Side Effect: Shingles

What is Shingles?

Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve tissue near the spinal cord and can reactivate years later, causing shingles.

What does Shingles look like?

Shingles typically begins with a painful, tingling, or burning sensation in a specific location of the body or face, followed by the appearance of a rash that usually develops into clusters of blisters that can be very painful. The rash typically lasts for two to four weeks and can be accompanied by fever, headache, and weakness. Nerve pain from shingles can remain even after the rash has resolved. This is known as postherpetic neuralgia which can persist for months or even years.

It is important to know that a person with shingles can spread the virus to others through direct contact with the rash, blister or even from breathing in virus particles. You can prevent spreading the virus to others by doing the following:

• Cover the rash
• Avoid touching, scratching, and irritating the rash
• Avoid popping blisters
• Wash your hands frequently
• Avoid contact with people until the rash and blisters scab over

Who gets Shingles?

Anyone who has had chickenpox can develop shingles, but it is most common in older adults and people with weakened immune systems. Patients receiving intensive chemotherapy for acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) and those undergoing an autologous or allogeneic bone marrow transplant are at higher risk of reactivation of the VZV virus due to a significantly weakened immune system. Some chemotherapy agents that are known to cause an increased risk of shingles include:

Proteosome Inhibitors

• Bortezomib (Velcade®)
• Carfilzomib (Kyprolis®)
• Ixazomib (Ninlaro®)

CD38 antibodies

• Daratumumab (Darzalex®)
• Isatuximab (Sarclisa®)

CD57 antibody

• Alemtuzumab (Campath®)

Purine analogs

• Fludarabine (Fludara®)
• Pentostatin (Nipent®)

How to prevent Shingles

One way to prevent shingles is to get vaccinated with the shingles vaccine, Shingrix®. The Centers for Disease Control and Prevention (CDC) recommends that people age 50 and older get the vaccine. Preventative antiviral medications may also be used during periods where there is a high risk for shingles. Commonly used antiviral medications include:

• Acyclovir (Zovirax®)
• Valacyclovir (Valtrex®)
• Famciclovir (Famvir®)

How to treat Shingles

In cancer patients, shingles can be particularly severe and can even be life-threatening. Treatment typically involves antiviral medication to help reduce the severity and duration of the infection. Shingles may be treated with oral antiviral medication in the outpatient setting but for more severe cases, treatment with intravenous (IV) therapies in the hospital may be necessary.

Oral therapies

• Acyclovir (Zovirax®)
• Valacyclovir (Valtrex®)
• Famciclovir (Famvir®)
• Valganciclovir (Valcyte®)

IV therapies

• Acyclovir (Zovirax®)
• Foscarnet (Foscavir®)
• Ganciclovir (Cytovene®)
• Cidofovir (Vistide®)

In some cases, pain management may also be necessary. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioids may be used to control generalized pain while some seizure medications, antidepressants, or local anesthetics can be used to treat nerve pain.

NSAIDs

• Ibuprofen (Motrin®, Advil®)
• Naproxen (Aleve®)
• Meloxicam (Mobic®)
• Celecoxib (Celebrex®)

Opioids

• Tramadol (Ultram®)
• Hydrocodone (Vicodin®)
• Oxycodone (Roxicodone®, Percocet®)

Seizure medications

• Gabapentin (Neurontin®)
• Pregabalin (Lyrica®)

Antidepressants

• Amitriptyline (Elavil®)
• Nortriptyline (Pamelor®)

Local anesthetics

• Lidocaine patch (Lidoderm®)