From the FDA Drug Label
14 CLINICAL STUDIES 14. 1 Cold Sores (Herpes Labialis) Two double‑blind, placebo‑controlled clinical trials were conducted in 1,856 healthy adults and adolescents (aged greater than or equal to 12 years) with a history of recurrent cold sores.
The medication of choice for HSV 1 prn cold sore outbreak is valacyclovir (PO).
- The recommended dosage is 2 grams twice daily on Day 1.
- Previous hep C exposure is not a contraindication for valacyclovir use, but caution should be exercised as the drug label does not provide specific guidance on this condition 1.
- It is essential to note that valacyclovir is primarily used for the treatment of cold sores (Herpes Labialis), genital herpes, and herpes zoster.
- The decision to use valacyclovir should be made on a case-by-case basis, considering the individual's medical history and current health status.
From the Research
For HSV-1 cold sore outbreaks in a patient with previous hepatitis C exposure, the medication of choice is valacyclovir (Valtrex) 2 grams taken twice, 12 hours apart, at the first sign of a cold sore. This recommendation is based on the fact that valacyclovir is effective in treating HSV-1 infections and has a favorable safety profile, even in patients with previous hepatitis C exposure 2. Some key points to consider when treating HSV-1 cold sore outbreaks in patients with previous hepatitis C exposure include:
- The choice of antiviral medication is not significantly affected by previous hepatitis C exposure, as these medications are primarily metabolized and eliminated by the kidneys rather than the liver.
- However, if there is current liver dysfunction, dose adjustments may be needed.
- Alternative treatment options, such as acyclovir (Zovirax) 400 mg five times daily for 5 days or famciclovir (Famvir) 1500 mg as a single dose, can also be effective.
- For patients with frequent outbreaks (more than 6 per year), daily suppressive therapy with valacyclovir 500-1000 mg once daily may be appropriate.
- Topical treatment with docosanol 10% cream (Abreva) applied 5 times daily until healing occurs can provide some relief.
- Starting treatment at the earliest symptoms (tingling, burning) rather than waiting for visible lesions significantly improves outcomes and may prevent the cold sore from fully developing. It's worth noting that the most recent study on hepatitis C management 3 does not directly address the treatment of HSV-1 cold sore outbreaks, but it does provide updated guidelines for screening and treatment of hepatitis C virus (HCV) infection.