From the Guidelines
The standard maintenance dose for herpes simplex virus (HSV) suppression therapy is acyclovir 400 mg twice daily, valacyclovir 500 mg once daily, or famciclovir 250 mg twice daily, as recommended by the most recent guidelines 1. These medications should be taken continuously for suppression therapy, which is typically recommended for patients experiencing frequent outbreaks (6 or more per year) or for those with severe symptoms. For patients with HIV or who are immunocompromised, higher doses may be needed: valacyclovir 500-1000 mg twice daily or acyclovir 400-800 mg two to three times daily, as suggested by previous studies 1. Some key points to consider when prescribing suppression therapy include:
- The frequency of recurrences decreases over time in many patients, and discontinuation of therapy should be discussed with the patient after 1 year of continuous suppressive therapy 1
- Suppression therapy significantly reduces outbreak frequency and viral shedding, but does not completely eliminate the risk of transmission, so barrier protection during sexual activity is still recommended even during treatment
- Reactivation of HSV can cause severe localized systemic infections with significant morbidity and mortality, including encephalitis, meningitis, pneumonia, oesophagitis, and colitis, especially in immunocompromised patients 1
- Routine prophylaxis to suppress virus replication should be considered for patients with frequent recurrent attacks, who are already taking intermittent suppressive antiviral therapy, or both 1
From the FDA Drug Label
The recommended dosage of valacyclovir hydrochloride for chronic suppressive therapy of recurrent genital herpes is 1 gram once daily in patients with normal immune function. In patients with a history of 9 or fewer recurrences per year, an alternative dose is 500 mg once daily
- The maintenance dose for herpes simplex virus (HSV) suppression therapy is 1 gram once daily in patients with normal immune function.
- An alternative dose is 500 mg once daily in patients with a history of 9 or fewer recurrences per year 2
From the Research
Maintenance Dose for Herpes Simplex Virus (HSV) Suppression Therapy
The maintenance dose for HSV suppression therapy varies depending on the medication and the frequency of recurrences.
- For patients with a history of less than 10 recurrences per year, 500 mg of valaciclovir once daily is effective for suppression of recurrent genital herpes 3.
- For patients with 10 or more recurrences per year, 1 g of valaciclovir once daily, 250 mg of valaciclovir twice daily, or 400 mg of acyclovir twice daily are more effective 3.
- Famciclovir 250 mg twice daily is also an effective treatment for the suppression of genital HSV infection in patients with frequent recurrences 4.
- Valacyclovir 1 g daily and famciclovir 250 mg twice daily are effective in suppressing 70 to 80 percent of symptomatic recurrences in patients who have six or more recurrences of genital herpes per year 5.
- A comparative study found that valacyclovir 500 mg once daily appears to be somewhat better than famciclovir 250 mg twice daily for suppression of genital herpes and associated shedding 6.