Valacyclovir Dosing for Recurrent Genital Herpes
For recurrent episodes of genital herpes, the recommended dose of Valtrex (valacyclovir) is 500 mg twice daily for 3 days. 1
Dosing Recommendations Based on FDA Label
The FDA-approved dosing for valacyclovir in recurrent genital herpes includes:
- Recurrent Episodes: 500 mg twice daily for 3 days 1
- Treatment should be initiated at the first sign or symptom of an episode to maximize effectiveness
Alternative Dosing Strategies
For patients with different clinical scenarios, the following dosing regimens are recommended:
- Initial Episode: 1 gram twice daily for 10 days 1
- Suppressive Therapy:
- Transmission Reduction: 500 mg once daily for the source partner with history of 9 or fewer recurrences per year 1
Treatment Duration Considerations
Clinical evidence supports shorter treatment courses for recurrent episodes:
- The standard 3-day course (500 mg twice daily) has been shown to be as effective as a 5-day course for recurrent episodes 3
- Treatment is most effective when started at the earliest signs of recurrence (tingling, itching, or burning) 1
Special Populations
- HIV-infected patients may require longer courses of therapy and closer monitoring 2
- More aggressive suppressive therapy is recommended for patients with frequent recurrences, particularly those with HIV infection 2
Practical Considerations
- Valtrex may be taken without regard to meals 1
- For patients with frequent recurrences (≥10 per year), suppressive therapy with 1 gram once daily may be more appropriate than episodic treatment 4
- Once-daily regimens for suppressive therapy have been shown to improve patient compliance 5
Common Pitfalls to Avoid
- Delayed initiation: Treatment should begin at the first sign of recurrence to maximize effectiveness
- Inadequate dosing: Using lower doses than recommended may reduce efficacy
- Inappropriate duration: Using longer courses than necessary doesn't improve outcomes but may increase side effects and costs
- Not considering suppressive therapy: For patients with frequent recurrences (≥9 per year), suppressive therapy should be considered instead of episodic treatment
The CDC guidelines align with the FDA recommendations, confirming that 500 mg twice daily for 3-5 days is appropriate for recurrent episodes of genital herpes 2.