What is the dosage and treatment plan for Valacyclovir (valacyclovir) for herpes simplex virus infections?

Valacyclovir Dosage and Treatment Plan for Herpes Simplex Virus Infections

The recommended dosage of valacyclovir for herpes simplex virus infections varies by clinical scenario: for initial genital herpes episodes, 1 gram twice daily for 10 days; for recurrent episodes, 500 mg twice daily for 3 days; and for suppressive therapy, 1 gram once daily (or 500 mg once daily for patients with ≤9 recurrences per year). 1

Initial Episode of Genital Herpes

• Dosage: 1 gram twice daily for 10 days 1
• Therapy is most effective when initiated within 48 hours of symptom onset
• Alternative option: Acyclovir 200 mg orally five times daily for 7-10 days 2

Recurrent Episodes of Genital Herpes

• Dosage: 500 mg twice daily for 3 days 1
• Treatment should be initiated at the first sign or symptom of an episode (prodrome or within 2 days of lesion onset) for maximum benefit 2

Suppressive Therapy for Genital Herpes

• For patients with normal immune function:

  • 1 gram once daily 1
  • Alternative dose for patients with ≤9 recurrences per year: 500 mg once daily 1

• For HIV-infected patients with CD4+ count ≥100 cells/mm³:

  • 500 mg twice daily 2, 1

• For reduction of transmission to susceptible partners:

  • 500 mg once daily (for source partner with ≤9 recurrences per year) 1
  • This reduces transmission risk by 50-75% 2

Cold Sores (Herpes Labialis)

• Dosage: 2 grams twice daily for 1 day (taken 12 hours apart) 1
• Therapy should be initiated at the earliest symptom (tingling, itching, or burning) 1

Dosage Adjustments for Renal Impairment

Creatinine Clearance	Genital Herpes Recurrent	Genital Herpes Suppressive	HIV-Infected Suppressive
≥50 mL/min (normal)	500 mg every 12 hours	1 gram every 24 hours	500 mg every 12 hours
30-49 mL/min	No reduction	No reduction	No reduction
10-29 mL/min	500 mg every 24 hours	500 mg every 24 hours	500 mg every 24 hours
<10 mL/min	500 mg every 24 hours	500 mg every 24 hours	500 mg every 24 hours

2, 1

Treatment Considerations and Patient Education

• Valacyclovir offers better bioavailability than acyclovir, allowing for less frequent dosing 3
• Twice-daily valacyclovir has been shown to be as effective as five-times-daily acyclovir in treating first-episode genital herpes 4
• Patients should be educated about:
  • Prodromal symptoms (tingling, burning, itching) that may precede outbreaks
  • The need to abstain from sexual contact when lesions or prodromal symptoms are present
  • Asymptomatic viral shedding and transmission risk 2

Special Considerations

• For severe cases or complications, consider intravenous acyclovir 5-10 mg/kg every 8 hours for 5-7 days 2
• Hemodialysis patients should receive the recommended dose after hemodialysis 1
• If lesions don't begin to resolve within 7-10 days of starting therapy, suspect acyclovir-resistant HSV and obtain viral culture and susceptibility testing 2
• For patients with frequent recurrences, suppressive therapy has been shown to be effective in preventing recurrences 5, 6

Monitoring

• Patients on suppressive therapy should be followed up within 3-6 months to assess tolerance and effectiveness
• The need for continued suppressive therapy should be reevaluated annually 2
• Monitor renal function before starting therapy and ensure adequate hydration during treatment, especially with high doses 2