From the Guidelines
For a genital herpes outbreak, prescribe valacyclovir 1 gram twice daily for 7-10 days for an initial episode, as this regimen has been shown to be effective in reducing symptoms and shortening outbreak duration 1. For recurrent outbreaks, prescribe 500 mg twice daily for 3-5 days, as this dosing strategy is most feasible for patient adherence and has been recommended for episodic therapy 1. Treatment should begin at the earliest sign of an outbreak for maximum effectiveness. Some key points to consider when prescribing valacyclovir include:
- The same medication dosages and frequencies are recommended for genital HSV-1 infection as for genital HSV-2 infection 1
- For patients with frequent recurrences (more than 6 per year), consider suppressive therapy with valacyclovir 500-1000 mg once daily, which can reduce outbreaks by up to 80% 2
- Valacyclovir works by converting to acyclovir in the body, which inhibits viral DNA synthesis and replication of herpes simplex virus
- Patients should be advised that while treatment reduces symptoms and may shorten outbreak duration, it does not cure the infection, and they can still transmit the virus even when asymptomatic, though suppressive therapy reduces this risk 2.
From the FDA Drug Label
2. 1 Adult Dosing Recommendations... Genital Herpes Initial Episode: The recommended dosage of VALTREX for treatment of initial genital herpes is 1 gram twice daily for 10 days. Therapy was most effective when administered within 48 hours of the onset of signs and symptoms. Recurrent Episodes: The recommended dosage of VALTREX for treatment of recurrent genital herpes is 500 mg twice daily for 3 days Initiate treatment at the first sign or symptom of an episode.
For a genital herpes outbreak, the prescribed dosage of valacyclovir is:
- Initial Episode: 1 gram twice daily for 10 days
- Recurrent Episodes: 500 mg twice daily for 3 days Initiate treatment at the first sign or symptom of an episode 3.
From the Research
Dosage and Duration of Valacyclovir for Genital Herpes Outbreak
- The recommended dosage of valacyclovir for the suppression of genital herpes recurrences in immunocompetent individuals is 500 mg to 1000 mg daily 4.
- For episodic treatment of recurrent genital herpes, valacyclovir 1000 mg once daily is as effective as 500 mg twice daily 5.
- A 3-day valacyclovir regimen (500 mg twice daily) is effective for episodic therapy in immunocompetent patients 6.
- Single-day famciclovir therapy (1000 mg administered twice daily) was noninferior to 3-day valacyclovir therapy in reducing time to healing of all nonaborted genital herpes lesions 6.
Treatment Duration
- The treatment duration for valacyclovir in genital herpes outbreak can range from a single day to several days, depending on the severity of the outbreak and the patient's response to treatment 5, 6.
- For immunocompetent individuals, a 5-day treatment course with valacyclovir 1000 mg once daily or 500 mg twice daily is effective for episodic treatment of recurrent genital herpes 5.
- Daily antiviral therapy with valacyclovir has been shown to be effective in reducing both symptomatic and asymptomatic reactivation of herpes simplex virus type 2 (HSV-2) when compared to placebo 7.
Safety and Efficacy
- Valacyclovir is well tolerated at dosages used to suppress recurrent episodes of genital herpes (500 to 1000 mg/day) in immunocompetent and HIV seropositive individuals, with headache being reported most often 4.
- The overall incidence of adverse events with valacyclovir is similar to that of famciclovir, with headache, nausea, diarrhea, vomiting, and abdominal pain reported most often 6.