From the Guidelines
For recurrent genital herpes simplex infections, the recommended dose of valacyclovir is 500 mg orally twice daily for 3 days, as this regimen has been shown to be effective in reducing symptoms and viral shedding 1. This regimen should be started at the first sign of recurrence, such as tingling, itching, or the appearance of lesions, for maximum effectiveness. Alternatively, a 1-gram dose taken twice daily for one day can also be effective. For patients experiencing frequent recurrences (more than 6 episodes per year), suppressive therapy may be appropriate, consisting of valacyclovir 500 mg to 1 gram once daily, as supported by the 2021 Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines 1. Valacyclovir works by converting to acyclovir in the body, which then inhibits viral DNA synthesis, preventing the herpes virus from replicating. The medication is generally well-tolerated, though common side effects may include headache, nausea, and abdominal pain, as noted in various studies, including those published in the Journal of Crohn's and Colitis 1 and MMWR Recommendations and Reports 1. Patients should maintain adequate hydration while taking valacyclovir and should be aware that while the medication reduces symptoms and viral shedding, it does not cure herpes infection, and precautions should still be taken to prevent transmission to partners. Key considerations in the management of genital herpes include the selection of practical treatment regimens that prioritize patient adherence, as emphasized in the 2021 Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines 1.
From the FDA Drug Label
Recurrent Episodes: The recommended dosage of VALTREX for treatment of recurrent genital herpes is 500 mg twice daily for 3 days Initiate treatment at the first sign or symptom of an episode. The dose of valacyclovir for recurrent herpes simplex genital is 500 mg twice daily for 3 days. Initiate treatment at the first sign or symptom of an episode 2.
From the Research
Dose of Valacyclovir for Recurrent Herpes Simplex Genital
- The recommended dose of valacyclovir for the suppression of genital herpes recurrences in immunocompetent individuals is ≥ 500 mg daily 3.
- A randomized, double-blind study found that valacyclovir dosages of 250 mg, 500 mg, or 1 g once daily, or 250 mg twice daily, were significantly more effective than placebo at preventing or delaying recurrences 4.
- The study also showed a dose-response relationship across the once-daily valacyclovir regimens, with 500 mg of valacyclovir once daily being effective for patients with a history of < 10 recurrences per year, and 1 g of valacyclovir once daily, 250 mg of valacyclovir twice daily, or 400 mg of acyclovir twice daily being more effective in patients with ≥ 10 recurrences per year 4.
- Valacyclovir is also effective in the episodic treatment of recurrent genital herpes, with a 3-day course being as effective as other antivirals 5.
- A 1-day course of valacyclovir (2000 mg given by mouth twice daily) has been shown to be effective in reducing the duration and severity of genital herpes recurrences, with a median lesion duration of 5 days and a median pain duration of 3 days 6.
Treatment Options
- Valacyclovir is available for both episodic and daily suppressive treatment of genital herpes 7.
- The choice of therapy depends on factors such as cost, ease of dosing, and acyclovir resistance 7.
- Valacyclovir is well tolerated, with convenient dosing frequencies for the treatment of genital herpes, making it a useful option for patients who require suppressive therapy for management of genital herpes 3, 4, 5.