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NEWS & OPINION
19
know that there is an increased risk
of ocular issues."
A
key with VZV infections is to
get patients on the oral antiviral
medications early, he emphasized.
The common oral medications, acy-
clovir, valacyclovir, and famciclovir,
are all effective, Dr. Mah noted. "The
main thing is you want to start them
as early as possible," he said, adding
that systemic literature mentions a
72-hour
window for reducing post-
herpetic neuralgia. Still, the oph-
thalmic literature shows that
patients who aren't treated during
this window can still benefit from
antiviral treatment. "Even if it has
been 4 days and they have not been
started on antivirals, I will start the
antivirals," Dr. Mah said.
However, all of these antiviral
medications may not be equal.
Dr. Mah cited a study showing that
while acyclovir was fine for reducing
the likelihood and severity of post-
herpetic neuralgia, valacyclovir was
better, and famciclovir was the best
of the three. "If it were my family, I
would push for famciclovir," Dr.
Mah said.
Meanwhile, Dr. Jeng empha-
sized the need for higher dosing for
VZV. "The dosing for zoster is twice
that of what we would normally do
for simplex," Dr. Jeng said. "It tends
to be a tougher virus."
For the pain associated with
post-herpetic neuralgia on the skin,
Dr. Jeng uses Neurontin (gabapentin,
Pfizer) to deaden the nerves. Dr.
Mah said another possibility for
treating pain is Elavil (amitriptyline,
AstraZeneca, London). In addition,
anti-inflammatories and possibly
steroids may help. However, Dr. Mah
said that an equal number of studies
dispute the effectiveness of systemic
steroids.
Going forward, Dr. Jeng is hope-
ful that new study results will give
practitioners more to go on with
VZV. He pointed out that the multi-
center study for HSV came out 20 or
30 years ago. A new study promises
the same for zoster.
"I think it's going to answer a
lot of questions in terms of how to
treat these patients to prevent long-
term sequelae," Dr. Jeng said.
EW
Editors' note: Dr. Jeng has no financial
interests related to his comments. Dr.
Mah
has financial interests with Alcon
(Fort Worth, Texas), Allergan (Irvine,
Calif.), and Bausch + Lomb.
Contact information
Jeng:
BJeng@som.umaryland.edu
Mah: Mah.Francis@scrippshealth.org
July 2014
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