How does Pamelor treat shingles pain?

Doctors are not sure how Pamelor (nortriptyline) works to treat the pain that can linger after a bout of shingles (herpes zoster). Pamelor is approved by the Food and Drug Administration to treat depression in adults, but is sometimes prescribed "off label" for treating the nerve pain that can result from shingles.

When you develop chicken pox, the varicella virus that causes that disease stays in your body in a dormant state. Years later it can be reactivated, causing the painful body rash characteristic of shingles. About 1 million Americans -- about half of them adults age 60 and older -- develop shingles each year. After the rash clears, the nerve pain, known as postherpetic neuralgia, can remain indefinitely.

Doctors believe that Pamelor improves postherpetic neuralgia by raising the levels of the "feel-good" brain chemicals serotonin and norepinephrine. Pamelor may work best when it's started early in the course of the herpes zoster infection and when it's combined with an antiviral medication. Your doctor may start you on a low dose of Pamelor and increase your dose gradually over several weeks. It may take as long as three months before you experience the full pain-relieving benefit of Pamelor.

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