Parlez-en à votre pharmacien

June 16, 2022
Q:

I heard that pharmacists can now assess and treat shingles. Is this true?

A:

It's true! As of June 12, 2022, New Brunswick pharmacists can assess and prescribe where appropriate for the treatment of Herpes zoster (i.e., shingles) infection. In addition, pharmacists can now also prescribe hormonal contraception medication (i.e., birth control).

For me, professionally, this is exciting. I worked the night shift this weekend and was able to assess and prescribe appropriate antiviral therapy for a person with new onset shingles rash. I found it rewarding because that person shared with me that the wait time in the emergency room was lengthy due to people there who had more serious health issues that needed attention first. Allowing pharmacists to assess for shingles gives more health care access to New Brunswickers and helps triage care.

Shingles is a viral illness caused by reactivation of the same virus responsible for chickenpox. At times when our body's ability to fight infection off is weakened, it is possible to experience shingles.

Typically, a rash occurs which follows a nerve pattern on the body known medically as a dermatome. The rash is present on only one side of the body. Sometimes the rash is preceded by a burning, tingling, itchy, sensation of the skin. Once the rash appears, you may notice clear fluid filled vesicles or water blisters. These blisters will eventually burst, weep, and later crust over. If the rash involves the eye, or anywhere around the eye, this infection is best assessed by a physician or nurse practitioner.

Up until the rash crusts over, it is possible to spread shingles from person to person through direct skin to skin contact. A good rule is to keep away from anyone with a compromised immune system until the rash heals over. 

The cost of this assessment will be covered by Medicare and there will be no charge to the patient for the assessment. Based on their clinical judgement according to Canadian treatment guidelines, algorithms, and best practice, pharmacists will either treat the patient for shingles or refer them to the most appropriate health care provider. 

If a pharmacist writes a prescription for treatment, the cost of the medication is the responsibility of the patient. Patients may take the prescription to the pharmacy of their choice to have the medication dispensed. 

Eligible patients are limited to one Herpes zoster assessment and prescribing service by a pharmacist per year. Patients must be a resident of the province of New Brunswick with a valid Medicare card. Patients who are residents of a long-term care facility are not included in this program. Eligible patients must be age 12 or older and present with symptoms of herpes zoster that includes a rash. Earlier treatment, particularly less than 72 hours from symptom onset, has been linked to a shorter duration of infection, less severe disease, and less likelihood of long- term painful phlebitis that can occur from untreated shingles.  

Treatment options for mild to moderate shingles include acyclovir, famciclovir, valacyclovir. The usual duration of treatment is seven days. Your specific dosage and medication treatment plan will be individualized by your pharmacist based on your current medication therapy, other health conditions including kidney health, as well as individual factors that you and your pharmacist will discuss. Your pharmacist may also suggest over-the-counter medication therapy for any pain associated with your shingles outbreak. Your pharmacist will discuss with you when to expect a treatment response and when further evaluation by a physician or nurse practitioner is warranted. 

It's an exciting time to be a pharmacist in New Brunswick. Pharmacies are located in communities around the province and are very well situated to provide primary health care services to citizens seeking front line health care. We recognize the importance of providing timely access and the highest level of health care service and we have devoted ourselves as professionals to care for you.

There is also a vaccine available to prevent the severity of shingles infection. You can read about the details of this immunization on the New Brunswick Pharmacists’ Association web site: https://nbpharma.ca/ask-your-pharmacist/252/page-9. Currently the shingles immunization is not covered by Medicare.

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Shoppers Drug Mart in Quispamsis, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.