How do pharmacists treat shingles?

October 9, 2025 •

4 min read

Approximately one-third of Americans will develop shingles in their lifetime. This makes understanding how do pharmacists treat shingles? essential, as they are often the first point of contact for timely medication, symptom management, and prevention strategies.

Quick Summary

Pharmacists provide key interventions for shingles, including dispensing antiviral medications, recommending pain relievers and topical treatments, administering preventive vaccines, and offering detailed patient counseling and referral when necessary.

Key Points

Timely Antivirals: Pharmacists ensure patients begin antiviral medication, like valacyclovir or famciclovir, within the critical 72-hour window for maximum efficacy.
Pain Management: Pharmacists recommend a combination of OTC pain relievers (acetaminophen, ibuprofen) and topical treatments (lidocaine, calamine lotion) for symptom relief.
Vaccination Champion: Pharmacists promote and administer the Shingrix vaccine to eligible adults (50+ and immunocompromised 19+) to prevent shingles and its complications.
Patient Counseling: Pharmacists educate patients on how to care for the rash, manage side effects, and prevent spreading the virus to vulnerable individuals.
Strategic Referral: They identify signs indicating a need for physician referral, such as eye involvement, ear symptoms, or severe illness, to prevent serious complications.
Risk Reduction: Early pharmacist intervention and patient adherence to treatment protocols can significantly reduce the risk of developing postherpetic neuralgia.

The pharmacist’s role in managing shingles, or herpes zoster, extends far beyond simply dispensing prescriptions. With their accessible position in the community, pharmacists are invaluable healthcare providers who can ensure timely antiviral therapy, recommend appropriate pain management, educate patients on symptom care, and champion preventative vaccination. Early intervention is crucial for mitigating the severity of the illness and preventing long-term complications like postherpetic neuralgia (PHN).

The Critical Role of Early Antiviral Therapy

For shingles treatment to be most effective, it must begin within 72 hours of the first sign of the rash. Pharmacists are instrumental in ensuring patients start this treatment promptly. In many regions, pharmacists are authorized to dispense or even prescribe these crucial medications.

The primary antiviral agents used include acyclovir, valacyclovir, and famciclovir. These medications work by suppressing the replication of the varicella-zoster virus, which reduces the severity and duration of the rash and helps prevent PHN. A pharmacist's patient counseling will emphasize the importance of taking the medication exactly as prescribed for the full course of treatment, even if symptoms begin to improve. They also check for potential drug interactions, especially for immunocompromised patients or those on other therapies.

Comparison of Antiviral Treatments


Feature	Acyclovir	Valacyclovir	Famciclovir
Dosing Frequency	5 times per day	3 times per day	3 times per day
Bioavailability	Low (approx. 10-30%)	High (approx. 54%)	High (approx. 77%)
Convenience	Less convenient due to high dosing frequency	More convenient than acyclovir	High convenience
Cost (generic)	Generally the most affordable	Higher cost than acyclovir	Similar to or higher than valacyclovir
Renal Adjustment	Required in patients with kidney impairment	Required in patients with kidney impairment	Required in patients with kidney impairment

Managing Shingles Pain and Symptoms

Intense pain is a hallmark of shingles, and pharmacists provide valuable guidance on managing it with a range of medications.

Over-the-counter (OTC) pain relievers: For mild to moderate pain, pharmacists recommend oral analgesics like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil). They can advise on proper dosage and potential drug interactions.
Topical treatments: To relieve localized pain and itching, pharmacists can suggest topical anesthetics containing lidocaine in cream or patch form. They also recommend soothing agents like calamine lotion or cool, wet compresses, which can be particularly helpful for managing skin discomfort.
Other prescribed medications: If a patient is experiencing severe nerve pain, especially in cases of suspected PHN, the pharmacist will recognize the need for stronger prescription medications. These can include anticonvulsants (e.g., gabapentin, pregabalin) or tricyclic antidepressants (e.g., amitriptyline), which specifically target neuropathic pain. Topical capsaicin cream may also be suggested for pain relief once the rash has crusted.

Preventing Complications and Future Outbreaks

Vaccination is the most effective way to prevent shingles and its most common complication, PHN. Pharmacists play a vital role in patient education and vaccine administration.

Vaccine Recommendation: Pharmacists assess eligibility for the recombinant zoster vaccine, Shingrix. This vaccine is recommended for all adults aged 50 and older, and for immunocompromised adults aged 19 and older.
Vaccine Administration: As trained vaccinators, pharmacists can administer the two-dose series of Shingrix, counsel patients on potential side effects (e.g., pain at injection site, fatigue), and ensure they complete the series for maximum protection.
Addressing Concerns: Pharmacists address common patient concerns, such as the effectiveness of the vaccine and the need for vaccination even if they have already had shingles or the older Zostavax vaccine.

Patient Education and Counseling

Patient counseling is a cornerstone of the pharmacist's care for shingles. They provide comprehensive advice on self-care and safety.

Contagion: Pharmacists explain that shingles itself is not contagious, but the virus can spread from open blisters to individuals who are not immune to chickenpox, such as infants, pregnant women, and immunocompromised people. They advise covering the rash and practicing good hand hygiene.
Symptom Care: They offer advice on non-drug interventions to provide comfort, such as using cool compresses, wearing loose, cotton clothing, and taking colloidal oatmeal baths.
Monitoring: Pharmacists advise patients on what to look for and when to contact a doctor, including signs of bacterial infection (increased redness, swelling, pus), worsening pain, or new symptoms.

When to Refer to a Physician

While pharmacists can provide extensive care, certain red flags necessitate immediate referral to a physician to prevent severe complications.

Eye Involvement: If the rash or blisters appear near or in the eye (herpes zoster ophthalmicus), an immediate ophthalmology consultation is necessary to prevent permanent vision loss.
Ear Involvement: A rash affecting the ear (Ramsay Hunt syndrome) may cause hearing loss or facial paralysis and requires prompt medical attention.
Immunocompromised Patients: Patients with weakened immune systems should be referred for specialized care, as their risk of disseminated disease is higher.
Severe or Worsening Symptoms: Any severe pain or systemic symptoms like a high fever should be evaluated by a physician.

Conclusion

Pharmacists are critical to effective shingles treatment, acting as accessible experts who combine medication dispensing with comprehensive patient education and preventative care. By prioritizing timely antiviral therapy, advising on pain and symptom relief, and promoting the highly effective shingles vaccine, they significantly improve patient outcomes and reduce the risk of long-term complications like PHN. As healthcare has evolved, so has the role of the pharmacist, making their expertise essential for managing this painful and potentially debilitating condition.

For more information on shingles and public health guidelines, visit the Centers for Disease Control and Prevention.

Frequently Asked Questions

The most important treatment is prescription antiviral medication, such as acyclovir, valacyclovir, or famciclovir, started as soon as possible, ideally within 72 hours of the rash first appearing.

Depending on the jurisdiction, a pharmacist may have the authority to prescribe antiviral medication for shingles. However, in many areas, they will dispense the medication based on a doctor's prescription.

Pharmacists can recommend OTC options like acetaminophen or ibuprofen for mild pain, and topical creams or patches containing lidocaine or capsaicin for localized nerve pain after the blisters have crusted.

The best way to prevent shingles is through vaccination. The recombinant zoster vaccine, Shingrix, is recommended for adults aged 50 and over, as well as for immunocompromised adults aged 19 and older.

To avoid spreading the virus, a pharmacist will advise keeping the shingles rash covered. The virus is present in the fluid of the blisters and is no longer contagious once the blisters have crusted over.

A patient with shingles should be referred to a doctor if the rash affects the eye or ear, symptoms worsen, or there are signs of a bacterial infection. These are indicators of potential complications.

No, over-the-counter creams and lotions, such as calamine, help soothe the symptoms of itching and pain but do not treat the underlying viral infection. They are best used in combination with prescribed antiviral medication.