In the immunocompetent patient, first-line treatment is valacyclovir 1,000 mg every 8 hours or famciclovir 500 mg every 8 hours for 7 days. If the pain at presentation is equal to or greater than 4 (on a 10-point scale), the addition of gabapentin (and analgesics) to the antiviral therapy may reduce the incidence and/or severity of PHN, and is now the standard of care. The old standard of care was acyclovir 800 mg 5 times daily (every 4 hours) for 7-10 days but often results in decreased patient compliance due to the frequent dosing schedule (but should still be considered in some patients as it is significantly cheaper than valacyclovir and famciclovir).
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