From the Guidelines
Cold sores can be effectively treated with antiviral medications like acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), with the goal of reducing morbidity, mortality, and improving quality of life. For best results, start treatment at the first sign of symptoms, such as tingling or burning. Typical dosing for valacyclovir is 2 grams twice daily for one day, while acyclovir is usually taken as 400mg five times daily for five days 1. Over-the-counter options include docosanol 10% cream (Abreva), which should be applied five times daily until healing occurs.
Treatment Options
- Antiviral medications: acyclovir, valacyclovir, famciclovir
- Over-the-counter options: docosanol 10% cream (Abreva)
- Pain relievers: acetaminophen, ibuprofen
- Cold compresses to reduce pain and swelling
- Petroleum jelly to prevent cracking
Preventing Recurrence
For frequent outbreaks (more than six per year), daily suppressive therapy with valacyclovir 500mg daily or acyclovir 400mg twice daily may be recommended to reduce recurrence 1. It is essential to note that the treatment should be started at the first sign of symptoms to inhibit viral replication and shorten outbreak duration.
Important Considerations
- Avoid touching the sore to prevent spreading the virus
- Use pain relievers like acetaminophen or ibuprofen for discomfort
- Intravenous foscarnet or cidofovir can be used to treat infection due to acyclovir-resistant isolates of HSV 1
From the FDA Drug Label
1 INDICATIONS AND USAGE 1.1 Adult Patients Cold Sores (Herpes Labialis) VALTREX is indicated for treatment of cold sores (herpes labialis).
INDICATIONS AND USAGE Denavir (penciclovir cream) is indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older.
Coldsore treatment options include:
- Valacyclovir (PO): indicated for treatment of cold sores (herpes labialis) in adults and pediatric patients aged greater than or equal to 12 years 2
- Penciclovir (TOP): indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older 3
From the Research
Coldsore Treatment Options
- Antiviral medications such as valacyclovir, acyclovir, and famciclovir are effective in treating herpes labialis (cold sores) 4, 5, 6, 7
- Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis and has been shown to be safe and effective in the treatment of patients with herpes simplex and herpes zoster 4
- Acyclovir and its analogues, including valacyclovir, are inhibitors of viral DNA replication and are the only approved medicines for HSV infection therapies 6
Treatment Efficacy
- Oral antiviral use has shown modest but statistically significant efficacy in treating herpes labialis, with most studies demonstrating a significant reduction in episode length and/or healing time 5
- High doses of oral acyclovir, valacyclovir, and famciclovir have been shown to speed the healing of herpes zoster and decrease associated acute and chronic pain in people 50 years of age or older 5
Emerging Therapies
- There is a need to develop new antiherpetic compounds with different mechanisms of action to address the development of drug-resistant viral isolates and dose-limiting toxicities associated with current drugs 8
- Significant advances have been made towards the design and development of novel antiviral therapeutics, with several new compounds in various phases of clinical trials 8