What is the dosing of valacyclovir (Valtrex) for cold sores in an immunocompetent adult?

From the Guidelines

For immunocompetent adults with cold sores, the recommended Valtrex (valacyclovir) dosing is 1,000 mg orally once a day, as indicated by the guidelines 1. This dosing is based on the 1998 guidelines for treatment of sexually transmitted diseases, which include recommendations for the treatment of herpes simplex virus infections, such as cold sores.

• The treatment should be started at the earliest sign of a cold sore, ideally during the prodrome or tingling phase, for maximum effectiveness.
• Valtrex works by converting to acyclovir in the body, which inhibits viral DNA replication and shortens the duration and severity of the outbreak.
• Common side effects may include headache, nausea, or dizziness, and it is essential to stay hydrated while taking this medication.
• For people who experience frequent cold sores, a different dosing regimen for suppressive therapy might be more appropriate, but this should be determined on a case-by-case basis, considering the individual's specific needs and medical history.
• It is crucial to take the full prescribed dose even if symptoms improve quickly to ensure the infection is fully treated and to minimize the risk of future outbreaks.

From the FDA Drug Label

1. 1 Adult Dosing Recommendations Cold Sores (Herpes Labialis) The recommended dosage of VALTREX for treatment of cold sores is 2 grams twice daily for 1 day taken 12 hours apart. Therapy should be initiated at the earliest symptom of a cold sore (e.g., tingling, itching, or burning).

The recommended dosing for valtrex in immunocompetent adults with cold sores is:

• 2 grams twice daily
• for 1 day
• taken 12 hours apart
• initiated at the earliest symptom of a cold sore 2.

From the Research

Valtrex Cold Sore Dosing for Immunocompetent Adults

• The dosing of Valtrex (valacyclovir) for cold sores in immunocompetent adults is typically as follows:
  • For episodic treatment, oral antiviral agents such as valacyclovir (Valtrex) are superior to topical antiviral therapy 3
  • The treatment should be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions to achieve optimal results 3
  • Valacyclovir is also effective in preventing recurrent herpes labialis when taken prior to the appearance of any symptoms or exposure to triggers 4
• The specific dosing regimen for Valtrex in immunocompetent adults is:
  • 2 grams twice daily for 1 day, taken 12 hours apart 5
  • Alternatively, 500 mg daily for 4 months can be effective in preventing recurrent herpes labialis 4
• It's worth noting that combination therapy of oral valacyclovir and topical clobetasol was found to be the most effective in reducing the time to heal in a network meta-analysis 6
• Oral antivirals, including valacyclovir, have been shown to decrease the duration of lesion episodes and pain by approximately one day, although they do not abort lesions from developing 7