What is the recommended dose of Valtrex (valacyclovir) for a genital herpes outbreak?

Valacyclovir Dosing for Genital Herpes Outbreaks

For treatment of recurrent genital herpes outbreaks, the recommended dose of Valtrex (valacyclovir) is 500 mg twice daily for 3 days. 1

Dosing Recommendations Based on Type of Episode

Initial Episode

• Valacyclovir 1 gram twice daily for 10 days 1
• Most effective when started within 48 hours of symptom onset
• Helps reduce duration of symptoms and viral shedding

Recurrent Episodes

• Valacyclovir 500 mg twice daily for 3 days 1
• Treatment should be initiated at the first sign or symptom of an outbreak
• Early initiation maximizes effectiveness

Alternative Dosing Option

• A once-daily alternative of valacyclovir 1000 mg for 5 days has been shown to be equivalent to 500 mg twice daily in treating recurrent episodes 2
• This may be preferred for patients who have difficulty with medication adherence

Treatment Considerations

Timing of Therapy

• Start treatment at the earliest sign or symptom (tingling, itching, burning)
• Efficacy decreases if treatment is delayed beyond the first 48-72 hours of symptom onset

Duration of Therapy

• A 3-day course has been shown to be as effective as a 5-day course for recurrent episodes 3
• The shorter course offers advantages of reduced cost and improved adherence

Suppressive Therapy Options

For patients with frequent recurrences (≥6 per year), suppressive therapy may be considered:

• For patients with normal immune function:

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

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

  • 500 mg twice daily 1

Common Pitfalls to Avoid

• Delayed initiation: Effectiveness decreases significantly if treatment is not started within the first 48 hours of symptoms
• Inadequate dosing: Using lower than recommended doses may lead to treatment failure
• Confusing dosing regimens: The dosing for initial episodes (1g twice daily for 10 days) differs from recurrent episodes (500mg twice daily for 3 days)
• Not considering suppressive therapy: Patients with frequent recurrences (≥6 per year) should be offered suppressive therapy options

Special Considerations

• Valacyclovir may be taken without regard to meals 1
• Dose adjustment is not typically required based on age alone but may be necessary for patients with renal impairment
• Valacyclovir is generally well-tolerated, with headache being the most commonly reported side effect 4

By following these evidence-based dosing recommendations, you can effectively manage genital herpes outbreaks and improve patient quality of life.