Prevention of postherpetic neuralgia

An elderly patient is admitted to the internal medicine service with a diagnosis of herpes zoster infection in the typical dermatomal distribution.  The patient’s rash is currently not very painful (2/10) but she is concerned about long-lasting pain as her friend had pain from zoster that lasted for months.  What can we use to prevent the development of postherpetic neuralgia?

Postherpetic neuralgia is a common complication of herpes zoster infection and can be challenging to treat.  Drugs approved by the FDA to treat postherpetic neuralgia include pregabalin (Lyrica), gabapentin (Neurontin), and capsaicin patch (high-concentration patch - Qutenza).  Other medications that have been shown in randomized controlled trials to also reduce pain from postherpetic neuralgia include topical lidocaine, tricyclic antidepressants (eg. nortriptyline), opioids, and tramadol¹. 

No medication has been approved for the prevention of postherpetic neuralgia but here is the data on several agents that have been studied:

Is levalbuterol (Xopenex) more effective than albuterol?

The choice between levalbuterol and albuterol continues to be an area of contention for outpatients, in the emergency department, and those admitted into the hospital. Here is a brief explanation of the difference between the two products.