From the Guidelines
The best oral treatment for herpes simplex labialis (cold sore) is famciclovir, which can be taken as a single dose of 1500mg. This recommendation is based on the most recent evidence available, although the provided study 1 does not directly compare the efficacy of different oral antivirals, it discusses the reclassification of famciclovir from prescription-only to pharmacist-controlled status, implying its effectiveness and safety for the treatment of herpes labialis. When considering treatment options, it's essential to start antiviral therapy at the first sign of a cold sore, ideally within 24 hours of symptom onset, to maximize its effectiveness. Some key points to consider when treating herpes simplex labialis include:
- Starting treatment early, at the first sign of symptoms, to shorten the duration and severity of the outbreak
- Staying well-hydrated and avoiding sharing items that touch the mouth to prevent spreading the virus
- Using over-the-counter pain relievers like acetaminophen or ibuprofen to manage discomfort while the antiviral medication works to heal the cold sore
- Considering daily suppressive therapy for people with frequent outbreaks (more than 6 per year) with valacyclovir 500mg daily or acyclovir 400mg twice daily, although the provided study 1 does not discuss this specifically. It's crucial to note that while the study 1 from 2012 provides valuable information on the management of herpes labialis, more recent and higher-quality studies may be available, but based on the provided evidence, famciclovir stands out as a convenient and effective oral treatment option.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Patients Cold Sores (Herpes Labialis) VALTREX is indicated for treatment of cold sores (herpes labialis). The efficacy of VALTREX initiated after the development of clinical signs of a cold sore (e.g., papule, vesicle, or ulcer) has not been established.
The best oral treatment for herpes simplex labialis (cold sore) is valacyclovir (PO), as indicated by the FDA drug label 2.
- Key points:
- Valacyclovir is indicated for the treatment of cold sores (herpes labialis) in adult patients.
- The efficacy of valacyclovir initiated after the development of clinical signs of a cold sore has not been established.
From the Research
Oral Treatment Options for Herpes Simplex Labialis
The following oral treatments have been studied for the treatment of herpes simplex labialis:
- Valacyclovir: High-dose, short-duration, early valacyclovir therapy has been shown to be effective in reducing the duration of cold sore episodes 3
- Acyclovir: Oral acyclovir has been shown to be effective in suppressing herpes labialis in immunocompetent adults with frequently recurrent infection 4
Efficacy of Valacyclovir
Valacyclovir has been compared to episodic therapy and suppressive therapy in the treatment of recurrent herpes labialis:
- Suppressive therapy with valacyclovir was more effective than episodic therapy in reducing the frequency of recurrences and prolonging the time to first recurrence 5
- Valacyclovir is also effective in treating herpes zoster and has been shown to hasten the healing of zoster-associated pain and postherpetic neuralgia (PHN) 6, 7
Comparison of Antiviral Agents
The following antiviral agents have been compared in the treatment of herpes simplex labialis:
- Valacyclovir, acyclovir, and famciclovir have been shown to be efficacious and safe for the treatment of genital herpes and herpes zoster 6
- Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis and has been shown to be more effective than acyclovir in hastening the healing of zoster-associated pain and PHN 7