What is the best oral treatment for suppressive therapy of recurrent herpes simplex (cold sores)?

From the Guidelines

For the suppressive therapy of recurrent herpes simplex (cold sores), the best oral treatment is valacyclovir (Valtrex) taken at a dose of 500 mg twice daily, as it is effective in preventing recurrences and reducing the frequency and severity of outbreaks 1. When considering suppressive therapy, it's essential to discuss the option with every HSV-infected patient, especially those who have frequent or severe recurrences. The goal of suppressive therapy is to reduce the morbidity and improve the quality of life for patients with recurrent herpes simplex. Some key points to consider when prescribing valacyclovir for suppressive therapy include:

• The dose of 500 mg twice daily is recommended, especially for HIV-infected persons 1
• Alternative options, such as acyclovir or famciclovir, can be used, but valacyclovir is preferred due to its efficacy and convenience
• Suppressive therapy should be continued for at least 4-12 months, after which it can be temporarily discontinued to reassess the frequency of recurrences
• Patients should be advised to maintain adequate hydration and avoid known triggers, such as excessive sun exposure, stress, and illness, to minimize the risk of breakthrough outbreaks
• Patients with kidney disease may require dose adjustments, and side effects, such as headache, nausea, or dizziness, should be monitored and managed accordingly.

From the FDA Drug Label

FAMCICLOVIR tablet, for oral use Initial U. S. Approval: 1994 INDICATIONS AND USAGE Famciclovir tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: Immunocompetent Adult Patients( 1. 1) • Herpes labialis (cold sores) o Treatment of recurrent episodes o Suppressive therapy of recurrent episodes • Genital herpes o Treatment of recurrent episodes o Suppressive therapy of recurrent episodes

The best oral treatment for suppressive therapy of recurrent herpes simplex (cold sores) is Famciclovir. The dosage is 250 mg twice daily 2.

From the Research

Oral Treatment for Suppressive Therapy of Recurrent Herpes Simplex

• The most effective oral treatment for suppressive therapy of recurrent herpes simplex (cold sores) is valacyclovir, as it has been shown to reduce the frequency of recurrences and prolong the time to first recurrence 3.
• Valacyclovir has been compared to episodic therapy and has been found to be more effective in reducing the frequency of recurrences of herpes labialis and prolonging the time to first recurrence 3.
• The recommended dosage for suppressive therapy is 1 g once daily, which has been shown to be effective in reducing the frequency of recurrences and is well-tolerated 3.
• Valacyclovir is also effective in the treatment of genital herpes and herpes zoster, and is the only oral antiviral agent approved for therapy of herpes labialis 4, 5.
• The efficacy and safety of valacyclovir have been demonstrated in several clinical trials, including a study that compared valacyclovir to acyclovir and found that valacyclovir was more effective in reducing the duration of herpes zoster-associated pain and postherpetic neuralgia 4, 5.

Comparison to Other Treatments

• Valacyclovir has been compared to other antiviral agents, including acyclovir and famciclovir, and has been found to be equally effective or more effective in the treatment of herpes simplex and herpes zoster 6, 4, 5.
• Valacyclovir has a higher bioavailability than acyclovir, which makes it a more effective treatment option 7, 6.
• The safety profile of valacyclovir is similar to that of other antiviral agents, with headache being the most commonly reported adverse event 6, 4.