Valacyclovir Dosing for HSV-1 Infections
For HSV-1 infections (cold sores/oral herpes), the recommended dose of valacyclovir is 2 grams twice daily for 1 day taken 12 hours apart, initiated at the earliest symptom of a cold sore. 1
Treatment Recommendations by Infection Type
Cold Sores (Herpes Labialis)
- First-line treatment: 2 grams twice daily for 1 day (12 hours apart) 1
- Start at earliest symptoms (tingling, itching, or burning)
- FDA-approved dosing for adults and children ≥12 years
Recurrent Episodes of Oral HSV-1
- For recurrent episodes: 500 mg twice daily for 5-10 days 2
- Effective when started early in the course of an outbreak
Suppressive Therapy for Frequent Recurrences
- For patients with frequent recurrences: 500 mg to 1 gram once daily 2, 1
- Consider suppressive therapy only for those with frequent or severe recurrences 2
- For HIV-infected patients: 500 mg twice daily for suppressive therapy 2
Special Considerations
Renal Dosing
- Dosage adjustments required for patients with impaired renal function 2
- For creatinine clearance <25 mL/min, dose reduction is necessary
Treatment Initiation Timing
- Treatment efficacy is maximized when started at the earliest symptom (tingling, itching, burning) 1, 3
- Delayed initiation significantly reduces effectiveness
Treatment Failure
If treatment fails, consider:
- Incorrect diagnosis
- Co-infection with another STI
- Poor medication adherence
- Development of antiviral resistance 2
Advantages of Valacyclovir
- Better bioavailability than acyclovir 4, 5
- More convenient dosing schedule (1-2 times daily vs. 5 times daily for acyclovir) 6, 5
- Comparable efficacy to acyclovir with simpler administration 6
Patient Monitoring and Follow-up
- Re-examine patients 3-7 days after starting therapy to assess response 2
- Advise patients to avoid close contact with susceptible individuals until lesions have crusted 2
- For immunocompromised patients, closer monitoring may be required 2
Valacyclovir's convenient dosing regimen and excellent bioavailability make it an effective option for treating HSV-1 infections, with the 2-gram twice daily single-day therapy being particularly effective for cold sores when initiated early.