From the Guidelines
Valacyclovir is recommended for suppressive treatment of herpes simplex at a dose of 500 mg to 1 gram once daily, with the standard suppressive dose being 500 mg daily for immunocompetent patients with recurrent genital herpes. The treatment duration can be up to 12 months, after which reassessment is recommended to determine if continued suppression is necessary based on recurrence frequency 1. Some key points to consider in the management of herpes simplex with valacyclovir include:
- The dose may be adjusted based on the frequency of recurrences, with 1 gram daily used for patients with more than 10 episodes per year 1.
- For patients with HIV or who are immunocompromised, the recommended dose is 500 mg twice daily.
- Suppressive therapy has been shown to reduce asymptomatic viral shedding by about 80% and transmission risk to uninfected partners by about 50% 1.
- Patients should maintain adequate hydration while taking valacyclovir and report any unusual side effects such as confusion, hallucinations, or decreased urination, which could indicate rare but serious adverse reactions.
- The frequency of recurrences decreases over time in many patients, and after 1 year of continuous suppressive therapy, discontinuation of therapy should be discussed with the patient to assess the patient's psychological adjustment to genital herpes and rate of recurrent episodes 1. It's worth noting that while valacyclovir is effective in reducing the frequency of genital herpes recurrences, it does not totally eliminate symptomatic or asymptomatic viral shedding or the potential for transmission 1.
From the FDA Drug Label
Suppressive Therapy: 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 recommended dose for suppressive treatment of herpes simplex (genital herpes) with valacyclovir is 1 gram once daily for patients with normal immune function. For patients with a history of 9 or fewer recurrences per year, an alternative dose is 500 mg once daily 2.
- Key points:
- Dose: 1 gram once daily (or 500 mg once daily for patients with 9 or fewer recurrences per year)
- Treatment duration: Not explicitly stated for suppressive therapy, implying continuous treatment until otherwise directed by a healthcare provider.
- Important consideration: The treatment should be initiated under the guidance of a healthcare provider, and the dosage may vary based on individual patient factors, such as immune status and recurrence frequency.
From the Research
Suppressive Treatment for Herpes Simplex
The recommended dose and treatment duration for valacyclovir in the suppressive treatment of herpes simplex can vary depending on the patient's condition and the frequency of recurrences.
- For immunocompetent patients with a history of less than 10 recurrences per year, 500 mg of valacyclovir once daily is effective for suppression 3.
- For patients with more than 10 recurrences per year, 1 g of valacyclovir once daily, 250 mg of valacyclovir twice daily, or 400 mg of acyclovir twice daily are more effective 3.
- In HIV-infected subjects, valacyclovir 500 mg twice daily is effective for the suppression of recurrent genital herpes simplex virus infections 4.
- The efficacy of valacyclovir for suppression of genital herpes recurrences in immunocompetent individuals is recommended at dosages of ≥ 500 mg daily 5.
Treatment Duration
The treatment duration for suppressive therapy with valacyclovir can be long-term, with studies showing efficacy for more than 90 days 5 and up to 1 year 3.
- A study of 1479 immunocompetent patients showed that valacyclovir was effective for suppression of recurrent genital herpes for 1 year 3.
- Another study in HIV-infected subjects showed that valacyclovir was effective for 6 months 4.
Dosage Comparison
Valacyclovir 1000 mg once daily is as effective as 500 mg twice daily in the episodic treatment of recurrent genital herpes 6.
- A double-blind, randomized study showed that the two regimens were equivalent in terms of percentage of lesions healed, time to healing, and safety 6.