What is the treatment for Bell's palsy after Valacyclovir (Valtrex)?

From the Guidelines

Treatment for Bell's palsy after Valacyclovir (Valtrex) should include oral steroids.

Treatment Overview

• The primary treatment for Bell's palsy is oral steroids, which should be prescribed within 72 hours of symptom onset for patients 16 years and older 1.
• Valacyclovir (Valtrex) may be used in addition to oral steroids, but there is limited evidence to support its use as a monotherapy 1.

Oral Steroids

• Prednisolone is the recommended oral steroid, with a dosage of 25 mg twice daily for 10 days or 60 mg per day for 5 days, then tapered over 5 days 1.
• Oral steroids have been shown to significantly improve facial nerve function and reduce recovery time in patients with Bell's palsy 1.

Combination Therapy

• Combination therapy with valacyclovir and prednisolone may be considered, but the evidence is limited and the benefits are not well established 1.
• One trial found a significantly higher rate of full facial nerve recovery at 6 months in patients treated with valacyclovir and prednisolone compared to prednisolone alone, but the results are suspect due to differences in baseline severity 1.

From the Research

Treatment for Bell's Palsy after Valacyclovir (Valtrex)

• The treatment for Bell's palsy after Valacyclovir (Valtrex) typically involves a combination of corticosteroids and antiviral medication, such as valacyclovir 2, 3, 4.
• Studies have shown that the combination of valacyclovir and prednisolone is more effective in treating Bell's palsy than prednisolone alone 4, 5.
• The recommended dosage of valacyclovir is 1 g three times per day for seven days, and the recommended dosage of prednisolone is 50 to 60 mg per day for five days followed by a five-day taper 3.
• Physical therapy may also be beneficial in patients with more severe paralysis 3.

Efficacy of Valacyclovir in Treating Bell's Palsy

• Valacyclovir has been shown to be effective in treating Bell's palsy, particularly in cases of severe palsy 4, 5.
• A study published in 2007 found that valacyclovir and prednisolone therapy was statistically more effective than placebo and prednisolone therapy in improving the recovery of patients with Bell's palsy 4.
• However, another study published in 2009 found that antiviral treatment, including valacyclovir, did not significantly improve the rate of complete recovery from Bell's palsy compared to placebo 6.

Adverse Events and Safety

• Studies have shown that valacyclovir is generally well-tolerated and safe, with no significant increase in adverse events compared to placebo or corticosteroids 2, 6.
• However, the cost-benefit ratio of valacyclovir treatment should be considered, particularly in cases of mild palsy 5.