From the Guidelines
For HSV-1 outbreaks, valacyclovir is typically dosed at 1 g orally twice a day for 7-10 days, as this regimen has been recommended by the Centers for Disease Control and Prevention 1. This dosing strategy is most feasible for patient adherence and has been shown to be effective in treating HSV-1 outbreaks. The medication works by converting to acyclovir in the body, which then inhibits viral DNA synthesis and replication. Some key points to consider when prescribing valacyclovir for HSV-1 outbreaks include:
- Starting treatment at the earliest signs of an outbreak, such as tingling or burning sensations
- Keeping medication on hand for patients with recurrent episodes to begin treatment promptly
- Considering alternative dosing regimens, such as 1 gram twice daily for 3 days, for more severe outbreaks
- Using suppressive therapy with valacyclovir 1 gram once daily for patients with frequent recurrences (more than 6 per year) to prevent outbreaks
- Adjusting dosage for patients with kidney impairment and monitoring for common side effects, such as headache and nausea. Although the most recent study 1 does not provide specific dosing recommendations for valacyclovir in the treatment of HSV-1 outbreaks, it emphasizes the importance of prioritizing dosing strategies that are most feasible for patient adherence. Given the available evidence, the recommended dosing regimen of 1 g orally twice a day for 7-10 days remains the most appropriate choice for treating HSV-1 outbreaks.
From the FDA Drug Label
The recommended dosage of VALTREX for treatment of cold sores is 2 grams twice daily for 1 day taken 12 hours apart. Therapy should be initiated at the earliest symptom of a cold sore (e.g., tingling, itching, or burning). The dosing for valacyclovir in HSV 1 outbreaks (cold sores) is:
- 2 grams twice daily for 1 day, taken 12 hours apart. Therapy should be initiated at the earliest symptom of a cold sore. 2
From the Research
Valcyclovir Dosing for HSV 1 Outbreaks
- The recommended dosing for valacyclovir in the treatment of facial herpes simplex virus (HSV) infection is 1000 mg twice daily for 1 day or 500 mg twice daily for 3 days 3.
- A study comparing single-day famciclovir therapy versus 3-day valacyclovir regimen for recurrent genital herpes found that valacyclovir (500 mg administered twice daily) was effective in reducing time to healing of all nonaborted genital herpes lesions 4.
- Valacyclovir is also effective in suppressing recurrent episodes of genital herpes and significantly prolongs the time to a recurrent episode of infection compared with placebo 5.
- The dosages of valacyclovir used to suppress recurrent episodes of genital herpes are 500 to 1000 mg/day in immunocompetent and HIV seropositive individuals 6.
Efficacy and Safety
- Valacyclovir has been shown to be effective in the treatment of herpes simplex, herpes zoster, and other viral infections 7.
- The efficacy of valacyclovir is similar to that of acyclovir and famciclovir in the treatment of genital herpes and herpes zoster 5, 4, 7.
- Valacyclovir is well tolerated, with a similar tolerability profile to acyclovir or placebo 5, 3.
- The most common adverse events reported with valacyclovir are headache, nausea, diarrhea, vomiting, and abdominal pain 4, 3.