From the Guidelines
Cold sores can be effectively treated with oral antiviral medications like acyclovir, valacyclovir, or famciclovir, which work by preventing the herpes simplex virus from replicating, shortening outbreak duration and reducing symptoms. For immediate treatment, over-the-counter antiviral creams containing docosanol (Abreva) should be applied at the first sign of tingling or burning, typically 5 times daily until healed. Prescription options include oral antiviral medications like acyclovir (400mg 3 times daily for 5-7 days), valacyclovir (2g twice in one day), or famciclovir (1500mg once) 1. These medications are effective in reducing the severity and duration of cold sore outbreaks. Some key points to consider when treating cold sores include:
- Applying treatment at the first sign of symptoms, ideally during the tingling phase before the blister appears
- Keeping the area clean and avoiding touching or picking at the sore to prevent spreading the infection
- Using pain relief measures such as applying ice to the sore and taking ibuprofen or acetaminophen as needed
- Considering suppressive therapy with daily antiviral medication for individuals who experience frequent outbreaks (more than 6 per year) 1. It's also important to note that cold sores typically heal within 7-10 days, but treatment works best when started at the earliest symptoms.
From the FDA Drug Label
Herpes labialis (cold sores):Famciclovir tablets are indicated for the treatment of recurrent herpes labialis in adult patients. The recommended dosage of famciclovir tablets for the treatment of recurrent herpes labialis is 1500 mg as a single dose. Therapy should be initiated at the first sign or symptom of herpes labialis (e.g., tingling, itching, burning, pain, or lesion). The treatment for cold sores with famciclovir is a single dose of 1500 mg, and therapy should be initiated at the first sign or symptom of cold sores, such as tingling, itching, burning, pain, or lesion 2.
From the Research
Cold Sore Treatment Options
- Cold sores are a common condition that can cause significant morbidity and are typically treated with antivirals 3.
- The most commonly prescribed medications for cold sores are acyclovir and valacyclovir, with valacyclovir use increasing over time 3.
- Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis and has been shown to be effective in treating herpes simplex and herpes zoster 4.
Comparison of Antiviral Medications
- Valacyclovir, famciclovir, and acyclovir are commonly used antiviral medications for treating herpes simplex virus infections 5, 6.
- Valacyclovir and famciclovir have been shown to decrease time to resolution of pain compared to acyclovir in patients with herpes zoster infections 5.
- The choice of antiviral medication and dosing regimen can be confusing due to competing clinical approaches and evolving dosing schedules 6.
Emerging Antivirals
- There is a need to develop new antiherpetic compounds with different mechanisms of action to address the development of drug-resistant viral isolates and dose-limiting toxicities 7.
- Significant advances have been made in the design and development of novel antiviral therapeutics, with several new compounds in various phases of clinical trials 7.