Acute Shingles or Post Herpetic Neuralgia?

Here is My Question:
I have suffered a severe attack of shingles and have just been prescribed 10 mg Nortriptytline. How long will this take to be effective?

Answer:
Answering your question on the treatment of shingles requires separating the treatment and management into two phases:

1. Acute Shingles refers to the classic rash in a single dermatome. This rash is usually preceded by itching or burning which continues after the rash subsides. Treatment of the acute rash, especially if started within 72 hours, with lotions (calamine lotion), antivirals (eg acyclovir, valcyclovir etc) and oral steroids can shorten the duration of symptoms and lessen the chance of developing post herpetic neuralgia (i.e. the persistent pain after the rash has disappeared that can last for months or even years). Treatment is more important for people over 50 and people considered immunosuppressed. People are often hospitalized for rashes over many dermatomes, rashes involving the region around the eye, for infected rashes or for involvement of other organ systems.

2. Post herpetic neuralgia is the pain that continues after the acute rash subsides. This pain can be debilitating and is treated with both topical agents ( capsaisin cream or lidocaine patches), anticonvulsant class medications (gabapentin, pregabalin, phenytoin and carbamezipine) and low dose tricylics (amitriptyline and nortriptyline); often many of these different treatments are required in combination to manage the pain: a common combination is the use of lidocaine patches applied for 12 hours with gabapentin during the day and low dose nortriptyline at bedtime. 

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Director of Hillcrest Neurology
Professor of Clinical Neurosciences
University of California San Diego