Pharmacological Management of Bell's Palsy

• Corticosteroid therapy is the mainstay of treatment in Bell's Palsy, with recommendation to initiate therapy within 72 hours (3 days) of symptoms onset. The dosage regimen is as followed:

Guidelines	Dosage regimen	Duration
UpToDate	Prednisone 60-80 mg/day	1 week
Medscape	Prednisolone 60mg/day x 5 days, then taper 10mg/day	10 days
Annals of Indian Academy of Neurology	Prednisolone 60mg/day x 5 days, then taper 10mg/day; or 25mg BD	10 days
American Academy of Otolaryngology-head and neck surgery 2013	Prednisolone 60mg/day x 5 days, then taper 10mg/day; or 50mg OD	10 days
US Pharmacist 2012	1mg/kg daily (maximum 80mg)	7-14 days

• Antiviral therapies are not routinely recommended as studies have showed no additional benefit. However, there are several recommendations regarding its usage in Bell's palsy:

Guidelines	Recommendation	Dosage
American Academy of Neurology 2012	Antivirals in addition to steroids might be offered to increase probability of recovery of facial function. Patients should be counselled that antiviral benefit has not been established and the possible benefit is likely modest at best.	Not stated
American Academy of Otolaryngology-head and neck surgery 2013	May use oral antiviral therapy in addition to oral steroids within 72 hours of symptoms onset	Not stated
American Family Physician 2007	Initiate in combination with prednisolone within 3 days of onset of symptoms.	Acyclovir 400mg 5x/day or Valacyclovir 1g TDS for 7 days
Annals of Indian Academy of Neurology	Not recommended as it is highly unlikely to be cost-effective.	-
Medscape	Herpes simplex virus (HSV-1 or HSV-2)	Acyclovir 400mg PO 5x/day for 10 days, or valacyclovir 500mg PO BD for 5 days
	Varicella-zoster virus (VZV)	Acyclovir 800mg PO 5x/day for 10 days, or valacyclovir 1g PO TDS for 5 days
UpToDate	For patients with severe facial palsy at presentation (House-Brackmann grade IV or higher)	Valacyclovir 1000mg TDS x 1/52 (with prednisone)
US Pharmacist 2012	Adult: 400-800mg 5X a day (with predinsolone) Children: >2 years 80mg/kg/day in 4 divided dose (max 3.2g)		7 days 5 days

References:

1. UpToDate. Bell's palsy: prognosis and treatment in adults. http://www.uptodate.com/contents/bells-palsy-prognosis-and-treatment-in-adults?source=search_result&search=bell%27s+palsy&selectedTitle=1~42#H5
2. Annals of Indian Academy of Neurology. Bell's palsy: treatment guidelines. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152161/
3. Medscape. Bell Palsy. http://emedicine.medscape.com/article/1146903-overview
4. Medscape. Bell Palsy Organism-Specific Therapy. http://emedicine.medscape.com/article/2018401-overview
5. CMAJ. Management of Bell palsy: clinical practice guideline. 2014. http://www.cmaj.ca/content/186/12/917.full
6. American Family Physician. Bell's palsy: diagnosis and management. http://www.aafp.org/afp/2007/1001/p997.html
7. http://www.uspharmacist.com/content/d/feature/c/31906/