Initiated within the first 72 hours of the rash, the aim of antiviral drugs prescribing is to reduce both acute neuralgia (AN) and later complications and especially postherpetic neuralgia (PHN). However their analgesic as well as preventative effect on AN and PHN is modest. With the lack of the preventive vaccine in Switzerland and in the absence of more effective antiviral drugs, combinations with analgesic drugs are often needed in pain management. However medication selection and prescribed dosage in the context of old patients' frailty, co-morbidities and often polypharmacy must be carefully considered. Based on analysing the evidences from the literature, this review presents the therapeutic options we have at one's disposal and proposes a stepwise management for both AN and PHN specifically designed for aged population.