What is the recommended dose of Valacyclovir (Valacyclovir hydrochloride) for herpes simplex infection?

Recommended Dosage of Valacyclovir for Herpes Simplex Infection

For first-episode genital herpes, valacyclovir should be administered at 1 gram orally twice daily for 7-10 days. 1

Dosing Recommendations by Type of HSV Infection

First Clinical Episode of Genital Herpes

• Valacyclovir 1 gram orally twice daily for 7-10 days 1, 2
• Treatment may be extended if healing is incomplete after 10 days of therapy
• Most effective when initiated within 48 hours of symptom onset 2

Recurrent Episodes of Genital Herpes

• Valacyclovir 500 mg orally twice daily for 3-5 days 1, 2
• Initiate at first sign or symptom of an episode
• A 3-day course has been shown to be as effective as a 5-day course 3
• Alternative regimen: Valacyclovir 1 gram once daily for 5 days 4

Suppressive Therapy for Recurrent Genital Herpes

• For patients with normal immune function:
  • Valacyclovir 1 gram once daily 2
  • For patients with ≤9 recurrences per year: 500 mg once daily 2, 5
  • For patients with ≥10 recurrences per year: 1 gram once daily or 250 mg twice daily 5

Cold Sores (Herpes Labialis)

• Valacyclovir 2 grams twice daily for 1 day (taken 12 hours apart) 2
• Initiate at earliest symptom (tingling, itching, or burning)

HIV-Infected Patients

• For suppressive therapy: Valacyclovir 500 mg twice daily 2
• For episodic treatment: Consider longer duration of therapy (5-14 days) 1

Clinical Considerations

Advantages of Valacyclovir

• Better bioavailability than oral acyclovir 6
• Less frequent dosing compared to acyclovir (which requires 5 times daily dosing) 7
• Equivalent clinical efficacy to acyclovir with more convenient dosing 7

Important Monitoring and Precautions

• No routine laboratory monitoring needed unless patient has substantial renal impairment 1
• Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome has been reported with high-dose valacyclovir (8 grams/day) but not at doses used for HSV therapy 1
• Treatment failure should be suspected if lesions don't begin to resolve within 7-10 days 1

Common Pitfalls to Avoid

1. Inadequate duration of therapy: Ensure full course is completed even if symptoms improve
2. Delayed initiation: Start treatment at earliest sign of symptoms for best results
3. Incorrect dosing for recurrence frequency: Adjust suppressive therapy dose based on number of annual recurrences
4. Insufficient patient education: Counsel patients about transmission risk even during asymptomatic periods
5. Short-course therapy in immunocompromised patients: Avoid short-course therapy (1-3 days) in HIV-infected patients 1

Valacyclovir is well-tolerated at dosages used for treating genital herpes, with headache being the most commonly reported side effect 6. The simplified dosing regimens of valacyclovir improve patient adherence compared to the more frequent dosing required with acyclovir.