Gabapentin For Shingles: Dosage, Effectiveness, And More

If you contract shingles, your doctor may prescribe certain medications to help you relieve the symptoms and discomfort of the illness. Management of shingles can include pain medication, antivirals, and, depending on your symptoms, other medications to alleviate discomfort and pain at the discretion of your doctor.

In some shingles cases, an individual may develop moderate to severe nerve pain that can extend well beyond the shingles illness and become a chronic condition known as postherpetic neuralgia. Although gabapentin is typically known for its use as an anticonvulsant and treatment to manage seizure-related disorders, its use has successfully treated nerve pain in patients.

How can gabapentin treat shingles?

Gabapentin is not a prescription that will be given to all patients in a typical case of shingles. However, suppose a patient continues to experience pain, likely due to nerve damage from the illness. In that case, a doctor may prescribe this medication to help manage pain and reduce the symptoms of the nerve damage that occurs after a shingles diagnosis.

Gabapentin does not work to treat the virus-causing shingles, but rather it is used to address the pain from nerve damage that can occur in certain individuals at higher risk of developing complications from shingles, termed postherpetic neuralgia.

Shingles explained

Shingles are a common ailment in individuals who previously had chickenpox or received a vaccination against the chickenpox virus, varicella. Shingles is not something you can catch from another person. Instead, it is when the varicella virus that has remained dormant, possibly for many years, suddenly reactivates in your body and begins to cause symptoms.

When this occurs, it is not a recurrence of chickenpox — it is shingles or herpes zoster and is a different disease.

You cannot catch shingles from someone, and the exact trigger for the condition to develop is unknown. You will likely experience a rash or blistering of the skin when you get shingles. Within these blisters is fluid containing the active varicella virus, which can infect people that come into contact with the blisters or fluid.

If someone has contracted chickenpox before at some point in their lifetime or received a varicella vaccine, they are not likely to develop any symptoms from the contact. However, suppose a person you come into contact with has never been vaccinated for varicella or has never had chickenpox. In that case, they can develop chickenpox from contacting the varicella virus particles after touching you or an infected surface.

Symptoms

The first indication that you may have shingles is discomfort relating to an area of skin on the body. At first, you may only feel pain, itching, or a burning sensation. However, within 2–3 days, you will notice a vesicular rash developing in a specific area of your body.

With shingles, although the blisters and lesions are similar to chickenpox, the area of skin affected is not as widespread. Individuals with shingles are likely to have a rash or blisters only on one side of the body, not crossing the midline and within the area of a single nerve tract, termed a dermatome. 

It can take 2–4 weeks for the blisters to dry and heal. While the blisters and rash are exposed, the fluid is highly contagious to those who come into contact with the infected person.  

While the blistering and rash in a single dermatome are hallmark signs of a shingles infection, other symptoms can affect how a person feels during the illness.

Symptoms in addition to a rash and blisters that can occur with shingles include:

• Fever

• Chills

• Malaise

• Mild to severe pain around the area of the blistering

• Headaches

Causes

The cause of shingles is the varicella virus that lives within a person's body after they have gone through a chickenpox infection or received a chickenpox vaccine. The virus can remain dormant for years or decades, causing no symptoms or health issues. However, at some point, the virus can reactivate and subsequently develop into shingles. 

While shingles can happen at any age, it is most common in the older population. It causes the most severe symptoms and complications in this group, along with those immunosuppressed. Varicella virus reactivation¹ is most common in those with a weakened immune system due to aging or other health concerns.

Shingles, while common, do not happen to everyone. Studies indicate that approximately one in three people² within the US will, at some point, develop shingles. 

Complications

When shingles develop, discomfort and pain can be significant for some patients as they go through the illness. In most cases, shingles resolve in a few weeks, and an individual can return to their normal day-to-day life. However, the reactivation of the varicella virus in some people can cause other health problems affecting their nerves, brain, hearing, or eyesight.

One of the most common complications that happen to a person after healing from a shingles infection is postherpetic neuralgia.

The development of postherpetic neuralgia happens when the nerves suffer damage during the course of the shingles illness. A person experiencing postherpetic neuralgia will feel significant pain and discomfort in the area of the skin where the rash or blisters were present. With postherpetic neuralgia, the pain does not go away when the blisters heal.

Instead, a person continues to experience often significant pain in the area, although there is no longer any disturbance to the skin. Over time with proper treatment, patients can experience relief and improvement from the pain of postherpetic neuralgia. However, this is often a long-term condition that requires a long-term treatment plan.

When to take gabapentin for shingles?

Your doctor will advise you when gabapentin is appropriate in your case. Since gabapentin is used for postherpetic neuralgia, your doctor would not normally prescribe it for uncomplicated zoster.

Gabapentin for postherpetic neuralgia

Postherpetic neuralgia³ is a possible lasting consequence of a shingles infection. The condition causes a person to continue feeling the pain associated with blisters and skin lesions even after the skin lesions heal. Although PHN can occur in anyone, it is rare in those under 60 who develop shingles or have severe pain or rash with acute herpes zoster.

Postherpetic neuralgia is the most widespread complication associated with a shingles infection. The data shows that as many as 18% of those over 70 and 7% of those 60-69 who develop shingles will experience PHN following the illness. Unfortunately, the condition can continue for a significant time after infection. The sooner an individual seeks help from their doctor and treatment, such as with gabapentin, the sooner they can begin to feel relief.

Gabapentin is used to manage pain because it has the ability to change how the body reacts to pain triggers. This medication is classified as an anticonvulsant and is used primarily to treat seizures caused by epilepsy. However, the properties of gabapentin have also been discovered to help relieve symptoms in individuals experiencing pain and discomfort from PHN and restless leg syndrome.

Brands of gabapentin

Gabapentin is sold under various brand names and as a generic prescription medication.

• Gralise

• Horizant

• Neurontin

• Gabarone

• FusePaq Fanatrex

What is the proper gabapentin dosage for shingles?

The most effective dose of gabapentin for treating pain relating to postherpetic neuralgia from shingles will be determined by working with your doctor. Your doctor will likely start you on a base dosage and work up to the dosage that works best for you. The initial dosage is 300mg three times daily, which can be incrementally increased over time under your doctor's watchful eye and guidance. The maximum dosage of gabapentin for the treatment of postherpetic neuralgia is up to 1800mg per day.

How long does it take gabapentin to work for shingles?

It is important to realize that gabapentin may not provide instant pain relief. It can take a few weeks to begin noticing the effects of gabapentin. Furthermore, your doctor will work with you to find the correct dose. Gabapentin does not work the same for every patient, and it may take some trial and error to adjust the medication to your needs with the help of your doctor. You should expect to see some improvements in a matter of weeks, although getting the maximum pain relief from the treatment can take longer.

Who should not be taking gabapentin for shingles?

The ingredients in gabapentin can cause a reaction in people who are taking certain other drugs or have certain medical conditions that may be affected negatively by the medication. It is always essential to speak with your doctor about your current prescriptions and medical history to ensure that gabapentin is safe for you.

Individuals who may not be a candidate to take gabapentin include:

• Those who are allergic to any of the ingredients in gabapentin

• Anyone who is currently pregnant or plans to become pregnant soon

• Those with a history of breathing or kidney problems

• Those with a history of addiction

Side effects of gabapentin

Gabapentin can cause side effects. Some of these side effects may subside after using gabapentin regularly, while others may not and should be discussed with your doctor.

Commonly reported gabapentin side effects to include:

• Fatigue

• Feeling drowsy

• Lightheadedness or dizzy

• Nausea

• Blurry vision

• Anxiousness

• Dry mouth

• Gastrointestinal upset

• Involuntary eye movement

• Swelling of extremities

• Weight gain

If you have any signs that you are experiencing anaphylaxis⁴ from an allergic reaction, you must call 911 or go to the emergency room immediately. Symptoms of anaphylaxis can include:

• Shortness of breath

• Swelling of the airways, lips, or eyes

• Gastrointestinal distress

• Hives

• Itching of the mouth or throat

• The feeling of impending doom

While most side effects are not life-threatening, there are some additional side effects that could be of serious concern and should lead you to call your doctor for help:

• Suicidal thoughts

• Anxiety

• Depression

• Feeling dangerous or reckless impulses

• Sudden and drastic mood or behavioral changes

What should you avoid while taking gabapentin?

Due to the effects and properties of gabapentin, various substances and medications can have an unintended and dangerous effect on your health if taken under gabapentin treatment. While the result of some interactions may be drowsiness, some combinations can be life-threatening.

Speak to your doctor when prescribed gabapentin to avoid dangerous potential reactions or interactions with your current medications.

Examples of medications and substances you should avoid or moderate the intake of while taking gabapentin include:

• Caffeine

• Alcohol

• Ginkgo

• Bupropion

• Dalfampridine

• Metoclopramide

• Ethacrynic acid

• Morphine

Shingles prevention

Shingles are not inevitable. There are ways you can protect yourself from developing shingles. The shingles vaccine can protect you from developing shingles in many cases and can significantly reduce the risk of developing serious complications such as postherpetic neuralgia, for which gabapentin may be necessary to treat.

When to seek medical help?

If you had shingles but are still experiencing discomfort and pain where the blisters were, you may be experiencing postherpetic neuralgia, a common but distressing complication of shingles. Contact your doctor to discuss your symptoms and whether gabapentin can help you find relief from the pain.

The lowdown

Postherpetic neuralgia after a shingles infection can negatively affect your quality of life and well-being. If you are experiencing prolonged pain after a shingles infection has resolved, you may have postherpetic neuralgia.

Consult with your doctor about the treatments available to help you manage this condition and whether gabapentin is an option that can help you improve your quality of life and lessen the pain after a shingles infection.