POSTHERPETIC NEURALGIA IN THE ELDERLY

• Introduction Postherpetic neuralgia (PHN) is a common complication from the reactivation of the varicella zoster virus manifested as herpes zoster. It affects mainly immunosuppressed people and the elderly. Despite improvements from modern pharmacology, the management and appropriate control of pain is still a challenge. Treatment specificities must be observed, especially with elderly population. • Objectives • To show principles of pharmacokinetics in the elderly aiming at the individualization of prescription and review updates of pharmacological therapy. • Method Bibliographical review about PHN in elderly people using Medline, Pubmed, and SciElo databases, with material published in the last 10 years. • Results and Conclusions Antiviral medications must be initiated as soon as possible, preferably up to 72 hours later, to reduce the severity/duration of eruptions and reduce pain in the acute phase. Neuropathic pain is often severe and affects the patient's quality of life. The first-line therapy is the tricyclic antidepressants and gabapentinoids, but they have a slow start of action and countless adverse effects. In elderly people, considerations like the decline of functional reserve, alterations of pharmacokinetics and pharmacodynamics, and the presence of comorbidities must be analyzed. Topical options for treatment could be used because they proved to be efficient with patients experiencing fewer side effects. The complex physiopathology of PHN allows for several therapeutic targets, even if the mechanism of action that promotes analgesia is still not completely understood. Treatment response is unpredictable, and two patients with postherpetic neuralgia can respond differently to the same action.