From the Guidelines
For the treatment of genital herpes (HSV-2), the recommended dosage of acyclovir is 400 mg taken orally three times daily for 7-10 days, or alternatively, 200 mg five times daily for 7-10 days, as indicated by the most recent and highest quality study 1. The dosage of acyclovir may vary depending on the severity of the infection and the patient's overall health.
- For a first episode, the standard regimen is 400 mg taken orally three times daily for 7-10 days, or alternatively, 200 mg five times daily for 7-10 days.
- For recurrent episodes, the recommended dosage is 400 mg three times daily for 5 days, or 800 mg twice daily for 5 days, or 800 mg three times daily for 2 days.
- For suppressive therapy to prevent outbreaks in patients with frequent recurrences (6 or more per year), acyclovir can be taken as 400 mg twice daily continuously. It is essential to note that acyclovir works by inhibiting viral DNA synthesis, preventing the herpes virus from replicating, as stated in 1. Adequate hydration should be maintained while taking this medication, and patients should complete the full course even if symptoms improve before completion. Common side effects may include nausea, headache, and diarrhea, as mentioned in the example answer. Those with kidney problems may require dosage adjustments, as indicated in 1. Treatment should begin as soon as symptoms appear for maximum effectiveness. It is also important to consider the prevention of transmission of HSV-2, as discussed in 1, which recommends consistent use of latex condoms and avoidance of sexual contact when partners have overt herpetic lesions.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Genital Herpes: Treatment of Initial Genital Herpes: 200 mg every 4 hours, 5 times daily for 10 days. Chronic Suppressive Therapy for Recurrent Disease: 400 mg 2 times daily for up to 12 months, followed by re-evaluation Alternative regimens have included doses ranging from 200 mg 3 times daily to 200 mg 5 times daily. Intermittent Therapy: 200 mg every 4 hours, 5 times daily for 5 days.
The recommended dosage of acyclovir for the treatment of genital herpes (Herpes Simplex Virus 2, HSV-2) infection is:
- Initial Treatment: 200 mg every 4 hours, 5 times daily for 10 days.
- Chronic Suppressive Therapy: 400 mg 2 times daily for up to 12 months.
- Intermittent Therapy: 200 mg every 4 hours, 5 times daily for 5 days. 2
From the Research
Acyclovir Dosage for Herpes 2 Infection
The recommended dosage of acyclovir for the treatment of genital herpes (Herpes Simplex Virus 2, HSV-2) infection varies depending on the severity and frequency of episodes.
- For severe first-episode and life-threatening infections, acyclovir may be administered intravenously for 7 to 10 days 3.
- For milder and non-life-threatening first-episode infections, acyclovir may be given orally in a dosage of 200 mg five times a day for 10 days 3.
- For recurrent episodes, a 2-day regimen of acyclovir (800 mg given by mouth 3 times per day) has been shown to be effective in reducing the duration of lesions, episode, and viral shedding 4.
- For patients with fewer than six recurrences a year, 200 mg acyclovir orally five times a day for 5 days beginning as soon as symptoms appear may be sufficient 3.
- For patients with more than six recurrences a year, continuous suppressive oral acyclovir therapy may be necessary 3.
Comparison of Different Dosages
A study comparing high- and standard-dose oral acyclovir for first-episode genital herpes infections found that higher doses did not result in greater clinical benefit or modify the time to first recurrence 5.
- The standard dose of 200 mg acyclovir five times a day for 5 days has been shown to be effective in reducing the duration of viral shedding, time to complete healing, and new lesion formation in patients with initial and recurrent genital herpes 6, 7.
Efficacy and Tolerability
Oral acyclovir has been shown to be effective and well-tolerated in patients with initial and recurrent genital herpes, and can be used in outpatient therapy 6, 7.