From the Guidelines
Valacyclovir (Valtrex) dosing for herpes infections should be based on the most recent and highest quality evidence, which recommends 1 gram twice daily for 7-10 days for first-episode genital herpes, 500 mg twice daily for 3 days for recurrent genital herpes, and 1 gram three times daily for 7 days for herpes zoster (shingles) 1. For the treatment of herpes infections, the dosage of valacyclovir varies based on the type of infection and the patient's immune status.
- For first-episode genital herpes, the recommended dose is 1 gram twice daily for 7-10 days.
- For recurrent genital herpes, 500 mg twice daily for 3 days is typically prescribed.
- For herpes zoster (shingles), 1 gram three times daily for 7 days is standard.
- For cold sores (herpes labialis), a single-day treatment of 2 grams taken twice, 12 hours apart, is effective.
- For suppressive therapy to prevent recurrent genital herpes, 500 mg to 1 gram once daily is recommended, with immunocompromised patients often requiring the higher dose, as noted in guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1. Dosage adjustments are necessary for patients with renal impairment, with reductions based on creatinine clearance, to minimize the risk of adverse events such as those seen with high doses of valacyclovir in immunocompromised patients 1. Valacyclovir works by converting to acyclovir in the body, which then inhibits viral DNA synthesis, preventing herpes virus replication. Treatment is most effective when started within 72 hours of symptom onset for episodic therapy, and patients should complete the full course of medication even if symptoms improve before completion, as recommended for patients with orolabial lesions and genital HSV infection 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
... 2.1 Adult Dosing Recommendations ... Cold Sores (Herpes Labialis) The recommended dosage of VALTREX for treatment of cold sores is 2 grams twice daily for 1 day taken 12 hours apart. ... Genital Herpes Initial Episode: The recommended dosage of VALTREX for treatment of initial genital herpes is 1 gram twice daily for 10 days. ... Recurrent Episodes: The recommended dosage of VALTREX for treatment of recurrent genital herpes is 500 mg twice daily for 3 days ... Suppressive Therapy: The recommended dosage of VALTREX for chronic suppressive therapy of recurrent genital herpes is 1 gram once daily in patients with normal immune function. ... Herpes Zoster The recommended dosage of VALTREX for treatment of herpes zoster is 1 gram 3 times daily for 7 days
The current dosing for Valtrex (valacyclovir) in the treatment of herpes infections is as follows:
- Cold Sores (Herpes Labialis): 2 grams twice daily for 1 day taken 12 hours apart
- Genital Herpes:
- Initial Episode: 1 gram twice daily for 10 days
- Recurrent Episodes: 500 mg twice daily for 3 days
- Suppressive Therapy: 1 gram once daily in patients with normal immune function
- Herpes Zoster: 1 gram 3 times daily for 7 days 2
From the Research
Current Valtrex Dosing for Herpes
The current dosing for Valtrex (valacyclovir) in the treatment of herpes infections is as follows:
- For the treatment of a first episode of genital herpes, valacyclovir can be administered at a dose of 1 g twice a day for 10 days 3
- For treating recurrences, valacyclovir can be administered at a dose of 500 mg twice a day for 5 days or 1 g once a day for 5 days 3, 4
- For prevention among patients with frequent recurrences, the efficacy of valacyclovir has been proven at a dose of 500 mg/d in a single dose 3 or 1 g once daily 5
- For suppression of recurrent episodes of genital herpes, valaciclovir dosages of ≥ 500 mg daily are recommended for immunocompetent individuals 6
- In patients with a history of < 10 recurrences per year, 500 mg of valaciclovir once daily is effective, while 1 g of valaciclovir once daily, 250 mg of valaciclovir twice daily, or 400 mg of acyclovir twice daily are more effective in patients with ≥ 10 recurrences per year 5
Key Considerations
- Valacyclovir is well tolerated at dosages used to suppress recurrent episodes of genital herpes (500 to 1000 mg/day) in immunocompetent and HIV seropositive individuals, with headache being reported most often 6
- A potentially fatal thrombotic microangiopathy (TMA)-like syndrome has been reported in some immunocompromised patients receiving high-dose prophylactic valaciclovir therapy (8 g/day) for CMV disease for prolonged periods 6