What patient education should be given about Valtrex (valacyclovir) dosing, administration, side effects, precautions, and safe sexual practices for genital herpes?

Patient Education for Valtrex (Valacyclovir)

Patients taking Valtrex must understand that this medication controls symptoms but does not cure herpes, cannot prevent all recurrences, and does not eliminate the risk of transmitting the virus to sexual partners even during suppressive therapy. 1

Dosing and Administration

For First Episode of Genital Herpes

• Take 1 gram (1000 mg) orally twice daily for 7-10 days 1
• Treatment may need to be extended beyond 10 days if lesions have not completely healed 1
• Maintain adequate hydration while taking this medication 2

For Recurrent Outbreaks (Episodic Therapy)

• Start treatment immediately at the first sign of an outbreak—during the prodrome (tingling, itching, burning) or within 24 hours of lesion appearance 1, 2
• Take 500 mg orally twice daily for 5 days 1
• Treatment started more than 24 hours after symptoms begin may not be effective 2
• Keep medication on hand or have a prescription ready so you can start treatment immediately when symptoms appear 1

For Suppressive Therapy (Frequent Recurrences)

• If you have 6 or more outbreaks per year, daily suppressive therapy reduces recurrence frequency by at least 75% 1
• Standard dose: 500 mg to 1 gram once daily 1
• Important caveat: If you have 10 or more recurrences per year, the 500 mg once-daily dose is less effective; you need a higher dose regimen 1
• After 1 year of continuous daily therapy, discuss with your provider whether to temporarily stop to reassess how often outbreaks occur, as recurrence frequency naturally decreases over time in many patients 1

If You Miss a Dose

• Take it as soon as you remember 2
• Do not double the next dose or take more than prescribed 2

Critical Information About Transmission and Sexual Activity

Abstinence During Active Disease

• You must abstain from all sexual activity when lesions or any prodromal symptoms (tingling, itching, burning) are present 1
• This is non-negotiable for preventing transmission to partners 1

Asymptomatic Viral Shedding

• The virus can be transmitted even when you have no visible sores or symptoms—this is called asymptomatic viral shedding 1, 2
• Asymptomatic shedding occurs more frequently with HSV-2 than HSV-1 and is most common during the first 12 months after infection 1
• Suppressive therapy reduces but does not eliminate asymptomatic shedding and transmission risk 1

Partner Communication and Protection

• You must inform all sexual partners that you have genital herpes 1, 2
• Use condoms during all sexual encounters with new or uninfected partners 1
• Condoms reduce but do not completely eliminate transmission risk 1
• Uninfected partners should be counseled that they may become infected even if you have no symptoms 2
• Type-specific blood testing can determine if your partner is already infected or at risk for acquiring HSV-2 2

Common and Important Side Effects

Generally Well Tolerated

• Valtrex has a safety profile similar to placebo in most studies 3, 4
• The most commonly reported side effect is headache 5
• Gastrointestinal complaints may occur, particularly at higher doses 5

Serious Adverse Effects (Rare)

• In immunocompromised patients receiving high doses (8 grams/day), a potentially fatal blood disorder called thrombotic microangiopathy can occur 5
• This is not a concern at standard doses for genital herpes in otherwise healthy individuals 5

Special Precautions and Monitoring

Renal Function

• Your kidney function should be assessed before starting therapy and monitored during treatment 1
• If you have kidney disease, your dose must be adjusted based on creatinine clearance 2
• Patients on hemodialysis should take their dose after dialysis 2

Pregnancy and Breastfeeding

• If you are pregnant or planning to become pregnant, inform your healthcare provider 1
• Pregnant women with genital herpes should receive antiviral prophylaxis starting at 36 weeks gestation until delivery to reduce recurrences at term and lower cesarean delivery rates 1
• Women taking Valtrex during pregnancy should be reported to the manufacturer's pregnancy registry 1

Drug Resistance

• If lesions do not begin to improve within 7-10 days of treatment, contact your provider—this may indicate drug resistance 1
• Resistance is extremely rare in otherwise healthy individuals (< 0.5%) but more common in immunocompromised patients 6

What Valtrex Does NOT Do

• Valtrex is not a cure—the virus remains in your body permanently 1, 2
• It does not prevent all recurrences, only reduces their frequency 1
• It does not eliminate the risk of transmitting herpes to sexual partners 1
• Valtrex has not been shown to reduce transmission of sexually transmitted infections other than HSV-2 2

Long-Term Safety

• Continuous daily suppressive therapy with acyclovir (the active form of Valtrex) has been documented as safe for up to 6 years 1
• Valacyclovir and famciclovir have documented safety for up to 1 year of continuous use 7
• Resistance does not develop in immunocompetent patients even with prolonged suppressive therapy 7

Storage and Preparation

• Store tablets at room temperature 2
• If prescribed as an oral suspension (for children), it must be refrigerated at 2-8°C (36-46°F) and discarded after 28 days 2
• Shake suspension well before each use 2