From the Guidelines
Cold sores in the mouth can be effectively treated with antiviral medications such as acyclovir, valacyclovir, or famciclovir, which should be started early to shorten the duration of symptoms and accelerate healing. For immediate relief, over-the-counter topical medications containing docosanol (Abreva) can be applied directly to the sore at the first sign of symptoms, typically a tingling sensation.
Treatment Options
- Prescription antiviral medications like acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) are more effective when started early, usually taken as 500mg twice daily for 5-7 days 1.
- For pain management, use benzocaine products like Orajel or rinse with salt water (1/2 teaspoon salt in 8 ounces warm water) several times daily.
- Avoid spicy, acidic, or rough foods that can irritate the sores.
- Apply ice to reduce pain and swelling.
- Keep the area clean and avoid touching the sores to prevent spreading the virus.
Importance of Early Treatment
The aim of antiviral therapy is to block viral replication to enable shortening the duration of symptoms and to accelerate healing of the lesions associated with herpes labialis, as stated in a study published in the Journal of Clinical Virology 1.
Additional Considerations
Most cold sores heal within 7-10 days, but if they persist longer than two weeks or occur frequently, consult a healthcare provider for possible suppressive therapy.
From the FDA Drug Label
Immunocompetent Adult Patients( 1. 1) • Herpes labialis (cold sores) o Treatment of recurrent episodes DOSAGE AND ADMINISTRATION Immunocompetent Adult Patients ( 2.1) Herpes labialis (cold sores) 1500 mg as a single dose
The treatment for cold sores in the mouth is famciclovir with a dosage of 1500 mg as a single dose 2 2.
- Key points:
- Drug name: famciclovir
- Dosage: 1500 mg as a single dose
- Indication: treatment of recurrent episodes of herpes labialis (cold sores) in immunocompetent adult patients.
From the Research
Treatment Options for Cold Sores in the Mouth
- Antiviral therapy can be used to block viral replication, which shortens the duration of symptoms, facilitates resolution of lesions, and lessens the risk of spreading the virus 3.
- The top two most commonly prescribed medications for cold sores are acyclovir and valacyclovir, with valacyclovir use increasing over time 4.
- Long-term use of oral antiviral agents, such as acyclovir and valacyclovir, can reduce the recurrence of cold sores 5.
- Topical antiviral agents, such as aciclovir 5% cream, may have little effect on preventing recurrence of cold sores 5.
- Sunscreen application can prevent recurrent cold sores induced by experimental ultraviolet light, but its effectiveness in preventing cold sores induced by sunlight is uncertain 5.
Management and Prevention
- Pharmacists can play a role in assessing and managing cold sores, and prescribing antiviral therapy to decrease time to treatment and improve patient satisfaction 3.
- Prevention of cold sores can be achieved through measures such as avoiding triggers, using sunscreen, and practicing good hygiene 6.
- There is no cure available for cold sores, and treatment is mainly focused on relieving symptoms and reducing the frequency of recurrences 6, 5.
Medications
- Valacyclovir is a highly bioavailable prodrug of acyclovir, and is approved for therapy of herpes labialis, as well as for episodic and suppressive treatment of recurrent genital herpes 7.
- Acyclovir and famciclovir are also effective in treating herpes simplex and herpes zoster, but valacyclovir may be more effective in hastening the healing of zoster-associated pain and postherpetic neuralgia 7.