What is shingles?

Shingles is caused by a reactivation of the varicella zoster virus, the same virus that causes chicken pox. Shingles is also called zoster and herpes zoster virus. The words "shingles" and "zoster" translate from the Latin into the word "belt," which describes the pattern of the rash of blisters as they appear on the body—generally a band (dermatome) on one side of the body.

What is FAMVIR?

FAMVIR^® (famciclovir) is an oral antiviral prescription medication that is indicated for:

• Treatment of acute herpes zoster (shingles)

How is FAMVIR prescribed for shingles?

The dose of FAMVIR for the treatment of herpes zoster (shingles) is 500 mg, three times a day, for 7 days.* ^†

* If you have kidney problems, your doctor will determine if FAMVIR is appropriate and if so, what the right dose is for you.

^† FAMVIR should be started within 72 hours (3 days) of the first sign of the shingles rash. Treatment started more than 72 hours (3 days) after the rash has appeared has not been studied.

What should I do if I miss a dose?

Please talk to your doctor about what you should do if you miss a dose of FAMVIR.

Does FAMVIR have any side effects?

FAMVIR is not for everyone. In clinical studies with FAMVIR, the most commonly reported side effects included headache, nausea, and diarrhea.

Should FAMVIR be taken with or without food?

FAMVIR can be taken with or without food.

Would should not take FAMVIR?

FAMVIR should not be taken by patients with known hypersensitivity to the product, its components, and DENAVIR^® (penciclovir cream). Women who are pregnant, planning to become pregnant or breastfeeding should talk to their doctor. Ask your doctor if FAMVIR is right for you.

Are there any drug interactions with FAMVIR?

FAMVIR has no clinically significant interactions with cimetidine, allopurinol, theophylline, digoxin, or zidovudine (AZT).

Concurrent use of FAMVIR with probenecid or other drugs significantly eliminated by active renal tubular secretion may result in increased plasma concentrations of penciclovir.

What happens when the chicken pox virus (varicella zoster virus) becomes active again?

After the chicken pox blisters have healed, the varicella zoster virus lies dormant (inactive) in neurons (nerve cells) next to your spinal cord, usually for decades. When the virus becomes active again, it travels down the nerve fibers that extend to your skin, and a rash develops.

Who gets shingles?

Anyone who has had chicken pox is at risk of developing shingles. More than 90% of Americans over age 15 have had chicken pox. Although young people can get shingles, this disease usually occurs in people over age 50. The frequency of shingles is basically constant between the ages of 20 and 50 years (2.5 cases per 1,000 people per year). The chances of getting shingles then doubles in people between ages 50 and 60 years, and then doubles again in people age 80 to 90 years.

The following may cause the varicella zoster virus to become active and cause an outbreak of shingles:

• Diseases that affect the immune system (eg, non-Hodgkin's lymphoma and HIV)
• Anticancer and immunosuppressive drugs that suppress the immune system (eg, chemotherapy)
• Temporary depression of the immune system from a cold or sunburn
• Stress (due to negative life events)
• Major depression

What are the symptoms of shingles?

The symptoms of shingles occur in two stages. The first stage, the prodromal stage, occurs about 2 to 5 days before the rash appears. Symptoms may include:

• Fever, headache, nausea, and chills
• Numbness on one side of the body or face
• Tingling, burning, or shooting pain on one side of the body or face (pain may be constant or intermittent)
• Itching on one side of the body or face

During the second stage, the eruptive stage, redness and swelling will appear at the site of the pain, along with clusters of blisters filled with clear fluid. The rash and blisters from shingles almost always occur on just one side of the body. New blisters will continue to appear for up to 5 days. These blisters can be scattered in patches or form a continuous band on the skin (dermatome), and they look a lot like chicken pox. The blisters can be mildly irritating, itchy, or intensely painful. Within 14 days, the blisters become filled with pus and then form a scab. At this point, they no longer contain the virus. The rash usually goes away in about 3 to 5 weeks. The blisters leave no scars, but you may have discoloration of the skin where they once were.

What is the incidence of shingles?

Approximately one million Americans suffer from shingles each year. It is estimated that shingles will affect 20 percent of the population at some time in their lives.

Is shingles contagious?

You cannot catch shingles from someone who has it. However, the rash that occurs with shingles sheds the same varicella zoster virus that causes chicken pox and may be contagious. So, if you have not had chicken pox or have not been vaccinated against the varicella zoster virus, you can develop chicken pox (not shingles) if you come in contact with someone who has shingles. People with shingles can transmit the virus only if the blisters have broken and the virus is transmitted when skin-to-skin contact with broken blisters occurs.

Can someone get shingles more than once?

Most people who get shingles develop immunity to the varicella zoster virus and will not get it again. Only about 4 percent of people will have another outbreak in the future. When shingles does recur, it is often in people with a compromised immune system (eg, they are infected with HIV or are undergoing chemotherapy treatments). A second outbreak of shingles may occur many years after the first outbreak. When shingles does recur, the rash usually does not appear in the same location as the first outbreak.

Can children get shingles?

Children born to mothers who develop chicken pox within 5 to 21 days before giving birth are susceptible to developing shingles. These babies are usually born with chicken pox or develop it within a few days of birth. One-third of these children develop shingles during the first 5 years of their life.

What is postherpetic neuralgia (PHN)?

PHN is the most common complication of shingles. It is a condition in which severe pain from shingles may last for months, and sometimes years, after the shingles rash has healed. PHN occurs from damage to the nerve fibers, caused by the varicella zoster virus. Nerve fibers send messages from the skin to the brain. When nerve fibers are damaged during an outbreak of shingles, they are not able to send messages as they normally do. The body may perceive these "mixed messages" as pain.

How is shingles diagnosed?

Before the shingles rash appears, diagnosis of this condition may be difficult. Symptoms of shingles can mimic other conditions. The initial symptoms may include itching, numbness, tingling, or pain on one side of the body or face. During this stage, the pain may be so severe that it may be mistaken for kidney stones, pleurisy, gallstones, appendicitis, or even a heart attack depending on where the affected nerve is located on the body.

Physicians can distinguish shingles from chicken pox, poison ivy, or other types of rash by the way the lesions are distributed on the body. The blisters of the shingles rash generally appear in the pattern of a band (dermatome) on one side of the body.

In addition to looking at how the rash appears on your body, physicians may also take a scraping or swab of the blisters to send to a laboratory for analysis.

How can shingles be treated?

The severity and duration of shingles can be significantly reduced for many people with the use of oral prescription antiviral medications. Oral antiviral medications like FAMVIR are used to treat shingles. Shingles should be diagnosed and treated early (within 72 hours) after the rash appears.

What is ophthalmic zoster?

Ophthalmic zoster is the involvement of any part of the fifth cranial nerve (trigeminal) with the varicella zoster virus. The symptoms include a zoster rash that extends from the eye to the vertex of the scalp. If left untreated, ophthalmic zoster can lead to inflammation, corneal ulcers/scarring, impaired vision, and even blindness.

What is the incidence of ophthalmic zoster?

Of the 1,000,000 herpes zoster outbreaks every year in the U.S., an estimated 10 percent are ophthalmic zoster patients.