From the Guidelines
For Herpes Simplex Virus Type 2 (HSV-2) infections, the recommended dosage of acyclovir is 400 mg orally three times daily for 7-10 days, or 200 mg five times daily for 7-10 days, as this regimen has been shown to effectively reduce symptoms and viral shedding 1. The dosage of acyclovir may vary depending on the severity of the infection, the patient's immune status, and the specific treatment goals.
- For a first episode of genital herpes, acyclovir is typically prescribed as 400 mg orally three times daily for 7-10 days, or 200 mg five times daily for 7-10 days.
- For recurrent episodes, the 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, 400 mg twice daily is recommended, with periodic reassessment after 12 months. Acyclovir works by inhibiting viral DNA synthesis, preventing the virus from replicating. It's most effective when started within 24 hours of symptom onset. Patients should complete the full course even if symptoms improve, stay hydrated, and be aware that acyclovir reduces but doesn't eliminate viral shedding or transmission risk. Common side effects include nausea, headache, and diarrhea. In cases where lesions persist despite acyclovir treatment, resistance of the HSV strain to acyclovir should be suspected, and alternative therapy such as foscarnet or topical cidofovir gel may be necessary 1. It's also important to note that acyclovir, valacyclovir, and famciclovir are occasionally associated with nausea or headache, and no laboratory monitoring is needed in patients receiving episodic or suppressive therapy unless the patient has substantial renal impairment 1.
From the FDA Drug Label
Initial Genital Herpes:Double-blind, placebo-controlled studies have demonstrated that orally administered acyclovir significantly reduced the duration of acute infection and duration of lesion healing. Recurrent Genital Herpes: Double-blind, placebo-controlled studies in patients with frequent recurrences (6 or more episodes per year) have shown that orally administered acyclovir given daily for 4 months to 10 years prevented or reduced the frequency and/or severity of recurrences in greater than 95% of patients
The recommended dosage of Acyclovir for Herpes Simplex Virus Type 2 (HSV-2) infections is not explicitly stated in the provided drug label. However, based on the information provided for initial and recurrent genital herpes, 400 mg twice daily can be considered for the treatment of recurrent genital herpes.
- Initial Genital Herpes: No specific dosage is mentioned.
- Recurrent Genital Herpes: 400 mg twice daily for 4 months to 10 years. 2
From the Research
Acyclovir Dosage for Herpes Simplex Virus Type 2 (HSV-2) Infections
The recommended dosage of Acyclovir for HSV-2 infections varies depending on the severity and frequency of recurrences.
- For immunocompetent patients, the standard oral Acyclovir therapy is initiated at a dose of 200 mg orally, five times a day for the first 3 to 5 days 3.
- In cases of poor response, the dose of oral Acyclovir can be increased to 800 mg five times a day 3.
- For episodic treatment of recurrent genital herpes, a dosage regimen of 800 mg twice a day for 5 days has been shown to be effective and safe 4.
- A shorter course of antiviral therapy, such as 800 mg given by mouth three times a day for 2 days, has also been found to be effective in reducing the duration of lesions, episode, and viral shedding, and increasing the proportion of aborted episodes 5.
- For suppressive therapy, continuous oral Acyclovir therapy may be used to manage frequent recurrences, with dosages ranging from 200 mg to 800 mg per day 6, 7.
Special Considerations
- In immunocompromised patients, Acyclovir therapy may need to be adjusted due to the increased risk of resistance and severe disease 3.
- Topical Acyclovir may be used to speed healing and decrease viral shedding and pain in immunocompromised patients with chronic, ulcerative herpetic lesions 7.
- Intravenous Acyclovir may be administered in severe first-episode and life-threatening infections, or in cases where oral therapy is not effective 3, 7.