From the Guidelines
Cold sores caused by HSV-1 can be effectively treated with antiviral medications such as valacyclovir, acyclovir, and famciclovir, with valacyclovir 2g twice daily for one day being a recommended regimen. These medications work by preventing viral replication in cells, reducing the duration and severity of outbreaks by approximately 1-2 days 1. For typical outbreaks, valacyclovir 2g twice daily for one day or 1g twice daily for three days is effective, while acyclovir can be used as 400mg five times daily for five days, and famciclovir is typically prescribed as 1500mg as a single dose.
Treatment Options
- Valacyclovir: 2g twice daily for one day or 1g twice daily for three days
- Acyclovir: 400mg five times daily for five days
- Famciclovir: 1500mg as a single dose
- Over-the-counter options: docosanol 10% cream (Abreva) applied five times daily until healing occurs
- Pain relief: benzocaine or lidocaine topical products
Preventing Recurrences
For people with frequent outbreaks (more than 6 per year), daily suppressive therapy with valacyclovir 500mg daily or acyclovir 400mg twice daily may be recommended to prevent recurrences 1. It is essential to start treatment at the first sign of an outbreak (tingling or burning sensation) for optimal effectiveness. Although the provided studies focus on genital herpes, the same medication dosages and frequencies are recommended for genital HSV-1 infection, and by extension, can be applied to the treatment of cold sores caused by HSV-1 1.
From the FDA Drug Label
Famciclovir tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: Immunocompetent Adult Patients( 1. 1) • Herpes labialis (cold sores) o Treatment of recurrent episodes Denavir (penciclovir cream) is indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older.
Medications for Cold Sore (HSV1) Treatment:
- Famciclovir (PO): indicated for the treatment of recurrent episodes of herpes labialis (cold sores) in immunocompetent adult patients 2, 2.
- Penciclovir (TOP): indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older 3. Dosage for Famciclovir (PO): 1500 mg as a single dose for herpes labialis (cold sores) 2.
From the Research
Cold Sore HSV1 Medications
- The primary treatment for herpes simplex virus (HSV) infections, including cold sores, involves antiviral medications such as valacyclovir, acyclovir, and famciclovir 4, 5.
- Valacyclovir is an effective treatment for herpes labialis (cold sores) and is approved for a 3-day course in the episodic treatment of recurrent genital herpes 4.
- Acyclovir and its analogues are inhibitors of viral DNA replication and are the only approved medicines for HSV infection therapies 5.
- Other treatment options include penciclovir and its prodrug famciclovir, which are also effective against HSV infections 6, 7.
- Novel antiviral approaches, such as therapeutic vaccines and small molecule inhibitors, are being developed for the treatment of genital or labial HSV infections 8.
- The choice of treatment and dosing regimen depends on the clinical characteristics of the patient and their preference, and may involve intermittent episodic therapy, intermittent suppressive therapy, or chronic suppressive therapy 7.