From the Guidelines
Cold sores can be treated with several effective options, including over-the-counter antiviral creams and prescription antivirals, which can reduce healing time and symptom severity by blocking viral replication. For immediate relief, over-the-counter antiviral creams like docosanol (Abreva) should be applied at the first sign of tingling, 5 times daily until healed. Prescription antivirals such as acyclovir (400mg orally, 3 times daily for 5-7 days), valacyclovir (2g twice daily for one day), or famciclovir (1500mg once) are more effective, especially when started during the prodromal phase, as noted in the study by 1.
Some key points to consider when treating cold sores include:
- Pain relief can be achieved with ice packs applied for 10 minutes several times daily or OTC pain relievers like acetaminophen or ibuprofen.
- Keeping the area clean and avoiding touching the sore prevents bacterial infection and spreading the virus.
- Lysine supplements (1000mg daily) may help some people, though evidence is limited, as discussed in various studies including 1.
- Cold sores typically heal within 7-10 days regardless of treatment, but medications can reduce healing time and symptom severity.
- For frequent outbreaks (more than 6 per year), daily suppressive therapy with valacyclovir or acyclovir may be recommended by your doctor, as suggested by 1.
It's essential to note that while there are various treatment options available, the most effective approach often involves a combination of these methods, and the best course of treatment should be determined in consultation with a healthcare professional.
From the FDA Drug Label
Herpes labialis (cold sores):Famciclovir tablets are indicated for the treatment of recurrent herpes labialis in adult patients. The recommended dosage of famciclovir tablets for the treatment of recurrent herpes labialis is 1500 mg as a single dose. Therapy should be initiated at the first sign or symptom of herpes labialis (e.g., tingling, itching, burning, pain, or lesion).
The treatment option for Herpes Simplex Labialis (cold sore) is Famciclovir, which is prescribed as a single dose of 1500 mg. Therapy should be initiated at the first sign or symptom of herpes labialis, such as tingling, itching, burning, pain, or lesion 2.
From the Research
Treatment Options for Herpes Simplex Labialis (Cold Sore)
- Antiviral medications are the typical treatment for cold sores, with acyclovir and valacyclovir being the most commonly prescribed medications 3.
- Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis, and it is also approved for a 3-day course in the episodic treatment of recurrent genital herpes, as well as for once daily dosing for suppressive therapy 4.
- Topical treatments, such as ME-609 (a combination of 5% acyclovir and 1% hydrocortisone), have also been shown to be effective in preventing the progression of cold sores to ulcerative lesions and reducing the cumulative lesion area 5.
- Famciclovir, a highly bioavailable prodrug of penciclovir, is another antiviral medication that may be used to treat herpes simplex labialis, although its effectiveness compared to valacyclovir and acyclovir is still being studied 4, 6.
- Prevention and treatment of cold sores may also involve symptomatic treatment and advice on preventing recurrence and contamination of other people 7.
Medication Comparison
- Valacyclovir has been shown to be more effective than acyclovir in hastening the healing of zoster-associated pain and postherpetic neuralgia 4.
- Famciclovir and valacyclovir appear to decrease time to resolution of pain compared with acyclovir in patients with herpes zoster infections 6.
- ME-609 has been shown to be more effective than topical acyclovir alone in preventing the progression of cold sores to ulcerative lesions and reducing the cumulative lesion area 5.