Is Your Medication Raising Your Risk for Shingles?

Certain medications, particularly immunosuppressive drugs used in the treatment of autoimmune conditions, like prednisone, increase the risk of shingles in susceptible individuals by affecting the immune system.^,

Keep reading to find out if your medications are increasing your risk of shingles and what steps you can take to prevent the condition.

Your immune system and shingles

Shingles (also referred to as herpes zoster) is an infection caused by the varicella-zoster virus – the same virus that causes chickenpox. Shingles is characterized by a painful, blistering rash that appears on the face and body.

When someone gets chickenpox, the immune system kicks in to fight the infection and clear symptoms, but the virus stays in the body in an inactive (dormant) state and hides in nerve cells near the spinal cord and brain.

The occurrence of shingles is closely linked to one's immune status. When the immune system's ability to control the dormant replication of the virus is compromised, it results in shingles.

Individuals with robust immunity seldom experience shingles.

Medications that lower immune function

Medications that suppress T-cell-mediated immunity – the body’s ability to recognize and eliminate foreign antigens – increase the risk of developing shingles.These medications are called immunosuppressant drugs and include:

• Drugs used in the management of rheumatic conditions, such as rheumatoid arthritis:
  • Non-biologic disease-modifying antirheumatic drugs (DMARDs), including methotrexate, hydroxychloroquine, and sulfasalazine. 
  • Corticosteroids, including prednisone, methylprednisolone, and triamcinolone.
  • Tumor necrosis factor (TNF) inhibitors, including adalimumab (Humira) and infliximab (Remicade). 
  • Janus kinase (JAK) inhibitors, including tofacitinib (Xeljanz) and upadacitinib (Rinvoq)
• Medication used in the treatment of cancer and organ transplant, such as: 
  • Chemotherapy agents 
  • Anti-rejection drugs (eg, cyclosporine)

Established research supports changes in the gut microbiome (good bacteria that live in the gastrointestinal tract) and reduced immunity with excessive use of antibiotics. While inconclusive, there is ongoing research to determine a possible connection between the antibiotic-related decline in immunity and the potential risk for shingles.

See 5 Types of Medication That Treat Rheumatoid Arthritis (RA)

Additional factors that may increase your risk for shingles

Even if you are not taking an immunosuppressant, you may still be at risk for developing shingles if any of the following factors apply to you:

• Age. Adults aged 50 years and older have a higher risk of shingles, which continues to increase due to the natural decline of immune function over time.
• Stress. Prolonged, high levels of stress, including physical trauma and emotional stress, can weaken the immune system and trigger shingles.
• Compromised immunity. Medical conditions that impact immune function include^,:
  • Autoimmune disease
  • Human immunodeficiency virus (HIV)
  • Solid organ and stem cell transplant
  • Chronic lung or kidney disease

It is important to note that not everyone with these risk factors will develop shingles, and the presence of these risk factors only increases the likelihood of developing shingles.

Next steps if you are at a higher risk for shingles

While some risk factors, such as age or a chronic medical condition, cannot be changed, there are a few steps you can take to help lower your risk of shingles and its related complications (eg, the persistence of nerve pain and vision or hearing problems).

• Get vaccinated. Vaccination is the most effective strategy for lowering your risk of shingles. The recombinant zoster vaccine (Shingrix) is recommended for anyone over 50, regardless of health status, or for anyone over 18 who is immunocompromised.^,
• Explore alternative medication. Some newer drugs for autoimmune conditions (eg, Cosentyx, Tremfya, and Skyrizi) target more specific proteins and receptors within the immune system and are associated with a lower risk of infections.^,
• Maintain a healthy lifestyle. Adequate nutrition, hydration, exercise, and stress management contribute to the optimal function of the immune system.
• Consider vitamins and supplements. Certain vitamins and supplements, such as vitamin C, zinc, echinacea, and turmeric, are associated with boosting immunity and may help enhance your immune system's strength.^,It is important to talk with your doctor before trying a new diet, home remedy, or supplement to make sure it does not adversely interfere with your health or current medications.

If you have questions or concerns about your risk of shingles, talk to your doctor about which strategies might be right for you to lower your overall risk.

Medications for treating shingles

While there are several strategies for reducing the risk, individuals who are susceptible may still find themselves developing shingles.

Medications that are prescribed and/or recommended for treating shingles include^,,:

• Antiviral drugs that specifically target herpes zoster virus, such as:
  • Acyclovir
  • Valacyclovir (Valtrex)
  • Famciclovir
• Topical antibiotics to prevent secondary bacterial infections of the skin, such as:
  • Mupirocin
  • Soframycin
• Eye drops to prevent secondary infections in the eye and/or alleviate symptoms, such as:
  • Erythromycin eye ointment
  • Prednisolone eye drops
  • Artificial tears
• Prescription pain-relievers that treat symptoms of nerve pain, such as:
  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Amitriptyline (Elavil)
• Topical pain-relieving agents to reduce pain and discomfort caused by blisters, such as:
  • Lidocaine
  • Capsaicin 
  • Aloe vera
• Over-the-counter pain-relievers for mild to moderate pain, such as:
  • Acetaminophen (Tylenol)
  • Ibuprofen (Motrin and Advil)

These medications play a crucial role in reducing the intensity and duration of shingles. 

See Pain Medications for Arthritis Pain Relief

If shingles is suspected, it's essential to promptly consult your doctor for treatment of the virus, addressing symptoms, and managing any potential secondary conditions.