, for example those patients with GVHD.

Topics: 2-Aminopurine; Acyclovir; Adolescent; Adult; Age of Onset; Aged; Analysis of Variance; Antiviral Agents; Bone Marrow Transplantation; Chickenpox; Dose-Response Relationship, Drug; Enzyme Activation; Famciclovir; Female; Ganciclovir; Graft vs Host Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Prodrugs; Retrospective Studies; Risk Factors; Skin Diseases; Transplantation, Homologous; Valacyclovir; Valine

An observational study with valaciclovir was conducted to assess clinical outcome in herpes zoster, especially pain and associated neurological signs and symptoms in relation to a series of demographic and disease characteristics discernible at presentation. The safety and acceptability of valaciclovir for treatment of zoster was assessed in a wide variety of primary care and clinic referral settings.. In total, 1897 immunocompetent adults with clinically diagnosed, localized acute herpes zoster were enrolled in this international, open-label study of valaciclovir. All subjects received treatment with oral valaciclovir (1000 mg three times daily) for 7 days from entry to the study and were asked to record the presence of zoster-associated pain and abnormal sensations throughout treatment and 6 months' follow-up. They were seen frequently in clinic to verify subjective assessments and for evaluation of rash healing. Safety and tolerability were assessed by adverse event monitoring.. Overall, 1191 subjects (63%) were aged > or = 50 years, and 203 (11%) had ophthalmic zoster. Cessation of zoster-associated pain was significantly faster in the younger age group; median times to loss of zoster-associated pain were 23 days and 9 days in the > or = 50 and < 50 years age groups, respectively. Similarly, abnormal sensations resolved significantly more rapidly in the younger subjects; the median duration of abnormal sensations was 31 days in the > or = 50 year olds and 16 days in those aged < 50 years. In cases of ophthalmic zoster, the rate of pain resolution was not different from those with zoster in other dermatomes (median duration of pain 18 vs. 16 days). However, abnormal sensations persisted significantly longer in subjects with ophthalmic zoster than in those with zoster at other sites (47 vs. 22 days). In addition to advancing age, subjects suffering moderate to severe prodromal pain or acute pain during the rash phase were at significantly greater risk of zoster-associated pain and abnormal sensations persisting for longer. Subjects with concomitant neurological disorders were also more likely to develop prolonged abnormal sensations. Valaciclovir treatment was well tolerated, and adverse events were rare and generally mild.. This study confirmed the prognostic importance of advancing age and the intensity of prodromal or acute pain as risk factors for prolonged zoster-associated pain and persisting abnormal sensations in the affected dermatome. Ophthalmic zoster and pre-existing neurological disorders are also identified as highly significant risk factors for prolonged abnormal sensations in herpes zoster.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Prognosis; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Prodrugs; Retrospective Studies; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

Acyclovir treatment of acute herpes zoster speeds rash healing and decreases pain and ocular complications. The limited oral bioavailability of acyclovir necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, is rapidly and almost completely converted to acyclovir in vivo and gives three- to fivefold increases in acyclovir bioavailability. In a randomized, double-blind, multicenter study, the safety and efficacy of oral valaciclovir given at a dosage of 1,000 mg three times daily for 7 or 14 days and oral acyclovir given at a dosage of 800 mg five times daily for 7 days were compared in immunocompetent adults aged > or = 50 years with herpes zoster. Patients were evaluated for 6 months. The intent-to-treat analysis (1,141 patients) showed that valaciclovir for 7 or 14 days significantly accelerated the resolution of herpes zoster-associated pain (P = 0.001 and P = 0.03, respectively) compared with acyclovir; median pain durations were 38 and 44 days, respectively, versus 51 days for acyclovir. Treatment with valaciclovir also significantly reduced the duration of postherpetic neuralgia and decreased the proportion of patients with pain persisting for 6 months (19.3 versus 25.7%). However, there were no differences between treatments in pain intensity or quality-of-life measures. Cutaneous manifestations resolved at similar rates in all groups. Adverse events were similar in nature and prevalence among groups, and no clinically important changes occurred in hematology or clinical chemistry parameters. Thus, in the management of immunocompetent patients > or = 50 years of age with localized herpes zoster, valaciclovir given at 1,000 mg three times daily for 7 days accelerates the resolution of pain and offers simpler dosing, while it maintains the favorable safety profile of acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Neuralgia; Pain; Quality of Life; Valacyclovir; Valine

In this paper, data from a clinical trial of a new antiviral agent for treating patients with zoster are used to answer the following question: Does the Nottingham Health Profile (NHP) add to the information obtained from the clinical measures? Three ways in which the NHP could add information are measured. First, Cox's regression analysis is used to determine whether health-related quality-of-life scores obtained at diagnosis give information about disease prognosis. Second, changes in mean NHP scores in different dimensions are computed after pain resolution to determine whether NHP scores provide more sensitive indicators of disease resolution. Third, linear regression is used to determine whether the impacts of disease on quality of life are measured adequately by the clinical parameters. These analyses show that use of the physical mobility and energy dimensions of the NHP increases understanding of disease prognosis; demonstrates the continuing impact of zoster on patients' sleep patterns and energy levels, disease symptoms not included as clinical measures, that persist after the cessation of zoster-associated pain; and gives a measure of the impact of zoster on the patient, which includes unmeasured and measured levels of severity.

Topics: Acyclovir; Antiviral Agents; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Pain; Prognosis; Quality of Life; Regression Analysis; Sleep; Valacyclovir; Valine

Varicella-zoster virus (VZV) is a latent virus that can remain in the central nervous system. Reactivation of the virus can cause some neurologic manifestations, and myelitis is one of the rarest of them. In this report, we aimed to present the MRI features of long-segment cervical myelitis after VZV infection, which is rarely reported in the literature.. A 69-year-old patient, who was diagnosed with varicella-zoster two months ago and treated with valacyclovir, was admitted to our clinic with worsening of his complaints and weakness in the right upper extremity. Neurological examination was normal in the left upper and bilateral lower extremities, but the muscle strength in the right upper extremity was evaluated as 4/5 grade. While rare leukocytes (10 leukocytes/mm³, 50 erythrocytes/mm³, high protein level (46 mg/dl, ref.15- 40 mg/dl)) were seen in the cerebrospinal fluid (CSF) analysis, no microorganisms were seen, and no growth was observed in the culture. VZV antibody-immunoglobulin G (Ab-IgG) was positive in CSF, while polymerase chain reaction [PCR] for VZV was negative. On cervical MRI, lesions showing T2 hyperintensity were observed from the C3-4 level to the C7-T1 level, eccentrically located in the right paramedian spinal cord. On post-contrast images, patchy heterogeneous contrast enhancement was noted in these regions of the spinal cord. When the patient's history, CSF features and MRI examinations were evaluated together, the lesions were consistent with VZV myelitis. The patient was started on valacyclovir treatment, and during the follow-up, the patient's complaints decreased, while no progress was observed in neurologic symptoms.. As a result, we aimed to report the MRI features of this rare complication of varicellazoster and emphasize the necessity of keeping this in mind in the etiology of myelitis, especially in cases with patchy enhancement, to achieve early diagnosis and treatment.

Topics: Aged; Chickenpox; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Myelitis; Valacyclovir

Topics: Acyclovir; Antiviral Agents; Dermatitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Valacyclovir

A man in his 70s presented to hospital with an acute kidney injury. He recently had started taking valacyclovir for treatment of shingles. The valacyclovir was stopped and his acute kidney injury improved. Work-up for other causes of acute kidney injury was negative and he was diagnosed with valacyclovir-associated acute kidney injury. He was discharged home after four days in the hospital with improving renal function.

Topics: Acute Kidney Injury; Herpes Zoster; Humans; Male; Valacyclovir

The objective of this study was to assess the status and trends of antiviral treatment in outpatients with herpes zoster in China.. Prescription data on antiviral drugs were extracted from the database of the Hospital Prescription Analysis Program of China according to the inclusion criteria. Yearly prescriptions and costs were calculated, and trends were analyzed. The trends were further stratified by age, sex, and specific drug use. The distribution of defined daily costs (DDCs) of valaciclovir and famciclovir were analyzed, and trends in the median DDCs were identified.. A total of 132,911 prescriptions from 49 hospitals located in six major areas of China were included in the analysis. The yearly prescriptions containing antivirals increased from 8,819 in 2010 to 16,361 in 2019. The percentage of prescriptions for patients aged 65 years and above also increased (27.7% in 2010 to 31.0% in 2019), and the number of prescriptions for females was higher than those for males (. The use of antivirals has increased over the decade, while the cost has not. Antiviral treatments adhere well to recent recommendations, except for the use of topical antivirals. The findings of this study may benefit the healthcare source allocation and management of herpes zoster in China.

Topics: Acyclovir; Antiviral Agents; China; Famciclovir; Female; Herpes Zoster; Humans; Male; Outpatients; Valacyclovir

Herpes zoster frequently causes dermatomal vesicular rash accompanied by severe neuralgia, and reaching a differential diagnosis may be challenging before the appearance of the vesicular rash.. A 40-year-old male patient visited the emergency department with a complaint of sudden onset motor weakness and ipsilateral radiating neuralgia to the Lt. thigh. He had suffered from chickenpox during childhood.. No skin lesion was present at the initial visit. The reverse Straight Leg Raise test was negative. Magnetic resonance imaging showed asymmetrically swollen dorsal root ganglion with Gadolinium enhancement. The vesicular rash that appeared on the sixth day after the symptom onset led to the diagnosis of herpes zoster.. Antiviral agent of valacyclovir (1000 mg t.i.d.) was administered for 7 days.. The patient recovered from motor weaknesses by 2 weeks from the onset of the symptom. Mild degree post-herpetic neuralgia recovered by 2 months.. A high index of suspicion is necessary to differentiate early herpes zoster radiculitis before the appearance of vesicular rash from compressive radiculopathy. In L2-3 ipsilateral radiating pain along the dermatome or myotome, the absence of reverse Straight Leg Raise sign may be a possible factor in differentiating herpes zoster radiculitis from compressive radiculopathy.

Topics: Adult; Antiviral Agents; Contrast Media; Gadolinium; Herpes Zoster; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Male; Paresis; Radiculopathy; Republic of Korea; Valacyclovir

A 26-year-old woman under immunosuppression with infliximab due to Crohn's disease was referred to the gynaecology emergency room with dispersed and coalescing vesicular lesions on the vulvar region extending to the right lower limb involving S2-S3 dermatome, associated with severe pain. Clinical history, physical examination and serological testing was consistent with herpes zoster infection. The patient was treated with valaciclovir for 14 days and cefradine for 7 days (due to the possibility of secondary bacterial infection). Significant symptomatic improvement was noted after 1 week. The 1-year follow-up was unremarkable. According to our knowledge and review of the literature, this is one of the few cases reported of vulvar herpes zoster, especially related to infliximab.

Topics: Adult; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infliximab; Valacyclovir; Vulva

Varicella-zoster virus is typically encountered in the emergency department (ED) in two forms: varicella (chickenpox) in children and zoster (shingles) in older adults. Zoster is infrequently encountered in young, healthy adults, and neurological complications are extremely rare.. We describe a case of a previously healthy 36-year-old woman who presented to the ED with fever, nuchal rigidity, and headache 4 days after being diagnosed with herpes zoster and started on oral valacyclovir. Lumbar puncture confirmed herpes zoster meningitis. Despite initiation of antivirals within 48 h of symptom onset, progression to zoster meningitis occurred. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must be aware that neurological complications of varicella zoster can develop despite initiation of oral antivirals. These patients must be identified in the ED, as admission for intravenous antivirals is indicated.

Topics: Adult; Aged; Chickenpox; Child; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Meningitis; Valacyclovir

A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient's symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient's dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.

Topics: Accessory Nerve; Acyclovir; Aged; Herpes Zoster; Humans; Male; Vagus Nerve; Valacyclovir

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Coinfection; Herpes Zoster; Humans; Influenza A virus; Influenza, Human; Male; Oseltamivir; Streptococcal Infections; Superinfection; Tonsillitis; Torso; Valacyclovir

Topics: Aged; Antigens, CD20; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunologic Factors; Male; Pemphigus; Recurrence; Rituximab; Valacyclovir; Virus Activation

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox Vaccine; Female; Herpes Zoster; Humans; Immunocompetence; Male; Meningitis; Valacyclovir

Topics: Aged, 80 and over; Antiviral Agents; Carcinoma, Squamous Cell; Female; Herpes Zoster; Humans; Mohs Surgery; Nose Neoplasms; Skin Neoplasms; Surgical Wound Infection; Valacyclovir

Topics: Abdominal Muscles; Abdominal Wall; Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Diagnosis, Differential; Hernia, Abdominal; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Middle Aged; Paralysis; Phenylpropionates; Treatment Outcome; Valacyclovir

Topics: Aged, 80 and over; Antiviral Agents; Cystitis; Emphysema; Female; Fever; Herpes Zoster; Humans; Peripheral Nervous System Diseases; Treatment Outcome; Urinary Bladder, Underactive; Urinary Tract Infections; Valacyclovir

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Psychoses, Substance-Induced; Valacyclovir; Valine

Topics: Acute Kidney Injury; Administration, Oral; Aged; Angiotensin II Type 2 Receptor Blockers; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Oliguria; Valacyclovir

Topics: Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Maintenance Chemotherapy; Mycosis Fungoides; Remission Induction; Skin Neoplasms; Valacyclovir

To observe the clinical efficacy and safety of topical ozone therapy for patients with herpes zoster by reflectance confocal microscopy (RCM).
 Methods: A total of 60 patients with herpes zoster were divided into a control group and an ozone treatment group (n=30). In the control group, patients took oral valacyclovir tablets or granules (0.3 g per day, three times a day) and they were subjected to local weak laser irradiation treatment plus topical 2% mupirocin ointment twice a day. In the ozone group, the treatment is same as the control group except mupirocin ointment was replaced with topical ozone treatment (hydrotherapy every day plus ozonated oil twice a day). The clinical symptoms, discoid cell and adverse reactions were observed and taken records at day 0, 3, 7 and 14. Statistical analysis was performed to compare the clinical efficacy between the 2 groups. 
 Results: On the seventh day of treatment, the discoid cells of the ozone group disappeared, and the difference between the control group and the ozone group was statistically significant (P<0.05). The difference of decreased percentage of pain scores at each time point between the 2 groups was statistically significant (P<0.05). The clinical efficacy was 100% in the ozone group and 86.7% in the control group, with significant difference between the 2 groups (P<0.05).
 Conclusion: Topical ozone therapy in patients with herpes zoster is helpful in relieving pain, shortening the course as well as improving the clinical efficacy without obvious adverse reactions. It is worth to be popularized.. 目的：应用反射式共聚焦显微镜(reflectance confocal microscope，RCM)观察臭氧外用治疗带状疱疹的临床疗效及安全性。方法：将60例带状疱疹患者分为对照组和臭氧组(n=30)。对照组口服伐昔洛韦片剂或颗粒剂(每日300 mg，每日3次)，同时采用局部弱激光照射治疗，外用2%莫匹罗星软膏(每日2次)；臭氧组将莫匹罗星改为臭氧水湿敷(每日1次)和臭氧油外用(每日2次)，分别在治疗前和治疗的第3，7，14天观察临床症状和体征的变化，并用RCM检测靶部位水疱内圆盘状细胞的变化，比较两组的临床疗效并记录不良反应。结果：治疗第7天，臭氧组包涵体消失，与对照组比较，差异有统计学意义(P<0.05)；各时间点臭氧组疼痛评分下降百分比明显高于对照组(P<0.05)；臭氧组患者总有效率为100%，对照组为86.7%，两组比较差异有统计学意义(P<0.05)；两组患者均未见明显不良反应和并发症发生。结论：臭氧外用治疗带状疱疹有助于缓解患者疼痛、缩短病程、提高临床疗效，无明显不良反应，值得临床推广应用。.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Case-Control Studies; Combined Modality Therapy; Drug Administration Schedule; Herpes Zoster; Humans; Hydrotherapy; Low-Level Light Therapy; Microscopy, Confocal; Mupirocin; Oils; Ozone; Pain Management; Pain Measurement; Treatment Outcome; Valacyclovir; Valine

Valacyclovir, a prodrug of acyclovir, is the first-line treatment for herpes zoster, but the renal function must be monitored, because acyclovir is metabolized by the kidneys. We herein report a case of valacyclovir-induced neurotoxicity with no preceding renal impairment. An 88-year-old man was admitted because of an impaired consciousness after the administration of valacyclovir at 3,000 mg daily for herpes zoster on the chest. His consciousness level gradually improved with hydration and valacyclovir withdrawal. It was later confirmed that the level of acyclovir on admission had been 35.45 μg/mL in the blood and 36.45 μg/mL in the cerebrospinal fluid.

Topics: Aged, 80 and over; Antiviral Agents; Herpes Zoster; Humans; Kidney; Male; Neurotoxicity Syndromes; Prodrugs; Valacyclovir

Pregnancy can complicate the presentation and workup of abdominal pain. A healthy 21-year-old gravida-3 para-1 woman at 34 weeks of gestation presented for severe pain localized to her abdominal left upper quadrant (LUQ. Physical exam was unremarkable except for localized pain on palpation, and she was discharged with acetaminophen and cyclobenzaprine for presumed musculoskeletal pain. The next day, she returned for worsening pain. An extensive workup including labs, electrocardiogram, chest x-ray, and abdominal computed tomography was unremarkable, and she was discharged with hydrocodone/acetaminophen. Later that evening, after two discharges, the patient presented for increased pain with new onset of vesicles in her left T6 dermatome. She was diagnosed with shingles, started on valacyclovir and gabapentin, and eventually went on to deliver a healthy infant. Shingles classically presents as excruciating pain followed by the eruption of vesicles. This case is important because it reviews the significance of shingles in pregnancy and is one of the first reports to extensively discuss the differential and workup of LUQ abdominal pain in pregnancy. Abdominal pain is a relatively common complaint during pregnancy, and a methodical approach should be taken when evaluating LUQ in pregnancy. Shingles could be considered in the differential diagnosis of pain of unclear origin.

Topics: Abdominal Pain; Analgesics; Antiviral Agents; Female; Gabapentin; Gynecological Examination; Hawaii; Herpes Zoster; Herpesvirus 3, Human; Humans; Pain; Pregnancy; Valacyclovir; Young Adult

This article describes an atypical herpes zoster (HZ) infection heralded by prodromic dental pain.. Trigeminal HZ is associated with any of the three divisions of the trigeminal nerve, and Ramsay Hunt syndrome is a rare variant of HZ infection of the ear, often accompanied with unilateral facial nerve palsy.. An 87-year-old man sought remedy for tooth-like pain. Within a week, he developed cutaneous, intraoral and otic eruptions, hearing loss, and mild facial palsy.. After ruling out odontogenic pain, he was diagnosed with trigeminal HZ and Ramsay Hunt syndrome.. Herpes zoster infection should be included as a possible aetiologic factor with atypical presentations of odontogenic pain. Diagnosis of trigeminal HZ infection and the Ramsay Hunt syndrome may lead to timely intervention with antivirals and improved patient outcomes.

Topics: Aged, 80 and over; Antiviral Agents; Herpes Zoster; Herpes Zoster Oticus; Humans; Male; Toothache; Trigeminal Nerve; Valacyclovir

An 82-year-old man with a history of end-stage renal disease presented with progressively worsening confusion and somnolence for the past 4-5 days. The patient was diagnosed with herpes zoster by his primary care physician 5 days ago and was started on a course of valacyclovir 1 g three times a day (dose not adjusted for renal impairment).A lumbar puncture was performed and cerebrospinal fluid (CSF) studies revealed 37 white blood cells (WBCs)/hpf (100% monocytes), protein 64 mg/dL and glucose 52 mg/dL. He was started on ceftriaxone, ampicillin and acyclovir. MRI of the brain was done and was unremarkable. Acyclovir-induced encephalopathy was high on differential, but his CSF findings were concerning for viral encephalitis. Nonetheless, all antimicrobials were discontinued and he was scheduled for a 5-hour dialysis session. The very next day, he showed immense improvement and eventually recovered completely. CSF PCR tests for both herpes simplex virus and varicella zoster virus came back negative.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Herpes Zoster; Humans; Male; Neurotoxicity Syndromes; Valacyclovir; Valine

We report a 57-year-old woman with end-stage renal disease (ESRD) on maintenance peritoneal dialysis (PD), who presented to the emergency room (ER) by ambulance with complaints of confusion and altered sensorium for 48 hours. She had been reviewed in a walk-in clinic 72 hours earlier and had been prescribed the standard 1000 mg three times per day of valacyclovir for an acute attack of shingles instead of 500 mg once a day on ESRD. In the ER, she received further 500 mg of intravenous acyclovir as herpes encephalitis was clinically suspected. CT of the brain and lumbar puncture were non-contributory to the diagnosis. Valacyclovir and acyclovir were discontinued when the diagnosis of valacyclovir-associated neurotoxicity became clinically evident. As the patient's Glasgow Coma Scale declined, we intensified her PD regimen from one to six exchanges per day and 24 hours later there was a significant neurological improvement.

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Confusion; Consciousness Disorders; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Middle Aged; Neurotoxicity Syndromes; Peritoneal Dialysis; Valacyclovir; Valine

We report acute retinal necrosis caused by the vaccine Oka strain following immunization of a 78-year-old woman with live zoster vaccine. Whole genome sequencing confirmed the ocular vOka strain to be derived from the vaccine and excluded the presence of new mutations or recombination with wild-type Varicella zoster virus.

Topics: Acyclovir; Aged; Antiviral Agents; DNA Viruses; DNA, Viral; Eye; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Retinal Necrosis Syndrome, Acute; Vaccination; Valacyclovir; Valine; Vitreous Body; Whole Genome Sequencing

Disseminated herpes zoster is defined as the presence of more than 20 lesions outside the dermatome. This unusual presentation is more common in immunosuppressed patients. Complications such as hepatitis, encephalitis, and pneumonitis are more likely in individuals with disseminated varicella zoster virus infection.A 63-year-old woman being treated for breast cancer developed multiple pustules and vesicles days after starting doxorubicin and cyclophosphamide chemotherapy. Ten individual lesions appeared on her chest, abdomen, back, and leg. Non-dermatomal disseminated herpes zoster was suspected. She was treated with oral antiviral therapy, as well as with oral and topical antibiotics. Varicella zoster virus infection was confirmed by direct fluorescent antibody staining. After one month, her skin lesions had resolved and she resumed chemotherapy.In a setting of immunosuppression, the rare presentation of disseminated herpes zoster without dermatome should be considered. Appropriate antiviral therapy should be administered while waiting for confirmation of the diagnosis, so as to reduce the risk of visceral dissemination of the varicella zoster virus infection.

Topics: Acyclovir; Antiviral Agents; Breast Neoplasms; Female; Herpes Zoster; Humans; Immunocompromised Host; Middle Aged; Valacyclovir; Valine

Herpes zoster, commonly called shingles, is a disease that results from the reactivation of varicella zoster virus. Local trauma has been reported as a precipitant for reactivation, but this condition is rarely seen localized to a fresh surgical incision. We present the case of a patient who developed shingles overlying the incision site of a recently buried central venous access port, illustrating the need to consider this diagnosis as a unique imposter of localized infection or reaction at sites of recent procedural trauma.

Topics: Acyclovir; Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Catheter-Related Infections; Central Venous Catheters; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Treatment Outcome; Valacyclovir; Valine

The epidemiology of herpes zoster (HZ) in contemporary autologous hematopoietic cell transplant (HCT) recipients, and the impact of acyclovir (ACV)/valacyclovir (VACV) prophylaxis, is not well described. In this observational study from 2002 to 2010, we retrospectively identified 1000 varicella zoster virus (VZV)-seropositive autologous HCT recipients with up to 5 years of follow-up. The incidence of HZ and use of ACV/VACV prophylaxis were determined through review of medical records and mailed questionnaires. Risk factors for HZ were determined by multivariable Cox regression. Over a period of 5 years after autologous HCT, 194 patients developed at least 1 HZ episode, with a cumulative incidence of 21%; 159 of 194 (82%) were not on prophylaxis at the time of HZ. A second episode of HZ occurred in 31 of 194 (16%) patients. Patients taking ACV/VACV had reduced risk for HZ (adjusted hazard ratio [aHR], .59; 95% confidence interval [CI], .37 to .91), whereas those older than the median age (≥55.5 years) had increased risk (aHR, 1.42; 95% CI, 1.05 to 1.9). Disseminated VZV was reported in 8% and postherpetic neuralgia in 13% of patients. We demonstrate a high burden of HZ late after autologous HCT, despite long-term antiviral prophylaxis. Improved prevention strategies are needed to provide sustained protection against HZ after autologous HCT.

Topics: Acyclovir; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Premedication; Retrospective Studies; Risk Factors; Time Factors; Transplantation, Autologous; Valacyclovir; Valine

Topics: Abdominal Muscles; Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Immunoglobulin G; Male; Middle Aged; Pain; Paralysis; Valacyclovir; Valine

Varicella zoster virus (VZV) is an uncommon cause of folliculitis. We present a case of a 29-year-old woman who presented with an atypical follicularly-based eruption localized to her inner thigh with an associated pain in her lower back and inner thigh prior to the papular eruption. She was successfully treated with valacyclovir 1,000 mg three times daily with no complications.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Biopsy; Female; Folliculitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Skin; Thigh; Valacyclovir; Valine

To analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment.. Retrospective multicenter study using the Swiss Pediatric Rheumatology registry. Children with rheumatic diseases followed in a Swiss center for pediatric rheumatology and treated with cDMARD and/or bDMARD with a clinical diagnosis of varicella or herpes zoster between January 2004 and December 2013 were included.. Twenty-two patients were identified, of whom 20 were treated for juvenile idiopathic arthritis, 1 for a polyglandular autoimmune syndrome type III, and 1 for uveitis. Of these 22 patients, 16 had varicella and 6 had herpes zoster. Median age at VZV disease was 7.6 years (range 2 to 17 years), with 6.3 years (range 2 to 17 years) for those with varicella and 11.6 years (range 5 to 16 years) for those with herpes zoster. The median interval between start of immunosuppression and VZV disease was 14.1 months (range 1 to 63 months). Two patients had received varicella vaccine (1 dose each) prior to start of immunosuppression. Concomitant immunosuppressive therapy was methotrexate (MTX) monotherapy (n = 9) or bDMARD monotherapy (n = 2), or a combination of bDMARD with prednisone, MTX or Leflunomide (n = 11). Four patients experienced VZV related complications: cellulitis in 1 patient treated with MTX, and cellulitis, sepsis and cerebellitis in 3 patients treated with biological agents and MTX combination therapy. Six children were admitted to hospital (range of duration: 4 to 9 days) and 12 were treated with valaciclovir or aciclovir.. The clinical course of varicella and herpes zoster in children under immunosuppression is variable, with 4 (18 %) of 22 children showing a complicated course. Thorough assessment of VZV disease and vaccination history and correct VZV vaccination according to national guidelines at diagnosis of a rheumatic autoimmune disease is essential to minimize VZV complications during a later immunosuppressive treatment.

Topics: Acyclovir; Adolescent; Antirheumatic Agents; Antiviral Agents; Arthritis, Juvenile; Chickenpox; Child; Child, Preschool; Etanercept; Female; Herpes Zoster; Humans; Immunocompromised Host; Immunosuppressive Agents; Isoxazoles; Leflunomide; Male; Methotrexate; Retrospective Studies; Treatment Outcome; Valacyclovir; Valine; Young Adult

An 81-year-old woman suffering from sarcoidosis, chronic renal failure caused by hypertention was treated by valacyclovir 500 mg/day, for the diagnosis of herpes zoster of her right back. Her consciousness gradually became worse, and 3 days after taking the drug, she was sent to the emergency department of the hospital. Her conscious level was E2V2M5 (Glasgow Coma Scale) and myoclonus especially in her lower extremities occurred. Head CT and MRI show no obvious, acute abnormal findings other than chronic ischemic lesions, while an electroencephalogram (EEG) shows periodic synchronous discharges (PSDs) and disorganized background activity. Based on these findings, she was diagnosed as valacyclovir-associated acute encephalopathy. After conservative therapy of maintenance hemodialysis, her consciousness gradually improved, and PSDs disappeared accordingly and background activity of EEG became improved. In this case report, we presented valacyclovir-associated neurotoxicity with PSDs in EEG as potentially a surrogate marker. We should be cautious to use valaciclovir which may cause drug-induced encephalopathy especially in elderly or patients with renal failure even though the dose was adjusted in advance.

Topics: Acute Disease; Acyclovir; Aged, 80 and over; Antiviral Agents; Brain Diseases; Electroencephalography; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Periodicity; Valacyclovir; Valine

Brincidofovir (BCV) is a broad-spectrum antiviral agent active in vitro against double-stranded DNA viruses including herpesviruses, adenoviruses, polyomaviruses, and poxviruses. We report successful BCV use in management of disseminated acyclovir- and cidofovir-resistant varicella zoster virus in an immunocompromised hematopoietic stem cell transplant patient with chronic graft-versus-host disease who was intolerant to foscarnet.

Topics: Acyclovir; Adult; Antibiotic Prophylaxis; Antineoplastic Agents; Antiviral Agents; Cytosine; Drug Resistance, Viral; Drugs, Investigational; Female; Foscarnet; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Investigational New Drug Application; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Organophosphonates; Transplantation, Homologous; Valacyclovir; Valine

Viral meningitis caused by varicella-zoster virus (VZV) is an uncommon neurological complication of herpes zoster. It may occur before or after the onset of the vesicular rash along the dermatomal distribution, which is the classic presentation of herpes zoster. We describe a case of a 51-year-old immunocompetent Caucasian man who presented with neck and severe right-sided facial pain. Eight days later, he had photophobia and papular rash on his forehead. Cerebrospinal fluid (CSF) examination confirmed aseptic meningitis and CSF PCR detected the presence of VZV DNA. Neurological complications of VZV infection, such as aseptic meningitis, may be difficult to diagnose and can cause delay in treatment, especially in cases with late onset of dermatological manifestations of herpes zoster. Definite diagnosis requires evidence of acute VZV infection in blood or cerebrospinal fluid.

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Exanthema; Herpes Zoster; Humans; Male; Meningitis, Viral; Middle Aged; Polymerase Chain Reaction; Valacyclovir; Valine

Herpes zoster is a neurocutaneous disease resulting from the reactivation of endogenous varicella-zoster virus (VZV) in dorsal sensory or cranial nerve ganglia. Rarely, this infection manifests without the characteristic dermatomal rash, a condition termed zoster sine herpete. Viral spreading of herpes zoster in the head and neck may manifest as various signs and symptoms because of the multiple possible combinations of cranial neuropathies. With only six cases reported in the English literature up to now, isolated neuropathies of the vagus nerve in the absence of cutaneous lesions tend to be misdiagnosed as idiopathic laryngeal paralysis.. We report a case of herpes zoster of the larynx in an 80-year-old man presenting with sore throat, dysphagia, and hoarseness.. Endoscopic examination revealed unilateral vocal fold paralysis, pooling of secretions, and mucosal vesicles of the hemilarynx. After the diagnosis of VZV infection with polymerase chain reaction (PCR) testing, the patient was treated with valacyclovir and corticosteroids, leading to complete recovery after 2 months.. Herpes zoster of the larynx is an uncommon condition that should be included in the differential diagnosis of laryngeal paralysis of idiopathic cause. We recommend performing a thorough examination of the pharyngolaryngeal structures and ordering PCR testing as the diagnostic method of choice.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Deglutition Disorders; Herpes Zoster; Herpesvirus 3, Human; Hoarseness; Humans; Laryngoscopy; Male; Pharyngitis; Polymerase Chain Reaction; Predictive Value of Tests; Remission Induction; Steroids; Time Factors; Treatment Outcome; Valacyclovir; Valine; Virus Activation; Vocal Cord Paralysis

The pain of acute herpes zoster (shingles) is severe and difficult to control. The medications used to control pain have a variety of important and potentially serious side effects. To the best of my knowledge, this is the first case report of using a plain topical occlusive dressing to reduce the pain of herpes zoster, avoiding the use of medication.. A 40-year-old Caucasian man and a qualified physician (the author), developed a dermatomal vesicular rash consistent with herpes zoster. Applying plain topical occlusive dressings reduced the severity of his pain to an ignorable level.. Plain topical occlusive dressings provide effective pain relief for acute herpes zoster, thereby avoiding the risks accompanying medication use.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Humans; Male; Occlusive Dressings; Pain; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fingolimod Hydrochloride; Follow-Up Studies; Herpes Zoster; Humans; Immunosuppressive Agents; Middle Aged; Multiple Sclerosis; Recurrence; Risk Assessment; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Foot Dermatoses; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Lymphoma, B-Cell, Marginal Zone; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Skin; Treatment Outcome; Valacyclovir; Valine; Virus Activation

Clopidogrel is an adenosine diphosphate receptor antagonist used for the prevention of vascular events in patients with atherothrombotic diseases manifested by recent myocardial infarction, ischemic stroke or peripheral arterial disease. Diarrhoea, rash and pruritus are rather common side effects of clopidogrel. Other side effects include epistaxis, nausea, abdominal pain, vomiting, gastritis, gastric and duodenal ulcer. Thrombocytopenia is the most common laboratory abnormality. Leucopenia and neutropenia are rare. We report three cases of purpuric herpes zoster in patients in therapy with clopidogrel. To our knowledge, only one case of haemorrhagic herpes zoster has been published in a patient in therapy with this drug.

Topics: Acyclovir; Aged; Antiviral Agents; Clopidogrel; Female; Herpes Zoster; Humans; Male; Pruritus; Ticlopidine; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Diagnosis, Differential; Facial Dermatoses; Female; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Arsenic Trioxide; Arsenicals; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Oxides; Retrospective Studies; Valacyclovir; Valine; Virus Activation

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Encephalitis, Varicella Zoster; Female; Fever; Herpes Zoster; Humans; Male; Middle Aged; Spain; Valacyclovir; Valine; Young Adult

We retrospectively analyzed 80 instances of varicella zoster virus (VZV) disease in 72 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and examined the clinical differences between localized and disseminated disease. Risk factors for developing VZV dissemination were also evaluated.. Of the 80 instances, 54 instances were localized diseases and 26 were disseminated diseases. Patient characteristics did not differ significantly between the 2 groups, except for the first-line therapy and the duration from symptom onset to treatment. In the disseminated group, intravenous acyclovir was used as the first-line therapy more frequently, and more time elapsed before beginning antiviral therapy compared with the localized group. In multivariate analyses, the duration from symptom onset to treatment was identified as an independent risk factor that significantly affected the development of VZV dissemination. Gender, total body irradiation, and chronic graft-versus-host disease, of which the latter 2 factors were reported as risk factors for the development of VZV disease after HSCT, did not affect the development of VZV dissemination.. Our results suggest that VZV infection or reactivation may easily progress to viremia with delayed use of antiviral agents and may result in VZV dissemination in immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Central Nervous System Viral Diseases; Chickenpox; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Rate; Time-to-Treatment; Valacyclovir; Valine; Virus Activation; Young Adult

Herein we report a rare case of disseminated herpes zoster(HZ) infection involving two widely separated bilateral dermatomes in an immunocompetent host. HZ involving two widely separated areas simultaneously is referred to as HZ duplex bilateralis. It is very rare, with an incidence of less than 0.1 percent of all HZ cases, and usually develops in immunocompromised patients.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Male; Middle Aged; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Humans; Valacyclovir; Valine

We describe a patient with zoster paresis and an MRI that revealed extensive spinal cord lesions from the upper cervical to the lower thoracic spinal cord. Importantly, the patient reported considerable spontaneous improvement in strength 2-3 weeks after zoster. This report reveals a previously undescribed remarkable preponderance of MRI lesions far beyond the site of zoster rash and focal lower motor neuron weakness.

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Motor Neuron Disease; Muscle Weakness; Spinal Cord; Spinal Nerve Roots; Valacyclovir; Valine

Valacyclovir induced neurotoxicity is a life-threatening complication, usually starting 24-48 h after drug-peak serum concentrations. The elderly with impaired renal function seem to be the most susceptible group to valacyclovir neurotoxicity. Although hemodialysis is considered the best method for rapid drug removal, our case showed that intensive peritoneal dialysis regimen leads to the recovery of neurotoxicity after 3 days.

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Kidney Failure, Chronic; Kidney Function Tests; Peritoneal Dialysis, Continuous Ambulatory; Risk Assessment; Treatment Outcome; Valacyclovir; Valine

Topics: Acne Keloid; Acyclovir; Adult; Anti-HIV Agents; Antiviral Agents; Azithromycin; Black People; Cicatrix; Disease Susceptibility; Hair Follicle; Herpes Zoster; HIV Infections; Humans; Male; Neck; Sebaceous Glands; Triamcinolone Acetonide; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antigens, Viral; Antiviral Agents; Biomarkers; Diagnosis, Differential; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Penile Diseases; Polymerase Chain Reaction; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Blister; Hemorrhage; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunologic Factors; Male; Opportunistic Infections; Purpura, Thrombocytopenic, Idiopathic; Rituximab; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster; Herpes Zoster Vaccine; Humans; Male; Neuralgia, Postherpetic; Risk Factors; Spouses; Valacyclovir; Valine

In patients with multiple myeloma (MM), bortezomib is associated with a significant risk of Varicella zoster virus (VZV) reactivation. There are some reports that acyclovir reduces the risk of VZV reactivation. We assessed whether VZV reactivation could be reduced by using prophylactic valacyclovir at a dose of 500 mg daily.. We retrospectively evaluated 32 patients with MM who received bortezomib and valacyclovir prophylaxis at the Kanazawa Medical University Hospital. Patients received valacyclovir prophylaxis orally at a dose of 500 mg daily, without cessation during bortezomib treatment.. The median age was 69 years (range=45-90 years). Fifteen patients were male and seventeen were female. The median bortezomib dose was 37.0 mg/m(2) (range=5.2-167.6 mg/m(2)). All patients also received corticosteroids. The median duration of valacyclovir prophylaxis was 301 days (range=24-1206 days) and the median valacyclovir dose was 150.5 g (range=12-603 g). VZV reactivation developed in only one patient during valacyclovir prophylaxis. VZV reactivation did not develop in three patients who had a past history of VZV reactivation without valacyclovir prophylaxis. Adverse events over grade 3 associated with valacyclovir were not observed.. Valacyclovir at a dose of 500 mg daily appears to be effective at preventing VZV reactivation and was well-tolerated by patients with MM who received bortezomib.

Topics: Acyclovir; Aged; Aged, 80 and over; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Multiple Myeloma; Pyrazines; Retrospective Studies; Valacyclovir; Valine; Virus Activation

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Middle Aged; Neurotoxicity Syndromes; Renal Dialysis; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Female; Herpes Zoster; Humans; Middle Aged; Neuralgia, Postherpetic; Skin Care; Valacyclovir; Valine

Worldwide, many patients have been treated with tumor necrosis factor-α (TNF-α) antagonists for indications that include chronic inflammatory diseases such as rheumatoid and psoriatic arthritis, inflammatory bowel disease and others. Since their approval, concerns regarding safety have been raised. Increased susceptibility to bacterial infections, especially due to intracellular bacteria like Mycobacterium tuberculosis that is responsible for the most serious complications associated with this treatment. Viral infections are less frequently reported but probably relatively common, representing an important cause of morbidity to remember. Varicella zoster virus is one of the most frequently implicated viruses. We present the case of a 20-year-old man with Crohn's disease under infliximab treatment who developed herpes zoster at the site of infliximab's 7th and 9th infusion.

Topics: Acyclovir; Adult; Antibodies, Monoclonal; Antiviral Agents; Crohn Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppression Therapy; Infliximab; Infusions, Intravenous; Male; Treatment Outcome; Tumor Necrosis Factor-alpha; Valacyclovir; Valine; Virus Activation; Young Adult

To evaluate the efficacy of treatment with gabapentin plus valacyclovir hydrochloride for the prevention of postherpetic neuralgia in patients with acute herpes zoster.. Uncontrolled, open-label study.. A private dermatology clinic.. Consecutive immunocompetent adults (age, ≥ 50 years) who presented with herpes zoster within 72 hours of vesicle formation with moderate to severe pain (≥ 4 on the 10-point Likert scale) were recruited for study participation. Intervention The patients received 1000 mg of valacylovir hydrochloride 3 times a day for 7 days plus gabapentin at an initial dose of 300 mg/d, titrated up to a maximum of 3600 mg/d, side effects permitting.. Proportion of patients with zoster pain (pain > 0) at 3, 4, and 6 months as well as average pain severity, the proportion of patients with sleep disturbance, and quality-of-life measures (determined by the Medical Outcome Study Short Form 36-Item Health Survey).. A total of 133 patients (mean age, 64.6 years) were enrolled in the study. The overall incidence of zoster pain at 6 months was 9.8%.. The combination of gabapentin and valacyclovir administered acutely in patients with herpes zoster reduces the incidence of postherpetic neuralgia. Trial Registration clinicaltrials.gov Identifier: NCT01250561.

Topics: Acute Disease; Acyclovir; Aged; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Glucocorticoids; Hemorrhage; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Male; Middle Aged; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Skin Diseases, Vesiculobullous; Splenectomy; Valacyclovir; Valine

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Neuralgia, Postherpetic; Valacyclovir; Valine

Tacrolimus ointment 0.1 percent is a well-established topical therapy for treating atopic dermatitis. Efficacy and safety have been described in several trials. Here, we present a patient with rapid onset of extensive varicella zoster infection in tacrolimus-treated skin: a side effect that has only occasionally been reported. Early recognition is important because rapid treatment for herpes zoster may lead to less frequent post-herpetic neuralgia and serious complications.

Topics: Acyclovir; Antiviral Agents; Dermatitis, Atopic; Dermatologic Agents; Drug Therapy, Combination; Female; Fusidic Acid; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Ointments; Tacrolimus; Treatment Outcome; Valacyclovir; Valine

Immune Reconstitution Inflammatory Syndromes (IRIS) are exaggerated pathological inflammatory reactions occurring after initiation of highly active antiretroviral therapy (HAART) due to exuberant immune responses to occult or apparent opportunistic infections or cancers. In view of paucity of studies from Nigeria, we report 3 cases of IRIS presenting as disseminated infections in HIV-1 infected patients initiating HAART. The first case was a previously healthy female who developed disseminated tuberculosis after 4 weeks of regular HAART. Her HAART regimen was continued and she improved after commencement of anti-tuberculosis drugs, with evidence of progressive increase in CD4 cell count. The second case was a HAART-experienced female who stopped her drugs for 4 months. Two months after recommencement of her previous HAART regimen, she developed features of disseminated herpes zoster infection, despite evidence of decrease in viral load by 95%. HAART was continued and she recovered completely after receiving valaciclovir tablets and antibiotics. The third patient was a female student who was commenced HAART on account of chronic cough and weight loss. Three months after regular HAART, she developed features of disseminated Kaposi's sarcoma involving the skin, oropharynx and lungs, despite evidence of 42% increase in CD4 cell count. Unfortunately, she rapidly deteriorated and died during the course of management. Clinicians should be alert to the possibility of IRIS in HIV-infected patients initiated or re-initiated on HAART. There is need for future prospective studies determining risk factors for IRIS in HIV-infected patients from Nigeria.

Topics: Acyclovir; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; Disease Susceptibility; Fatal Outcome; Female; Herpes Zoster; HIV Infections; HIV-1; Humans; Immune Reconstitution Inflammatory Syndrome; Nigeria; Respiratory Tract Neoplasms; Sarcoma, Kaposi; Skin Neoplasms; Tuberculosis, Miliary; Valacyclovir; Valine; Viral Load; Viremia; Young Adult

Herpes zoster (HZ) is a common condition among older adults, manifested by pain and the classic presentation of a unilateral rash that follows a dermatomal distribution and does not cross the midline of the body. It is caused by reactivation of the virus that caused chickenpox during an earlier infection. In many cases, acute HZ is followed by a severe and disabling complication known as postherpetic neuralgia (PHN), characterized by pain that persists for months or even years after the HZ rash heals. Using an individual example, this article provides information on the clinical manifestations, evidence-based treatment recommendations for, and prevention of HZ and PHN through use of the zoster vaccine Zostavax, licensed in the United States in 2006.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Chest Pain; Female; Geriatric Nursing; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Neuralgia, Postherpetic; Risk Factors; United States; Vaccination; Valacyclovir; Valine; Virus Activation

Herpes simplex and herpes zoster infections are common and often treated with antiviral drugs including acyclovir, valacyclovir, and famciclovir. Safety of these antivirals when used in the first trimester of pregnancy is insufficiently documented.. To investigate associations between exposure to acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and risk of major birth defects.. Population-based historical cohort study of 837,795 live-born infants in Denmark from January 1, 1996, to September 30, 2008. Participants had no diagnoses of chromosomal aberrations, genetic syndromes, birth defect syndromes with known causes, or congenital viral infections. Nationwide registries were used to ascertain individual-level information on dispensed antiviral drugs, birth defect diagnoses (categorized according to a standardized classification scheme), and potential confounders.. Prevalence odds ratios (PORs) of any major birth defect diagnosed within the first year of life by exposure to antiviral drugs.. Among 1804 pregnancies exposed to acyclovir, valacyclovir, or famciclovir in the first trimester, 40 infants (2.2%) were diagnosed with a major birth defect compared with 19,920 (2.4%) among the unexposed (adjusted POR, 0.89; 95% confidence interval [CI], 0.65-1.22). For individual antivirals, a major birth defect was diagnosed in 32 of 1561 infants (2.0%) with first-trimester exposure to acyclovir (adjusted POR, 0.82; 95% CI, 0.57-1.17) and in 7 of 229 infants (3.1%) with first-trimester exposure to valacyclovir (adjusted POR, 1.21; 95% CI, 0.56-2.62). Famciclovir exposure was uncommon (n = 26), with 1 infant (3.8%) diagnosed with a birth defect. Exploratory analyses revealed no associations between antiviral drug exposure and 13 different subgroups of birth defects, but the number of exposed cases in each subgroup was small.. In this large nationwide cohort, exposure to acyclovir or valacyclovir in the first trimester of pregnancy was not associated with an increased risk of major birth defects.

Topics: 2-Aminopurine; Abnormalities, Drug-Induced; Acyclovir; Adolescent; Adult; Antiviral Agents; Cohort Studies; Denmark; Famciclovir; Female; Herpes Simplex; Herpes Zoster; Humans; Middle Aged; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Risk; Valacyclovir; Valine; Young Adult

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Physical Examination; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Biopsy; Cicatrix; Herpes Zoster; Humans; Male; Myelodysplastic Syndromes; Skin; Valacyclovir; Valine

Drug-related eruptions that appear only on intertriginous or flexural folds and in gluteal areas have recently been termed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). We report a case of a 56-year-old woman with acute erythematous rash in the intertriginous areas after treatment with the L-valine ester of acyclovir, valacyclovir. Oral-challenge tests resulted in erythematous pruritic rash in the intertriginous area by valacyclovir. The patient was diagnosed as having SDRIFE due to valacyclovir.

Topics: Acyclovir; Antiviral Agents; Axilla; Drug Eruptions; Exanthema; Female; Herpes Zoster; Humans; Middle Aged; Neck; Valacyclovir; Valine

A 97-year-old lady was hospitalized for left leg cellulitis. Comorbidity included hypertension and congestive heart failure. While in hospital, she developed a painless vesicular rash localized to the territory of the left trigeminal nerve (third branch), which evolved to pustules and crusts (Figure 1). A chickenpox-like disseminated eruption of vesicles followed within 4 days, with the same evolution pattern (Figure 2).The diagnosis of disseminated zoster was suspected. A PCR analysis confirmed the presence of varicella-zoster-virus (VZV) in an abdominal vesicle. The patient was treated with oral valacyclovir for 7 days. Clinical examination, laboratory tests (including HIV serology), and a chest radiograph revealed no evidence of underlying immunodeficiency or malignancy.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Back; Face; Female; Heart Failure; Herpes Zoster; Herpesvirus 3, Human; Humans; Hypertension; Polymerase Chain Reaction; Valacyclovir; Valine

A 73-year-old man presented to our hospital with a sore throat (left-sided) and hiccups. The patient had mucosal swelling and erosions affecting the left posterior pillar, base of tongue, epiglottis, arytenoid, and aryepiglottic fold. As the laryngeal mucosal edema became worse, herpetic vesicles and erosions developed on the left cavum conchae, external auditory canal, and palate. The patient was treated with acyclovir and a steroid. His hiccups were treated with metoclopramide, but it had little effect, and hiccups only subsided gradually after the disappearance of erosions. His hiccups relapsed transiently with vomiting, and then resolved completely. Elevation of the CF titer after 2 weeks confirmed the diagnosis of herpes zoster. This condition should be considered in patients with unilateral sore throat and intractable hiccups, and treatment with acyclovir should be provided.

Topics: Acyclovir; Administration, Oral; Aged; Anti-Inflammatory Agents; Antiviral Agents; Diarrhea; Edema; Herpes Zoster; Hiccup; Humans; Hydrocortisone; Infusions, Intravenous; Laryngeal Mucosa; Laryngitis; Male; Metoclopramide; Retreatment; Valacyclovir; Valine

We present two prostate cancer patients, including one with a castration-resistant cancer whose rising serum prostate-specific antigen (PSA) levels showed a remarkable drop after a reactivated varicella-zoster virus infection treated with valaciclovir. In one patient, we found a temporary decrease in serum PSA lasting for at least 4 mo. In the patient with castration-resistant prostate cancer, serum PSA decreased to <0.01 microg/l and has remained undetectable since.

Topics: Acyclovir; Aged; Antiviral Agents; Herpes Zoster; Humans; Male; Prostate-Specific Antigen; Prostatic Neoplasms; Valacyclovir; Valine

To assess the incidence of and risk factors associated with postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT) varicella zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. The male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = .0075; odds ratio [OR] = 1.14; 95% confidence interval [CI], 0.97-1.33). On the other hand, advanced age (P = .0097; OR = 1.06; 95% CI, 1.01-1.12), male gender (P = .0055; OR = 12.7; 95% CI, 1.61-100.1), and graft-versus-host disease (GVHD) prophylaxis with a tacrolimus-based regimen (P = .0092; OR = 9.56; 95% CI, 1.44-63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients.

Topics: Acyclovir; Adolescent; Adult; Aged; Chickenpox; Child; Child, Preschool; Female; Genetic Diseases, Inborn; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Infant; Infant, Newborn; Japan; Male; Middle Aged; Neoplasms; Neuralgia, Postherpetic; Postoperative Complications; Retrospective Studies; Risk; Transplantation, Autologous; Transplantation, Homologous; Valacyclovir; Valine; Virus Activation; Young Adult

Tumor necrosis factor-alpha (TNFalpha)-blocking agents are immunomodulating agents introduced for treatment of a variety of chronic inflammatory disease conditions. Adverse effects include an increased incidence of infections. Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. In our report of a patient on etanercept therapy for rheumatoid arthritis, the correct diagnosis was delayed because disseminated herpes zoster was clinically mimicking vasculitis. Initially assuming rheumatoid vasculitis, immunosuppression was increased, resulting in worsening of skin lesions. Only an extended work-up, including a skin biopsy and viral cultures, established the correct diagnosis. Management of varicella zoster virus (VZV) infection primarily focuses on early initiation of antiviral therapy to control VZV replication. Therapy with intravenous acyclovir followed by oral valacyclovir allowed complete resolution of acute skin changes. In immunosuppressed patients, the possibility of infection with atypical presentation must always be kept in mind, and that this might mimic other disease conditions. Broad differential diagnosis and an extended diagnostic workup help in establishing the correct diagnosis.

Topics: Acyclovir; Aged; Antiviral Agents; Arthritis, Rheumatoid; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Etanercept; Female; Herpes Zoster; Humans; Immunoglobulin G; Immunosuppressive Agents; Receptors, Tumor Necrosis Factor; Rheumatoid Vasculitis; Risk Factors; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Arm; Ecchymosis; Female; Giant Cells; Herpes Zoster; Histological Techniques; Humans; Kidney Failure, Chronic; Lupus Nephritis; Purpura; Thrombocytopenia; Valacyclovir; Valine

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; CD4 Lymphocyte Count; Herpes Zoster; Humans; Male; Prednisone; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Neuralgia, Postherpetic; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lower Extremity; Neuralgia; Pregnancy; Pregnancy Complications, Infectious; Treatment Outcome; Valacyclovir; Valine

Intracranial aneurysms in the pediatric population are relatively rare entities. Immunocompromised patients (often from HIV/AIDS or pharmacological immunosuppression) represent a significant fraction of children with cerebral aneurysms. One proposed mechanism of aneurysm formation in these patients is from direct infection of the affected arteries. In this study, the authors report on a case of a 14-year-old girl with common variable immunodeficiency with T-cell dysfunction and a CSF polymerase chain reaction test positive for varicella-zoster virus who underwent evaluation for carotid and basilar artery fusiform aneurysms.

Topics: Acyclovir; Adolescent; Aneurysm; Angiography, Digital Subtraction; Antiviral Agents; Aspirin; Basilar Artery; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Common Variable Immunodeficiency; Female; Herpes Zoster; Humans; Image Processing, Computer-Assisted; Intracranial Aneurysm; Magnetic Resonance Angiography; Platelet Aggregation Inhibitors; T-Lymphocytes; Tomography, X-Ray Computed; Valacyclovir; Valine; Vasculitis; Vertebral Artery

Topics: Acetaminophen; Acyclovir; Analgesics, Non-Narcotic; Analgesics, Opioid; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Humans; Leg; Lidocaine; Male; Middle Aged; Tramadol; Valacyclovir; Valine

To assess the rate of occurrence and outcomes of herpes zoster in patients taking TNFalpha antagonists.. Retrospective review of the medical records of 300 patients who received TNFalpha antagonists to treat chronic inflammatory joint disease.. We identified 9 (9/300, 3%) patients who experienced herpes zoster, 6 women and 3 men, with rheumatoid arthritis (n=7) or ankylosing spondylitis (n=2). The drug was infliximab in 4 patients, adalimumab in 2 patients, and etanercept in 3 patients, including 2 patients with a prior history of infliximab therapy (for 12 and 36 months, respectively). Mean treatment duration at the occurrence of herpes zoster was 27 months (range, 6-42 months).. Glucocorticoid therapy (n=7) and methotrexate therapy (n=6) were the only risk factors identified in our study. Mean follow-up was 26 months. All 9 patients achieved a full recovery with antiviral treatment and interruption of the TNFalpha antagonist. One patient experienced a recurrence after resuming TNFalpha antagonist therapy.. The scant data in the literature suggest a higher risk of herpes zoster with anti-TNFalpha antibodies than with the soluble receptor. The role for concomitant treatments (glucocorticoids and methotrexate) should be taken into account.

Topics: Acyclovir; Adalimumab; Adult; Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antiviral Agents; Arthritis, Rheumatoid; Drug Therapy, Combination; Etanercept; Female; Glucocorticoids; Herpes Zoster; Humans; Immunoglobulin G; Immunosuppressive Agents; Infliximab; Male; Methotrexate; Middle Aged; Receptors, Tumor Necrosis Factor; Retrospective Studies; Risk Factors; Spondylitis, Ankylosing; Tumor Necrosis Factor-alpha; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Skin Diseases, Vesiculobullous; Time Factors; Treatment Outcome; Valacyclovir; Valine

Despite recent evidence suggesting that Bell's palsy is associated with reactivation of alfa-herpes viruses, the disease has been treated empirically, and the use of valacyclovir has not been definitively established. In 2007, two prospective, randomised, placebo-controlled trials evaluating valacyclovir were reported in patients with Bell's palsy. One demonstrated that valacyclovir/prednisolone therapy was statistically more effective than placebo/prednisolone therapy in improving the recovery of patients with Bell's palsy, excluding zoster sine herpete. However, considering the cost-benefit ratio of this treatment and the limitations of virological diagnoses, we recommend that valacyclovir should be used in cases of severe palsy within 3 days after the onset of Bell's palsy.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Cost-Benefit Analysis; Drug Therapy, Combination; Herpes Zoster; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Medical prescription errors are frequent in community settings and information exploring its magnitude during antiviral treatment of herpes zoster is scarce. A questionnaire was applied to 31 physicians working in hospital- or community-based settings in Santiago, Chile in order to characterize their dosing and timing preferences for aciclovir or valaciclovir prescriptions. Aciclovir was more often prescribed than valaciclovir (71.9 and 28.1%, respectively), but less than a third of prescription (27.3%) fulfilled the minimal aciclovir dosing and timing criteria for clinical efficacy (4 gr per day and <72 hours since rash initiation). The limited size of the simple prevented exploring factors linked to a misleading prescription. Appropriate knowledge on dosing and timing of aciclovir/valaciclovir therapy for herpes zoster was infrequent in a sample of physicians working in various clinical settings in Chile.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Medication Errors; Middle Aged; Surveys and Questionnaires; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Attitude of Health Personnel; Australia; Famciclovir; Female; Health Care Surveys; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Eye Infections, Viral; Ganciclovir; Herpes Zoster; Humans; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valganciclovir; Valine

Two cases of varicella zoster virus (VZV) meningitis are described in an 18-year-old girl and an 18-year-old boy. They occurred, respectively, 9 days and 9 months after allogeneic bone marrow transplantation. VZV nucleic acid was detected in the cerebrospinal fluid during the 1st week of illness. This recurrence occurred despite valaciclovir prophylaxis and without skin lesions. The two patients received aciclovir intravenously and immunoglobulins infusion. They responded to treatment and their clinical state improved rapidly.

Topics: Acyclovir; Adolescent; Antiviral Agents; Bone Marrow Transplantation; Cerebrospinal Fluid; Chemoprevention; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Viral; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Chickenpox Vaccine; Child; Child, Preschool; Contraindications; Disease Transmission, Infectious; Environmental Exposure; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Sera; Immunization, Passive; Infant; National Institutes of Health (U.S.); Postoperative Complications; Practice Guidelines as Topic; Premedication; Sensitivity and Specificity; United States; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Drug Resistance, Viral; Famciclovir; Guanine; Hepatitis B; Hepatitis C; Herpes Simplex; Herpes Zoster; Humans; Influenza, Human; Valacyclovir; Valine; Virus Diseases

Post herpes zoster (HZ) reactions have been associated with panoply of neoplastic, inflammatory, and fibro-inflammatory cutaneous disorders. Varicella zoster virus (VZV) DNA has not been identified in most of these reports. After an episode of HZ, a healthy, active 90-year-old female developed ulcerative nodules in the affected trigeminal V1 dermatome and the contra-lateral trigeminal region over a 1-year period. Excision and/or biopsy of all these lesions showed similar pathologic changes that consisted of herpetic folliculitis, adjacent dense mixed nodular lymphocytic infiltrates with germinal centers (cutaneous lymphoid hyperplasia (CLH)), and in the deeper excision specimens, an obliterative vasculitis of a vessel with smooth muscle in its wall. Immunophenotype analysis revealed a mixed, predominate T- and B-cell population without loss of pan-T cell antigens or aberrant expression by B cells of T-cell antigens. Polymerase chain reaction for herpetic DNA was positive for VZV DNA. Lymphocyte gene rearrangement analysis revealed 2 distinct, anatomically and chronologically, monoclonal B-cell populations and a monoclonal T-cell population in one nodule. Treatment with valacyclovir has lead to almost complete resolution of her cutaneous nodules after 6 months of therapy. In this case, it can be surmised that persistence of VZV infection and lack of effective cell-mediated immunity lead to development of both immunopathology (vasculitis) and excessive lymphoid cell proliferation (CLH).

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Arteritis; Clone Cells; DNA, Viral; Female; Folliculitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunophenotyping; Polymerase Chain Reaction; Pseudolymphoma; Valacyclovir; Valine

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Brain Diseases, Metabolic; Diabetes Complications; Diagnosis, Differential; Herpes Zoster; Humans; Hypertension; Male; Myoclonus; Renal Dialysis; Renal Insufficiency; Valacyclovir; Valine

To report a case of Clostridium difficile colitis associated with valaciclovir treatment.. A 73-year-old man with lumbar herpes-zoster started valaciclovir 1 g tid. After three days he began vomiting and developed diarrhea, three to four stools per day. Symptoms worsened over the following days and he was admitted. Valaciclovir was stopped and fluid and electrolyte replacement was started. He continued 6 days later with diarrhea of 7 to 13 stools per day and a stool test for diagnosis of C. difficile infection was performed with a positive result. The patient received oral metronidazole (500 mg/t.i.d. for 10 days) and rapid improvement and eventual resolution of his diarrhea was observed after 3 days of therapy.. Although no conclusive reports of this reaction exist, we think this is a case of C difficile colitis that appeared three days after valaciclovir was initiated. Colitis improved with metronidazole. Other causes of diarrhea were excluded, such as diabetes mellitus, renal failure, intestinal surgery and intestinal obstruction. Infection was confirmed by a positive test for C. difficile. The application of Naranjo's algorithm asserts the reaction as 'probable'.. Valaciclovir-associated C. difficile colitis, although rare, can have severe consequences for the patient's health. It should be included as a possible adverse effect of valaciclovir treatment by health professionals.

Topics: Acyclovir; Aged; Antiviral Agents; Clostridioides difficile; Diarrhea; Enterocolitis, Pseudomembranous; Herpes Zoster; Humans; Male; Valacyclovir; Valine

Medication errors may involve prescribing, dispensing, preparation and administration of drugs. We report a case in which an administration error occurred due to ambiguous labelling of a commercial drug. Tablets were packed in sets of two tablets per blister with the print on the blister 'Zelitrex 500', making the amount of drug per tablet unclear. A short survey among nurses and pharmacy technicians showed that the majority interpreted the strength of the tablets incorrectly. This case shows that, despite regulations for controlling and accepting labelling before marketing, ambiguous labelling may occur and can lead to medication errors.

Topics: Acyclovir; Adult; Antiviral Agents; Drug Labeling; Drug Packaging; Female; Herpes Zoster; Humans; Medication Errors; Valacyclovir; Valine

Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Drug Monitoring; Electromyography; Herpes Zoster; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Middle Aged; Patient Selection; Radiculopathy; Treatment Failure; Valacyclovir; Valine; Viral Load

Topics: Acyclovir; Aged; Aged, 80 and over; Anticonvulsants; Antiviral Agents; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Status Epilepticus; Treatment Outcome; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is a serious complication of herpes zoster that has a predilection for older individuals. PHN is often associated with significant morbidity, and it can cause insomnia, fatigue, depression and interference with daily activities in affected individuals. Treatment for PHN is initiated with antivirals during the acute herpes zoster outbreak. Acyclovir (Zoviraxr, GlaxoSmithKline), valacyclovir (Valtrex, GlaxoSmithKline) or famciclovir (Famvir, Novartis) can be used to treat herpes zoster, and all three have been shown to reduce the duration of the herpetic rash and zoster-associated pain. These antivirals are most effective when used within the first 72 hours of the onset of the rash. Side-effects of these antivirals are low and include nausea, vomiting, abdominal pain and headache. Other treatment options for PHN include topical analgesics, opioid analgesics, tricyclic antidepressants and gabapentin. Because of the complexity of PHN, most patients require a combination of treatment modalities for adequate pain relief.

Topics: 2-Aminopurine; Acyclovir; Age Factors; Aged; Amines; Analgesics; Analgesics, Opioid; Antidepressive Agents, Tricyclic; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Middle Aged; Neuralgia; Prodrugs; Risk Factors; Time Factors; Valacyclovir; Valine

A variable region, R2, on the varicella-zoster virus (VZV) genome contains a repeated 42-bp unit.. The purpose of this study is the derivation of significance from tandem reiteration structure in the R2 region.. Fifty-two specimens were collected from 52 patients with herpes zoster in Osaka and Tokyo, Japan. After treatment of the specimens to release viral DNA, the samples were amplified directly by polymerase chain reaction. In addition, 14 samples were collected from 7 of these zoster patients after valaciclovir or aciclovir therapy.. Analyses of the 52 specimens revealed that the number of repeats ranged from 4 to 13. Interestingly, the numbers of repeats among various VZV strains showed a normal distribution pattern, so that 6-9 repeats were found to be predominant in both Osaka (85%) and Tokyo (72%). The pre- and post-treatment strains taken from the same individuals showed the same numbers of repeats (7-9 in 6 cases and 11 in one).. Our results suggest that the 6-9 repetitions of the 42-bp unit, with presumed stability, may offer these virus strains an advantage in virulence to human skin.

Topics: Acyclovir; Antiviral Agents; Genome, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Japan; Phenotype; Tandem Repeat Sequences; Valacyclovir; Valine

Topics: Acute Disease; Acyclovir; Aged; Anticonvulsants; Antiviral Agents; Carbamazepine; Diagnosis, Differential; Female; Headache; Herpes Zoster; Humans; Oxcarbazepine; Time Factors; Trigeminal Neuralgia; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Necrosis; Nose; Palate, Hard; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Enzyme-Linked Immunosorbent Assay; Herpes Zoster; Humans; Immunocompetence; Immunoglobulin G; Male; Treatment Outcome; Trigeminal Nerve Diseases; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Controlled Clinical Trials as Topic; Female; Herpes Genitalis; Herpes Zoster; HIV Infections; Humans; Infant; Influenza Vaccines; Influenza, Human; Male; Public Health; Vaccination; Valacyclovir; Valine

The investigation was aimed to determine prognostic factors related to postherpetic neuralgia (PHN), and treatment options for preventing PHN. The data showed 34 (17.0%) out of 188 patients with herpes zoster had severe pain after 4 weeks, and 22 (11.7%) after 8 weeks, compared with 109 (58.0%) at presentation. The age (>/=50 yr), surface area involved (>/=9%), and duration of severe pain (>/=4 weeks) might be the main factors that lead to PHN. On the other hand, gender, dermatomal distribution, accompanied systemic conditions, and interval between initial pain and initiation of treatment might not be implicated in PHN. The subjects were orally received antiviral (valacyclovir), tricyclic antidepressant (amitriptyline), and analgesic (ibuprofen) as the standard treatment in the group 1. In addition to the standard medication, lidocaine solution was sub- and/or perilesionally injected in the group 2, while lidocaine plus prilocaine cream was topically applied to the skin lesions in the group 3. The rates of PHN in the 3 treatment groups were not significantly different, suggesting adjuvant anesthetics may not be helpful to reduce the severity of pain.

Topics: Acyclovir; Adolescent; Adult; Aged; Amitriptyline; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Tricyclic; Antiviral Agents; Child; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Ibuprofen; Male; Middle Aged; Neuralgia; Prognosis; Time Factors; Valacyclovir; Valine

In continuous ambulatory peritoneal dialysis (CAPD) patients, acyclovir-induced neurotoxicity is reported to be associated with high serum drug levels even when following the recommended reduced doses for this renal failure population. In view of the high oral bioavailability of valaciclovir (the L-valyl ester of acyclovir) the risk of neurotoxicity becomes more prominent. The present study was conducted in 12 CAPD patients who were administered a single oral dose of 500 mg valaciclovir. Acyclovir was analyzed by high-performance liquid chromatography. Relative pharmacokinetic parameters were estimated based on acyclovir concentrations at 8, 12 and 24 h post-dose. High inter-patient variations were observed with acyclovir apparent total clearance 7.238 +/- 4 l/h and half-life (T1/2) 22.27 +/- 16.82 h. However, dosage simulations confirmed supratherapeutic acyclovir concentrations for all participants when following the recommended dose of 1,000 mg valaciclovir/24 h for varicella zoster infections.

Topics: Acyclovir; Aged; Antiviral Agents; Biological Availability; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Aged; Aged, 80 and over; Chorea; Drug Interactions; Famciclovir; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Renal Dialysis; Valacyclovir; Valine

Managing the infectious complications associated with pentostatin (Nipent), used alone or in combination with other agents in patients with low-grade lymphomas, poses a significant problem for clinicians. Since there is limited experience with these therapies, definitive treatment recommendations concerning prophylaxis cannot be made. The panel members discussed the use of valacyclovir (Valtrex) to provide prophylaxis for herpes zoster, trimethoprim/sulfamethoxazole for Pneumocystis, and acyclovir (Zovirax) for varicella zoster. They also considered combinations of pentostatin with agents such as interferon, rituximab (Rituxan), and chlorambucil (Leukeran) and their effect on the immune system. The biology of B and T cells was discussed, with an emphasis on clinical application.

Topics: Acyclovir; Anti-Infective Agents; Anti-Infective Agents, Urinary; Antibiotics, Antineoplastic; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Chlorambucil; Encephalitis, Varicella Zoster; Herpes Zoster; Humans; Interferons; Lymphoma; Pentostatin; Pneumocystis Infections; Rituximab; Sulfamethoxazole; Trimethoprim; Valacyclovir; Valine

The treatment of herpes zoster relies on the intravenous or oral administration of antiviral drugs. Oral aciclovir for shingles is hindered by its low bioavailability. New antiviral drugs with improved oral bioavailability (famciclovir and valaciclovir) allow a better efficacy. The opportuneness of treating herpes zoster is different in the immunocompetent and immunocompromised patients, and during childhood and pregnancy.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Biological Availability; Child; Famciclovir; Female; Herpes Zoster; Humans; Immunocompetence; Immunocompromised Host; Injections, Intravenous; Pregnancy; Pregnancy Complications, Infectious; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; AIDS-Related Opportunistic Infections; Antiviral Agents; Biological Availability; CD4 Lymphocyte Count; Drug Resistance, Microbial; Famciclovir; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: 2-Aminopurine; Acetamides; Acyclovir; Aged; Amantadine; Animals; Anti-HIV Agents; Antiviral Agents; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Enzyme Inhibitors; Famciclovir; Ganciclovir; Guanidines; Guanine; Herpes Simplex; Herpes Zoster; History, 18th Century; HIV Infections; Humans; Injections, Intravenous; Interferon-alpha; Lamivudine; Neuraminidase; Oseltamivir; Pyrans; Rats; Ribavirin; Sialic Acids; Teratogens; Valacyclovir; Valine; Zanamivir

The efficacy of early versus late treatment with acyclovir and valaciclovir on zoster-associated pain was assessed from two databases (1076 patients) that were compiled from randomized trials. Early treatment was started < 48 h and late treatment was started 48-72 h after the onset of cutaneous herpes zoster. Median times to complete resolution of zoster-associated pain were 28 and 62 days, respectively, for patients (> or = 18 years of age) treated with acyclovir and placebo within 48 h (hazard ratio [HR], 1.68; 95% confidence limit [95% CL], 1.19, 2.38) and 28 and 58 days, respectively, for those treated later (HR, 2.20; 95% CL, 1.03, 4.71). In the valaciclovir versus acyclovir study (in patients > or = 50 years of age), the corresponding figures were 44 and 51 days for patients treated early (HR, 1.28; 95% CL, 1.03, 1.60) and 36 and 48 days for those treated later (HR, 1.40; 95% CL, 1.04, 1.87). Acyclovir significantly shortened the time to complete resolution of zoster-associated pain compared with placebo (and valaciclovir was superior to acyclovir in this regard) even when therapy was delayed up to 72 h after rash onset.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Databases, Factual; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Famciclovir and valaciclovir were approved for use in the treatment of herpes zoster despite controversy over antiviral therapy in zoster due to high costs and uncertain benefits. To explore these issues, a Markov decision model was developed, and the incremental cost effectiveness of antiviral treatment for herpes zoster was estimated using these agents compared with no antiviral therapy. A third-party payer perspective was taken. Sensitivity analyses were performed, modeling differences in antiviral efficacy, postherpetic neuralgia (PHN) risk, and other illness parameters. Treatment of severely symptomatic acute zoster was found reasonable from a cost-effectiveness standpoint in base-case and worst-case scenarios. Treatment of mildly symptomatic acute zoster was more expensive but would likely be considered cost effective in scenarios where PHN risk was higher, PHN duration longer, or antiviral shortening of PHN greater. Further research comparing antiviral efficacy in herpes zoster is needed.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Computer Simulation; Cost-Benefit Analysis; Famciclovir; Herpes Zoster; Humans; Markov Chains; Middle Aged; Models, Economic; Neuralgia; Risk Factors; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antifungal Agents; Antiviral Agents; Dermatologic Agents; Dermatology; Dermatomycoses; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Itraconazole; Nail Diseases; Naphthalenes; Prodrugs; Skin Diseases; Terbinafine; Valacyclovir; Valine

The animal model of necrotic hepatitis caused by HSV-1 infection in juvenile mice was used to compare the efficacies of the oral antiherpes agents famciclovir (FCV), valaciclovir (VACV) and brivudin (BVDU). The experimental infection allows the measurement of viral replication in the liver by macroscopic lesions and the evaluation of mortality from encephalitis. Mice intravenously inoculated with a highly virulent clinical HSV-1 isolate were orally treated by gavage over a period of 3 days starting on day 2 post infection. The reference drug acyclovir (ACV) was administered subcutaneously. Necrotic hepatitis was significantly (p < 0.01) reduced by treatment with FCV, VACV and ACV at a dose of 50 mg/kg per day divided into 3 doses. No significant effect was achieved with BVDU at 200 mg/kg per day. Treatment with FCV at 50 mg/kg per day, ACV at 100 mg/kg per day, and VACV at 200 mg/kg per day significantly (p < 0.001) decreased mortality in mice. BVDU treatment at 200 mg/kg per day did not reduce mortality but significantly prolonged (p < 0.05) the survival time.

Topics: 2-Aminopurine; Acyclovir; Animals; Antiviral Agents; Bromodeoxyuridine; Cell Line; Disease Models, Animal; Famciclovir; Hepatitis, Animal; Herpes Zoster; Herpesvirus 1, Human; Liver; Mice; Mice, Inbred BALB C; Valacyclovir; Valine; Viral Plaque Assay; Virus Replication

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Guanine; Herpes Labialis; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Clinical Trials as Topic; Famciclovir; Herpes Zoster; Humans; Neuralgia; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Pain; Valacyclovir; Valine