Patient information from BMJ

Shingles: what are the treatment options?

Last published:Apr 29, 2025

Shingles (also known as herpes zoster) is a painful rash that is more common in older people. The illness happens when the virus that causes chickenpox ‘reactivates’ in the body.

Usually, shingles goes away on its own and doesn’t cause any long-term problems. But it can cause more serious issues in some people.

Getting treatment quickly can help shorten an attack and prevent long-lasting problems.

More information about shingles and its symptoms is available in our patient information Shingles: what is it?

What are the treatment options for shingles?

Antivirals

The main treatment for shingles is with antiviral tablets. This type of medicine aims to:

• shorten the time where the shingles virus is replicating in your nerve cells

• stop new rashes from forming on your skin

• reduce your pain.

Antivirals are most effective when they’re started within 2 to 3 days of a shingles rash appearing. So it’s important that you see your doctor right away if you think you have shingles.

Treatment with antivirals is taken for 7 days, but your doctor may recommend you take it for up to 10 days if the shingles has affected your eye.

In more severe cases of shingles, you may need to be given antivirals through a drip (also called an IV or intravenous infusion).

Like all medications, antivirals can cause side effects in some people. These can include a headache or feeling sick. But these side effects are not usually serious.

Pain medicines

The pain from shingles can be more severe for some people than for others. If you have milder pain, you can try taking over-the-counter painkillers, like paracetamol or ibuprofen. You can also use calamine lotion to soothe itching and pain.

In more severe cases, your doctor might recommend you take a strong opioid painkiller, such as oxycodone. Side effects of opioids include constipation, drowsiness, and nausea. It’s important that you speak to your doctor if you’re concerned about any side effects from medication.

You may also be prescribed a local anaesthetic to apply to your skin.

Skin care

Shingles can be very uncomfortable. But there are some ways to care for your skin that can help with your symptoms, such as:

• Wearing loose clothing that is unlikely to irritate your skin.

• Keeping the rash clean and dry.

• Protecting the rash with a loose, non-stick, sterile dressing.

• Cooling the rash by using an ice pack wrapped in a towel or taking a cool bath.

If you get long-lasting pain from shingles

Lasting pain after shingles is called post-herpetic neuralgia. It continues after your rash has cleared up, sometimes for months or longer. But there are treatments available that may help you manage the pain.

If your pain is mild, taking over-the-counter painkillers, such as paracetamol or ibuprofen, can help. Some people also find that using a cream containing the chilli-pepper extract capsaicin helps their pain.

Your doctor might also recommend taking a weak opioid painkiller, such as codeine.

If your pain is more severe your doctor might prescribe a stronger opioid medicine, such as tramadol.

Tramadol can also cause other side effects, including constipation, drowsiness, and nausea.

If strong painkillers don't help enough, your doctor may prescribe a type of medicine called a tricyclic antidepressant. These medicines are usually used to treat depression. But at a low dose they can help reduce nerve pain.

You may need to take a tricyclic antidepressant for several weeks before it starts to work. Possible side effects of this medicine can include dry mouth, drowsiness, and dizziness. 

Another option for severe pain is a type of medicine called an anticonvulsant. These medicines are usually used to treat epilepsy but they can also help with nerve pain.

Side effects of anticonvulsants can include feeling dizzy or sleepy, weight gain, and diarrhoea.

It’s important that you speak to your doctor if you’re concerned about any side effects from medication.

Relaxation techniques and counselling can also sometimes help with lasting pain. Your doctor may recommend this if they think this treatment will help.

What happens next?

Shingles usually resolves on its own, but treatment with antivirals can help speed up your recovery and prevent long-lasting issues like post-herpetic neuralgia.

People with weakened immune systems are usually at higher risk for severe shingles. So your doctor will want to keep a closer eye on you if this is the case.

If shingles affects either of your eyes, your doctor will urgently refer you to an ophthalmologist (a type of doctor that specialises in eye care). This is because it’s important to get the right treatment quickly to avoid any problems with your eye or eyesight.

Older people have a higher chance of developing long-lasting pain from shingles. Usually, this pain resolves within around 6 months, but it can take longer for some people. If you’re finding it difficult to cope with the pain, speak to your doctor. They may be able to recommend a different treatment option for you.

It’s important to remember that you can’t catch shingles from someone who has shingles. But you can catch chickenpox from someone who has shingles. If you have shingles and know someone hasn’t had chickenpox before (or the chickenpox vaccine), try to avoid close contact with them. You should avoid contact if the shingles rash is still weeping (i.e., oozing fluid), and cannot be properly covered with a non-sticky dressing, or until the rash becomes dry.