From the Guidelines
To manage herpes labialis (cold sores), start treatment at the first sign of symptoms with oral antiviral medication, such as valacyclovir 2000 mg twice daily for one day, acyclovir 400 mg 5 times daily for 5 days, or famciclovir 1500 mg once, as these treatments have been shown to be effective in reducing the duration and severity of symptoms 1. When managing herpes labialis, it is essential to consider the following:
- Apply an over-the-counter antiviral cream like docosanol 10% (Abreva) or benzyl alcohol 10% (Zilactin) to the affected area 5 times daily for 4-5 days.
- Use pain-relieving gels containing benzocaine or lidocaine for temporary relief.
- Keep the area clean and dry, avoiding touching or picking at the sore to prevent bacterial infection.
- Apply ice wrapped in a cloth to reduce swelling and discomfort.
- Use lip balm with SPF to protect the area from sun exposure, which can trigger outbreaks. For patients with frequent outbreaks (>6 per year), consider daily suppressive therapy with oral antivirals, as this has been shown to be effective in preventing recurrences 1. It is crucial to note that early intervention is key, as antivirals are most effective when started at the first sign of tingling or burning. While cold sores typically heal on their own within 7-10 days, these measures can significantly shorten healing time and provide symptom relief.
From the FDA Drug Label
Famciclovir tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: Immunocompetent Adult Patients( 1. 1) • Herpes labialis (cold sores) o Treatment of recurrent episodes
DOSAGE AND ADMINISTRATION Immunocompetent Adult Patients ( 2.1) Herpes labialis (cold sores) 1500 mg as a single dose
The management of herpes labialis (cold sores) is treatment of recurrent episodes with:
- Famciclovir (PO): 1500 mg as a single dose 2, 2
- Penciclovir (TOP): applied as a cream for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older 3
From the Research
Management of Herpes Labialis (Cold Sores)
The management of herpes labialis, also known as cold sores, involves the use of antiviral medications to reduce the severity and duration of symptoms.
- Valacyclovir is an effective treatment for herpes labialis, with studies showing that it can reduce the duration of the episode by 1-2 days 4.
- A 1-day treatment regimen of valacyclovir (2g twice daily) has been shown to be safe and effective in reducing the duration of cold sore episodes 4.
- Valacyclovir has also been compared to other antiviral medications, such as acyclovir and famciclovir, and has been found to be at least as effective in treating herpes labialis 5.
Treatment Options
Several treatment options are available for herpes labialis, including:
- Valacyclovir: a highly bioavailable prodrug of acyclovir that can be taken orally 6, 7, 4, 5.
- Acyclovir: an antiviral medication that can be taken orally or topically 6, 7.
- Famciclovir: a highly bioavailable prodrug of penciclovir that can be taken orally 7, 5.
Efficacy and Safety
The efficacy and safety of valacyclovir in treating herpes labialis have been established in several studies:
- Valacyclovir has been shown to be safe and effective in reducing the duration of cold sore episodes, with a 1-day treatment regimen being a convenient and effective option 4.
- Valacyclovir has also been found to be well-tolerated, with a similar adverse event profile to acyclovir and famciclovir 7, 5.