From the Guidelines
For a type 2 herpes flare, valacyclovir is typically dosed at 1 g orally twice a day for 7-10 days. This dosing regimen is based on the guidelines for treatment of sexually transmitted diseases, as outlined in the 1998 report by the Centers for Disease Control and Prevention 1. The recommended treatment duration is 7-10 days, and it is essential to start treatment as soon as symptoms appear for maximum effectiveness.
Key Considerations
- Treatment should begin ideally within 24-48 hours of symptom onset
- Patients should complete the full course of medication even if symptoms improve before finishing
- Valacyclovir works by converting to acyclovir in the body, which inhibits viral DNA synthesis and replication
- The medication should be taken with plenty of water, and dosage adjustments may be needed for patients with kidney impairment
- Common side effects include headache, nausea, and abdominal pain Some key points to consider when prescribing valacyclovir for type 2 herpes flare include:
- The importance of starting treatment early to reduce symptom severity and duration
- The need for patients to complete the full treatment course, even if symptoms resolve before finishing
- Potential side effects and the importance of monitoring for these
- The fact that valacyclovir does not cure HSV-2 infection and that viral shedding can still occur during treatment, as noted in the study 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Valcyclovir Dosing for Type 2 Herpes Flare
- The dosing of valacyclovir for type 2 herpes flare is not directly addressed in the provided studies, as they focus on herpes zoster, genital herpes, and other viral infections.
- However, study 2 compares the efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding, suggesting that valacyclovir may be effective in reducing symptomatic and asymptomatic reactivation of herpes simplex virus type 2 (HSV-2).
- Study 3 describes the pharmacology, pharmacokinetics, and clinical efficacy of valacyclovir for the treatment of herpes simplex, herpes zoster, and other viral infections, including its use in episodic and suppressive therapy for genital herpes.
- Study 4 discusses the episodic and daily suppressive treatment of genital herpes with antiviral agents, including valacyclovir, and recommends clinical strategies for comprehensive management.
- Study 5 compares single-day, patient-initiated famciclovir therapy with a 3-day valacyclovir regimen for recurrent genital herpes, finding that single-day famciclovir therapy was noninferior to 3-day valacyclovir therapy in reducing time to healing of all nonaborted lesions.
Dosage Information
- Study 6 investigates the use of oral valacyclovir 1.5 g twice daily for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age.
- Study 2 uses daily famciclovir 250 mg twice daily and valacyclovir 500 mg once daily for suppressive therapy in persons with genital herpes.
- Study 5 uses single-day famciclovir (1000 mg administered twice daily) and 3-day valacyclovir (500 mg administered twice daily) for episodic therapy in immunocompetent patients with recurrent genital herpes.
Efficacy and Safety
- The studies suggest that valacyclovir is safe and effective in the treatment of herpes simplex, herpes zoster, and other viral infections, with a favorable adverse-effect profile 6, 2, 3, 5.
- Valacyclovir may be useful in reducing symptomatic and asymptomatic reactivation of HSV-2, and in preventing transmission of genital herpes 2, 4.