From the Guidelines
For patients with genital herpes, suppressive valacyclovir therapy with additional valacyclovir during outbreaks is the recommended approach, as it reduces the frequency of recurrences by greater than or equal to 75%. This management strategy is based on the guidelines for treatment of sexually transmitted diseases, which suggest that daily suppressive therapy is effective in reducing the frequency of genital herpes recurrences 1. The recommended dose for suppressive therapy is valacyclovir 500 mg once daily, although patients with frequent recurrences exceeding 10 episodes yearly may require 1000 mg daily. During outbreaks, while on suppressive therapy, an additional 500 mg of valacyclovir twice daily for 3-5 days at the first sign of prodromal symptoms is suggested. Key benefits of this approach include:
- Reduced asymptomatic viral shedding by about 80%
- Reduced symptomatic recurrences by 70-80%
- Better bioavailability and less frequent dosing compared to acyclovir
- Generally well-tolerated with minimal side effects like headache or nausea It is essential to note that long-term use of valacyclovir requires regular kidney function monitoring, especially for patients with pre-existing renal issues 1. After 1 year of continuous suppressive therapy, discontinuation of therapy should be discussed with the patient to assess their psychological adjustment to genital herpes and the rate of recurrent episodes.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Patients Genital Herpes ... Suppressive Therapy: VALTREX is indicated for chronic suppressive therapy of recurrent episodes of genital herpes in immunocompetent and in HIV-1−infected adults. Recurrent Episodes: VALTREX is indicated for treatment of recurrent episodes of genital herpes in immunocompetent adults.
The FDA-approved use of valacyclovir includes both suppressive therapy for recurrent episodes of genital herpes and treatment of recurrent episodes. This means that valacyclovir can be used for both daily suppressive therapy to reduce the frequency of outbreaks and for treatment of outbreaks when they occur. Suppressive valacyclovir can be used in conjunction with outbreak valacyclovir treatment, as the drug label indicates that valacyclovir is effective for both uses in immunocompetent adults 2.
From the Research
Suppressive Valacyclovir with Outbreak Valacyclovir
- The use of valacyclovir for the suppression of genital herpes simplex virus (HSV) infection has been studied in several trials 3, 4.
- Valacyclovir has been shown to be effective in preventing or delaying recurrences of genital herpes, with a dose-response relationship observed across different dosages 4.
- A study found that valacyclovir at 500 mg twice daily was effective in preventing or delaying recurrences of genital herpes compared with placebo, and with valacyclovir at 1000 mg once daily 5.
- The safety profile of valacyclovir has been found to be similar to that of acyclovir, with headache being the most commonly reported adverse event 3, 5.
Dosage and Administration
- Valacyclovir dosages of ≥ 500 mg daily are recommended for suppression of genital herpes recurrences in immunocompetent individuals 3.
- Once-daily regimens of valacyclovir offer a useful option for patients who require suppressive therapy for management of genital herpes 4.
- Twice-daily valacyclovir and acyclovir have been found to be similar in effectiveness for suppression of recurrent genital herpes 4.
Efficacy in HIV-Infected Patients
- Valacyclovir has been found to be effective and well-tolerated for the treatment and suppression of recurrent genital herpes in HIV-infected persons 5.
- A study found that valacyclovir at 1000 mg twice daily was comparable to acyclovir at 200 mg 5 times daily in accelerating healing of a single episode of genital herpes in HIV-infected patients 5.