From the Guidelines
Valacyclovir (Valtrex) is typically prescribed at a dose of 1000 mg (1 gram) three times daily for 7 days for the treatment of Bell's palsy. This regimen should be started as soon as possible after symptom onset, ideally within 72 hours, for maximum effectiveness 1. The medication works by inhibiting viral replication, as Bell's palsy is believed to be associated with herpes simplex virus reactivation in many cases.
Key Considerations
- The antiviral therapy helps reduce inflammation of the facial nerve, potentially improving recovery outcomes.
- Patients should take the full course of medication even if symptoms begin to improve.
- Common side effects may include headache, nausea, and stomach pain.
- Adequate hydration should be maintained while taking valacyclovir.
- This antiviral treatment is typically prescribed alongside a corticosteroid like prednisone, which addresses the inflammatory component of Bell's palsy, as the combination therapy may provide better outcomes than either medication alone 1.
Evidence Summary
The evidence from studies 1 suggests that valacyclovir, in combination with corticosteroids, is an effective treatment for Bell's palsy, especially when initiated within 72 hours of symptom onset. However, the use of antiviral monotherapy is not recommended due to limited benefits compared to placebo 1.
Clinical Decision
Given the current evidence, the recommended dose of Valtrex (valacyclovir) for Bell’s palsy is 1000 mg three times daily for 7 days, initiated as soon as possible after symptom onset, and preferably in combination with corticosteroid therapy 1.
From the Research
Valtrex Dose for Bell's Palsy
- The recommended dose of Valtrex (valacyclovir) for Bell's palsy is 1 g three times per day for 7 days, as stated in the study published in The Annals of otology, rhinology, and laryngology 2.
- Another study published in Otology & neurotology found that valacyclovir was administered at a dose of 1,000 mg three times daily for 7 days 3.
- A multicenter, randomized, placebo-controlled study published in Otology & neurotology used a dosage of 1,000 mg/d for 5 days 4.
- A randomised, double-blind, placebo-controlled, multicentre trial published in The Lancet. Neurology used a dose of 1000 mg valaciclovir three times per day for 7 days 5.
Treatment Outcomes
- The combination of valacyclovir and prednisone has been shown to be effective in treating Bell's palsy, with a significantly better outcome compared to no medical treatment 2.
- The use of valacyclovir and prednisolone has been found to be more effective than conventional prednisolone therapy in treating Bell's palsy, excluding zoster sine herpete 4.
- However, another study found that prednisolone shortened the time to complete recovery in patients with Bell's palsy, whereas valaciclovir did not affect facial recovery 5.