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ACYCLOVIR REDUCES RISK FOR POSTHERPETIC NEURALGIA.

Elderly patients are known to be at high risk for developing postherpetic neuralgia. Several prior studies of acyclovir have yielded inconsistent results, primarily because of small sample sizes. This meta-analysis pooled data from five randomized, placebo-controlled trials that had oral dosing regimens of appropriate strength and well-described inclusion criteria.

Altogether, the trials included 792 patients with herpes zoster (average age, about 60) treated with 800 mg of acyclovir five times daily within 72 hours of rash onset. Overall, acyclovir reduced the incidence of any pain at 6 months by 46 percent.

Comment: It's been previously suggested that 800 mg of acyclovir five times daily may reduce the risk for postherpetic neuralgia, but this is the first controlled evidence for a strong effect. Although these results aren't from a single large randomized trial, they have sufficient power to influence the practices of many physicians. Presumably newer antivirals like valacyclovir and famciclovir, which offer simpler dosing regimens at a similar cost, would have the same benefit, but this conclusion awaits further research.

— TL Schwenk

Published in Journal Watch General Medicine May 13, 1997

Citation(s):

Jackson JL et al. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia: A meta-analysis. Arch Intern Med 1997 Apr 28 157 909-912.

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