From the FDA Drug Label
- 2 Pediatric Dosing Recommendations Cold Sores (Herpes Labialis) The recommended dosage of VALTREX for the treatment of cold sores in pediatric patients aged greater than or equal to 12 years is 2 grams twice daily for 1 day taken 12 hours apart.
- Pediatric dosing for cold sores: For pediatric patients aged 12 years and older, the recommended dose is 2 grams twice daily for 1 day, taken 12 hours apart 1.
- Dosing for patients under 12: There is no recommended dose provided for pediatric patients under 12 years of age for the treatment of cold sores.
- Key consideration: Therapy should be initiated at the earliest symptom of a cold sore (e.g., tingling, itching, or burning).
From the Research
For pediatric cold sores, valacyclovir dosing depends on the child's age and weight, with the recommended dose for children 12 years and older being 2 grams twice daily for one day, as supported by the study 2.
Key Considerations
- For children 2-11 years old, the typical dose is 20 mg/kg (maximum 1 gram) taken three times daily for one day.
- For infants under 2 years, dosing should be determined by a pediatrician.
- Treatment is most effective when started at the first sign of a cold sore (tingling, burning sensation).
- Valacyclovir works by inhibiting viral DNA replication, shortening the duration and severity of outbreaks.
- Side effects may include headache, nausea, or stomach pain, as noted in the study 3.
Additional Guidance
- Adequate hydration should be maintained during treatment.
- For recurrent cold sores in children, a preventive regimen might be considered, but this requires physician evaluation, as discussed in the study 4.
- Parents should consult their child's healthcare provider before administering valacyclovir, as individual factors may affect appropriate dosing.
Evidence-Based Recommendation
The most recent and highest quality study 4 supports the use of valacyclovir for the treatment of herpes labialis, with oral antiviral agents being superior to topical antiviral therapy for episodic treatment.
Important Notes
- Valacyclovir and famciclovir have greater oral bioavailability and are better absorbed than acyclovir, require less frequent dosing, but are more expensive and are not approved for children, as mentioned in the study 4.
- Topical antiviral agents such as 5% acyclovir cream/ointment (Zovirax) ± hydrocortisone (Xerese), 1% penciclovir (Denavir) cream, and 50 mg Buccal Adhesive Tablet (ABT-50 mg) can also be used for episodic treatment of herpes labialis, but are not effective in the prevention of recurrent herpes labialis, as noted in the study 4.