From the Guidelines
For the treatment of herpes labialis, valacyclovir is recommended at a dose of 2 grams taken twice daily for one day, with the doses separated by about 12 hours, as this regimen has been shown to be effective in reducing the duration and severity of symptoms 1. The goal of treatment is to initiate it at the earliest sign of a cold sore, such as tingling, itching, or burning sensation, for maximum effectiveness.
- The medication works by converting to acyclovir in the body, which inhibits viral DNA replication, preventing the herpes simplex virus from multiplying.
- For people who experience frequent cold sores (more than 6 episodes per year), a suppressive therapy of 500 mg to 1 gram daily may be recommended.
- Valacyclovir is generally well-tolerated, though common side effects may include headache, nausea, or dizziness.
- Adequate hydration is recommended while taking valacyclovir, and those with kidney disease may require dose adjustments.
- It is essential to inform your healthcare provider about any other medications you're taking to avoid potential interactions. The most recent and highest quality study 1 supports the use of valacyclovir for the treatment of herpes labialis, and its findings should be prioritized in clinical practice. Some studies suggest that valacyclovir and famciclovir may provide increased ease in administration compared to acyclovir, which is an important consideration for prolonged treatment 1. However, the study by Cunningham et al. 1 provides the most up-to-date and relevant guidance for the treatment of herpes labialis with valacyclovir.
From the FDA Drug Label
The recommended dosage of VALTREX for treatment of cold sores is 2 grams twice daily for 1 day taken 12 hours apart. Therapy should be initiated at the earliest symptom of a cold sore (e.g., tingling, itching, or burning). The recommended dose and treatment guideline for valacyclovir (Valtrex) upon onset of herpes labialis (cold sore) is 2 grams twice daily for 1 day, taken 12 hours apart. Therapy should be initiated at the earliest symptom of a cold sore, such as tingling, itching, or burning 2.
- Key points:
- Dose: 2 grams
- Frequency: twice daily
- Duration: 1 day
- Timing: 12 hours apart
- Initiation: at the earliest symptom of a cold sore
From the Research
Recommended Dose and Treatment Guideline for Valacyclovir (Valtrex)
The recommended dose and treatment guideline for valacyclovir (Valtrex) upon onset of herpes labialis (cold sore) is as follows:
- The dose of valacyclovir is 2 g twice daily for 1 day 3, 4
- This treatment regimen is safe and effective in reducing the duration of the episode, preventing lesion development, and reducing the time to lesion healing and cessation of pain and/or discomfort 3, 4
- The 1-day valacyclovir regimen offers patients a unique and convenient dosing alternative compared to available topical therapies 3
Efficacy of Valacyclovir
The efficacy of valacyclovir in the treatment of herpes labialis is supported by two randomized, double-blind, placebo-controlled studies 3, 4
- The studies demonstrated that valacyclovir reduced the median duration of the episode by 1.0 day (P = 0.001) with 1-day treatment and 0.5 days (P = 0.009) with 2-day treatment compared to placebo 3
- The proportion of subjects in whom cold sore lesion development was prevented and/or blocked was increased by 6.4% (P = 0.096) with 1-day treatment and 8.5% (P = 0.061) with 2-day treatment compared to placebo 3
Comparison with Other Studies
Other studies have investigated the use of valacyclovir in the treatment of genital herpes simplex virus and cytomegalovirus infections 5, 6, 7
- These studies demonstrated the efficacy of valacyclovir in suppressing recurrent episodes of genital herpes and reducing the incidence of cytomegalovirus disease 5, 6
- However, the dosing regimens and patient populations in these studies were different from those in the studies investigating the treatment of herpes labialis 3, 4