Zoster Oticus (On Valtrex - palpitations)

Posted , 2 users are following.

Brief (but not so brief) history haha. I had my first break of shingles 2 months ago and the rash appeared above my right eye, cheek and scalp. Reported to the urgent care doctor that I was having ear pain but she failed to examine my ear; as well as my PCP whom I followed up with a couple of days later. Treated with acyclovir for 7 days. Initially prescribed the wrong dose by the urgent care doctor (another strike!) but fortunately my opthalmologist caught it. Rash and blisters healed within 2 weeks and it took another 2 weeks for the pain and intense itch to resolve. Did not have further ear pain since the shingles diagnosis. I was completely back to normal within a month.

Now to why I'm really here. Lucky me was just diagnosed with zoster oticus aka Ramsay Hunt Syndrome a couple of days ago. Lucky because this is quite rare said Dr. Google. I saw my PCP due to tinnitis, ear pain and muffled hearing. I attributed it from a cold I caught from my daughter. She loves to share with me all the germs she gets from preschool. So all along I thought I had an ear infection of some sort. My doctor saw new fluid filled vesicles in my ear canal and identified it right away. I asked to be prescribed Valtrex for the convenience (less daily dose compared to acyclovir 3 vs. 5) and efficacy. Been on Valtrex for 3 days and experiencing daily tachycardia (heart rate up to 140s). Although I have a history of tachycardia, cardiac work up negative. Normally my palpitations occur 2x month which is managed with occasional beta blockers.

Has anyone else experienced palpitations on Valtrex? Any other zoster oticus sufferers out there? Please share your stories.

0 likes, 3 replies


3 Replies

  • Posted

    Dear May!

    I am so sorry for your recurring Herpes Zoster-Shingles. I hope your Vitamin D level is normal, as you shouldn't be having recurrent Herpes Zoster-Shingles, at least this frequently.

    Valcyclovir can cause tachycardia. I would therefore stop it immediately, and see a clinician and request Famvir, which doesn't have that side effect listed. It is more efficacious and easier to swallow.


    I am so sorry you are going through this right now. I understand the agonizing, lancinating pain, sleepless nights, and suffering.

    I am a Nurse Practitioner in the States. I have had Herpes Zoster-Shingles in my right ear, mouth, and throat every three to five weeks for the past twenty-two years and twice in my right eye. It has now escalated to include my entire right scalp, as well, just to keep me doing more headstands, I am certain.

    This is a summary of the stages, signs and symptoms of Herpes Zoster-Shingles, and medical management of the disease.

    During the pre-eruptive phase, you may have some of the following symptoms:

    Duration one to ten -days, but the rash occasionally takes much longer to appear



    Generalized Aches and Pains

    Fever, Chills, and Sweating

    Enlarged Lymph Nodes near the pain and rash

    Fatigue and Exhaustion

    Pain usually preceding the rash, but not always


    Description of pain: deep burning or aching pain, or electric shock–like pains.

    Acute Eruptive Phase

    Rash of grouped vesicle-blisters in a dermatomal pattern.

    Occurs in waves or crops over a period of 5-7 days.

    Vesicle-blisters look dissimilar and are of different sizes.

    The rash is on a red base.

    The pain may continue to increase into the second and third week.

    The clear vesicle-blisters cloud over, look like pustules, scab over, and turn black. This process may take between 2-4 weeks. Once every vesicle-blister has scabbed over, you are no longer infectious!

    You are considered infectious (contagious) if your rash is open to the air, ie not covered, to anyone who has not had chickenpox. This includes all pregnant women! Remember, not all women know they are pregnant!

    Chronic Phase (Post Herpetic Neuralgia PHN)

    30 days after onset of rash. Definition varies

    Duration may last months or years after initial episode of Herpes Zoster-Shingles.

    The resolution of the scars can take up to a year to heal.

    Management and Medications


    Famciclovir 500 mg 3x daily 7-10 days, sometimes 14 days.

    Smallest Tablet

    Convenient dosing

    Least Resistance

    Valcyclovir 1000 mg 3x daily 7-10 days

    Large Tablets difficult to swallow for some

    Based on Acyclovir

    Acyclovir 800 mg 5x daily 7-10 days

    Inconvenient Dose Schedule

    Growing Resistance to Varicella Virus

    Acyclovir is the antiviral most often prescribed in the UK

    What dosage of the medication are you on? Sometimes, the Physician places the patient on a lower dose, but needs to increase it to help with the pain-itching.

    Sometimes, you need to be placed on a cocktail of medications, as they will work synergistically to help you. These are all by prescription. I have grouped them according to class. A clinician would start with one from the Anticonvulsant class, taper the dosage up, then one from the Antidepressant Class, etc. This list is by no means complete.





















    2. I would find 100% cotton knit clothing. Make sure there are no seams to irritate your skin. The cotton knit is the most breathable, least irritating cloth to most individuals.

    3. Use Lidocaine Cream or Spray OTC topically to help with the pain- itching, eg, Solarcaine with Aloe or Bactine. Many on this forum feel either Lidocaine or Benzocaine help with the pain-itching. The cream might soothe the inflamed nerve endings better and last longer on the skin. You can only use Lidocaine 12 hours on and 12 hours off, as the usefulness will extinguish itself.

    4. Use ice or cool compresses. Do not take hot showers, as it will only increase the pain-itching

    1. You need to rest and sleep. You cannot power through this disease. Do not go back to work! This virus is way stronger than you are, and you will only get more pain, the more exertion you do.
    2. Most Importantly, get the Shingrex Immunization. It is a two phase vaccine, two months apart. It is given intramuscularly. It is highly efficacious in stopping Post Herpetic Neuralgia PHN and recurrent episodes of Herpes Zoster-Shingles.

    Shingrex is available in the US at the pharmacy and covered by insurance if you are over 50 years of age. If you are younger than 50, and have had a documented case of shingles, it is still covered.

    If you are in the UK/Canada/Australia/NZ, I know it has been distributed there, but the national health insurance may not cover it until age 70, which is ridiculous. It is expensive, but I would have paid thousands not to have recurrent shingles.

    Best Wishes

    Merry Juliana

    Report Reply
    • Posted

      Hi Ms. Merry,

      I really appreciate your quick response, your compassion and very helpful information and tips on management of shingles. I am vitamin D deficient and the last time I checked my labs, I was a just above the normal range (28 I think). I am taking 2,000 IU daily. My doctor didn't address the numbers as suboptimal. Should I increase my dose?

      Best regards,


      Report Reply
    • Posted

      Dear May,

      As you are taking 2000 IU of hopefully "D3", you should be fine. Most physicians are ignorant of nutrition. The level 28 probably placed you at a level in which you were immunocompromised, as Vitamin D is essential for a strong immune system. The medical community does not really know the normal level of Vitamin D, as when they initially did the testing, they thought Vitamin D only was involved in the metabolism of the bones. Your level should be at least 50.

      Best Wishes

      Merry Juliana

      Report Reply

Report as inappropriate

Thanks for your help!

We want the forums to be a useful resource for our users but it is important to remember that the forums are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the forums is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.

newnav-down newnav-up