Can You Increase Your Valacyclovir Dose During a Prodrome?
Yes, you should increase your dose to 500 mg twice daily for 3 days when you feel a herpes outbreak starting, rather than continuing your usual 500 mg daily suppressive dose. 1
Episodic Treatment During Breakthrough Outbreaks
When you experience prodromal symptoms (tingling, itching, burning) or early lesion development while on suppressive therapy, you need to switch to an episodic treatment regimen:
- Take 500 mg twice daily for 3 days starting at the first sign of an outbreak 1
- Treatment is most effective when initiated within the first 24 hours of prodromal symptoms or lesion onset 2
- After completing the 3-day episodic treatment course, resume your regular 500 mg daily suppressive dose 1
Why Your Current Suppressive Dose Isn't Enough
- Your daily 500 mg suppressive dose is designed to prevent recurrences, not treat active outbreaks 2, 3
- Episodic treatment requires higher total daily dosing (1000 mg/day vs 500 mg/day) to adequately control viral replication during an active episode 2, 1
- The 500 mg once-daily suppressive regimen is specifically noted to be less effective in patients with very frequent recurrences (≥10 episodes per year) 2, 3
Important Considerations
- Do not simply double your suppressive dose without switching to the proper episodic regimen - the timing and total daily dose matter for efficacy 1
- If you experience frequent breakthrough episodes while on 500 mg daily suppression, discuss increasing your suppressive dose to 1000 mg once daily with your provider 3, 1
- Keep extra medication on hand so you can start episodic treatment immediately when prodromal symptoms begin 2