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DRUG INFORMATION ROUNDS

Bell's Palsy: A Review of Treatment Using Antiviral Agents

at time of writing, PharmD Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; now, Clinical Pharmacy Specialist-Intensive Care Unit, University of Alberta Hospital, Edmonton, Alberta, Canada

Peter J Zed, PharmD FCSHP

Pharmacotherapeutic Specialist—Emergency Medicine, CSU Pharmaceutical Sciences, Vancouver General Hospital; Clinical Associate Professor, Faculty of Pharmaceutical Sciences; Associate Member, Division of Emergency Medicine, Department of Surgery, Faculty of Medicine, University of British Columbia

Reprints: Dr. Zed, CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Ave., Vancouver, BC V5Z 1M9, Canada, fax 604/875-5267, zed{at}interchange.ubc.ca

OBJECTIVE: To review the evidence evaluating the efficacy and safety of antiviral agents to reduce morbidity associated with Bell's palsy.

DATA SOURCES: MEDLINE, EMBASE, and PubMed were searched (all up to April 2006) for English-language, prospective, randomized, controlled clinical trials that evaluated the use of antiviral agents in Bell's palsy. Search terms included Bell's palsy, acyclovir, valacyclovir, famciclovir, and randomized controlled trials.

STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, controlled trials that evaluated efficacy and safety endpoints of antiviral agents in the treatment of Bell's palsy were included. Primary efficacy outcomes included facial paralysis recovery profile, facial paralysis recovery index, and the House-Brackmann facial nerve grading scale. Safety outcomes were also identified by each trial.

DATA SYNTHESIS: Two prospective, randomized clinical trials were included in this review, both involving the use of acyclovir for treatment of Bell's palsy. Acyclovir monotherapy was shown to be inferior to prednisone monotherapy; however, the combination of acyclovir and prednisone was found to be superior to prednisone alone. There are limited data describing the safety of acyclovir in Bell's palsy.

CONCLUSIONS: The use of acyclovir in the treatment of Bell's palsy remains controversial. Additional, adequately powered, randomized, placebo-controlled trials are needed to definitively support its use. For the time being, the evidence reviewed in this article would favor the combination of acyclovir and prednisone if commenced within the first 72 hours of symptom onset.

Key Words: acyclovir, antiviral, Bell's palsy, idiopathic facial nerve paralysis

Published Online, September 12, 2006. www.theannals.com, DOI 10.1345/aph.1H077

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