Can valacyclovir (Valtrex) 2 grams twice daily be taken for 2-4 days for recurrent herpes labialis (cold sores)?

From the Guidelines

Valacyclovir 2 grams twice daily for 1 day is the recommended dosage for recurrent cold sores, not 2-4 days. The typical recommended regimen for recurrent herpes labialis (cold sores) is valacyclovir 2 grams twice daily for one day only (just two doses total, taken 12 hours apart) 1. This shorter, high-dose therapy has been shown to be effective in reducing the duration and severity of cold sores when started at the first sign of symptoms, such as tingling or burning.

Key Considerations

• The dose mentioned (2 grams twice daily for 2-4 days) is significantly higher than recommended and could increase the risk of side effects like nausea, headache, dizziness, or kidney problems without providing additional benefit.
• Valacyclovir works by inhibiting viral DNA replication, which is most effective when started during the prodromal phase before the blister appears.
• For best results, keep the medication readily available so you can start treatment immediately when you feel the first symptoms of an outbreak.
• Staying well-hydrated while taking valacyclovir can help prevent kidney-related side effects.

Important Points to Note

• Patient education using targeted campaigns is specifically recommended for HSV, stressing the importance of initiating treatment during the prodrome phase 1.
• Ensuring the correct diagnosis and establishing patient history is necessary for the correct treatment to be sold.
• Pharmacist education through training, continuing professional development, and suitable approved protocols will improve pharmacy resources.

From the FDA Drug Label

The recommended dosage of VALTREX for treatment of cold sores is 2 grams twice daily for 1 day taken 12 hours apart. The answer is no, valacyclovir 2 gm twice daily should not be taken for 2-4 days for recurrent cold sores, as the recommended duration is 1 day. 2

From the Research

Valacyclovir Dosage for Recurrent Cold Sores

• The recommended dosage of valacyclovir for recurrent cold sores is 2 g twice daily for 1 day 3, 4.
• However, some studies have explored the efficacy of valacyclovir for 2-4 days, with positive results 5.
• A pilot trial found that valacyclovir 2 g orally twice daily for 1 day, combined with topical clobetasol gel for 3 days, reduced the mean healing time of classical lesions and the mean maximum lesion size compared to placebo 5.
• Another study suggests that episodic treatment with oral antivirals, such as valacyclovir, should be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions to achieve optimal results 6.

Efficacy of Valacyclovir for Recurrent Cold Sores

• Valacyclovir has been shown to be effective in reducing the duration of lesion episodes and pain by approximately one day 3, 4, 7.
• The medication can also reduce the time to lesion healing and the time to cessation of pain and/or discomfort 3.
• However, valacyclovir may not abort lesions from developing, and its clinical implications appear relatively modest 7.

Safety and Tolerability of Valacyclovir

• Valacyclovir has been found to be safe and well-tolerated, with adverse events similar to those of placebo 3, 5.
• The combination of valacyclovir and topical clobetasol gel has also been shown to be safe, with minimal adverse events reported 5.