Condition

Shingles

Herpes zoster - Viral infection causing painful rash

20M
People Affected
50
Active Trials
86.7M
New Cases/Year
14K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Valacyclovir
90% Effectiveness• 95% Confidence• 75% Safety• 23 trials• 35K participants
HIGH EvidenceExcellent ValueDose: 1000 mg three times daily for 7 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

1-3 days for symptom improvement

Duration

7 days

Response Rate

85%

Remission Rate

75%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

100

Common Side Effects:

Nausea: 18%
Headache: 18%
Vomiting: 8%
Diarrhea: 8%

Annual Cost of Care

Drug Cost

$30

Monitoring

$50

Side Effects

$10

Total Annual

$90

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$25,000/QALY

Cost per Remission

$120

Cost per Responder

$105.88

Treatment Outcomes
Primary Outcomes
Time to Full Rash Crusting24 days
-20.83% (-5 days)
Time to Cessation of New Lesions5.5 days
-27.27% (-1.5 days)
Time to Resolution of Zoster-Associated Pain48 days
-31.25% (-15 days)
Duration of Postherpetic Neuralgia (in affected patients)150 days
-33.33% (-50 days)
Secondary Benefits
Pain Intensity (NRS 0-100)70/100 points
-21.43% (-15 points)
Time to Return to Normal Activities25 days
-28% (-7 days)
Quality of Life (SF-36 PCS score 0-100)38 points
+13.16% (+5 points)
Common Side Effects
Nausea
+18%
Headache
+18%
Vomiting
+8%

Clinical Trial Phases:

Phase 4
2
Famciclovir
90% Effectiveness• 95% Confidence• 75% Safety• 5 trials• 30K participants
HIGH EvidenceExcellent ValueDose: 500 mg three times daily for 7 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

1-3 days for symptom improvement

Duration

7 days

Response Rate

85%

Remission Rate

75%

Number Needed to Treat (NNT)

9

Number Needed to Harm (NNH)

100

Common Side Effects:

Headache: 18%
Nausea: 12%
Diarrhea: 8%
Fatigue: 7%

Annual Cost of Care

Drug Cost

$30

Monitoring

$50

Side Effects

$10

Total Annual

$90

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$27,000/QALY

Cost per Remission

$120

Cost per Responder

$105.88

Treatment Outcomes
Primary Outcomes
Duration of Postherpetic Neuralgia (PHN) in patients >50 years60 days
-30% (-18 days)
Time to Full Lesion Healing (Crust Formation)9.5 days
-25% (-2.4 days)
Time to Loss of Zoster-Associated Pain (ZAP)32 days
-19% (-6 days)
Overall Acute Pain Severity (NRS 0-10)Peak daily pain (NRS): 7/10
-20% (-1.4 points)
Secondary Benefits
Duration of Viral Shedding7 days
-45% (-3.15 days)
Impact on Daily Activities (Zoster-Impact Scale 0-100, higher is worse)Zoster-Impact Scale: 70/100
-25% (-17.5 points)
Days Requiring Analgesic Medication25 days
-28% (-7 days)
Common Side Effects
Headache
+18%
Nausea
+12%
Diarrhea
+8%

Clinical Trial Phases:

Phase 4
3
Acyclovir
85% Effectiveness• 95% Confidence• 75% Safety• 31 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 800 mg five times daily for 7-10 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

1-3 days for symptom improvement

Duration

7-10 days

Response Rate

80%

Remission Rate

70%

Number Needed to Treat (NNT)

11

Number Needed to Harm (NNH)

100

Common Side Effects:

Nausea: 12%
Headache: 12%
Vomiting: 8%
Diarrhea: 8%

Annual Cost of Care

Drug Cost

$15

Monitoring

$50

Side Effects

$10

Total Annual

$75

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.06

ICER

$15,000/QALY

Cost per Remission

$107.14

Cost per Responder

$93.75

Treatment Outcomes
Primary Outcomes
Time to full crusting of lesions8.5 days
-17.6% (-1.5 days)
Time to resolution of acute pain25 days
-20% (-5 days)
Peak acute pain intensity (NRS)NRS score: 7.5/10
-13.3% (-1 point)
Incidence of Postherpetic Neuralgia (PHN) at 6 months15% risk
-20% (-3 percentage points)
Secondary Benefits
Time to complete healing of all lesions21 days
-14.3% (-3 days)
Duration of analgesic use for acute pain20 days
-25% (-5 days)
Overall reduction in rash severityRash Severity Score: 10 points
-20% (-2 points)
Common Side Effects
Nausea
+12%
Headache
+12%
Vomiting
+8%

Clinical Trial Phases:

Phase 4
4
Gabapentin
70% Effectiveness• 80% Confidence• 65% Safety• 8 trials• 8K participants
MODERATE EvidenceExcellent ValueDose: 300-3600 mg daily in divided doses
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

Days to weeks for full effect

Duration

Weeks to months

Response Rate

55%

Remission Rate

%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

20

Common Side Effects:

Dizziness: 25%
Somnolence: 22%
Peripheral edema: 8%
Ataxia: 7%

Annual Cost of Care

Drug Cost

$80

Monitoring

$150

Side Effects

$50

Total Annual

$280

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$30,000/QALY

Cost per Responder

$509.09

Treatment Outcomes
Primary Outcomes
Average Daily Pain Intensity7/10 on Numeric Rating Scale (NRS)
-35% (-2.5 points on NRS)
Pain Interference with Sleep6.5/10 on Pain Interference Scale
-25% (-1.6 points on Scale)
Pain Interference with Daily Activities6.5/10 on Pain Interference Scale
-25% (-1.6 points on Scale)
Secondary Benefits
Overall Health-Related Quality of Life55/100 on Visual Analog Scale (VAS)
+13% (+7 points on VAS)
Allodynia/Dysesthesia Severity6/10 on Neuropathic Symptom Scale
-25% (-1.5 points on Scale)
Frequency of Rescue Analgesic Use3 days/week
-50% (-1.5 days/week)
Common Side Effects
Dizziness
+25%
Somnolence
+22%
Peripheral edema
+8%

Clinical Trial Phases:

Phase 4
5
Pregabalin
70% Effectiveness• 80% Confidence• 65% Safety• 7 trials• 7K participants
MODERATE EvidenceExcellent ValueDose: 75-300 mg twice daily
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

Days to weeks for full effect

Duration

Weeks to months

Response Rate

55%

Remission Rate

%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

20

Common Side Effects:

Dizziness: 30%
Somnolence: 25%
Peripheral edema: 8%
Weight gain: 7%

Annual Cost of Care

Drug Cost

$150

Monitoring

$150

Side Effects

$50

Total Annual

$350

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$35,000/QALY

Cost per Responder

$636.36

Treatment Outcomes
Primary Outcomes
Average Daily Pain Score (NRS)7.0/10 (NRS)
-35.7% (-2.5 points (NRS))
Sleep Interference Score (NRS)6.5/10 (NRS)
-30.8% (-2.0 points (NRS))
Interference with Daily Activities (NRS)6.0/10 (NRS)
-30% (-1.8 points (NRS))
Secondary Benefits
Health-Related Quality of Life (EQ-5D VAS)55/100 (EQ-5D VAS)
+18.2% (+10 points (EQ-5D VAS))
Anxiety Symptoms (HADS-A)12/21 (HADS-A)
-25% (-3 points (HADS-A))
Depression Symptoms (HADS-D)10/21 (HADS-D)
-20% (-2 points (HADS-D))
Common Side Effects
Dizziness
+30%
Somnolence
+25%
Peripheral edema
+8%

Clinical Trial Phases:

Phase 4