Prevented And/or Blocked Lesions
The primary efficacy measure in study 2 and the secondary efficacy measure in study 1 was the proportion of subjects in whom cold sore lesion development was prevented and/or blocked and did not progress beyond the papular stage. Subjects with a blocked lesion could experience prodromal symptoms, erythema, or a papule but not the vesicle, ulcer, or hard-crust lesion stages.
What Conditions Do Acyclovir And Valacyclovir Treat
Acyclovir and valacyclovir are both used for the following indications:
- Treatment of chickenpox
Additionally, the acyclovir injection can be used to treat:
- Herpes of the brain in children and adults
- Herpes infection in newborn babies
Acyclovir and valacyclovir do not cure cold sores, herpes, or shingles. However, they relieve the symptoms of the outbreaks and help the lesions heal faster.
Why Is This Medication Prescribed
Acyclovir is used to decrease pain and speed the healing of sores or blisters in people who have varicella , herpes zoster , and first-time or repeat outbreaks of genital herpes . Acyclovir is also sometimes used to prevent outbreaks of genital herpes in people who are infected with the virus. Acyclovir is in a class of antiviral medications called synthetic nucleoside analogues. It works by stopping the spread of the herpes virus in the body. Acyclovir will not cure genital herpes and may not stop the spread of genital herpes to other people.
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How Does This Medication Work What Will It Do For Me
Valacyclovir belongs to the class of medications known as antivirals. It is used to treat a viral infection affecting the skin known as shingles . It is also used to treat cold sores, and to treat and prevent recurrences of genital herpes. It works by interfering with the way the virus reproduces. Valacyclovir works by stopping the virus from multiplying and spreading to nearby healthy cells.
It does not cure shingles, cold sores, or genital herpes, but it does help the sores to heal more quickly, and it relieves pain and discomfort. When used to prevent recurrences of herpes, it also reduces the risk of transmission of the infection to others.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
When Treatments For Genital Herpes Are Given
- Initial treatment. If you have symptoms such as sores when youre first diagnosed with genital herpes, your doctor will usually give you a brief course of antiviral therapy to relieve them or prevent them from getting worse. Your doctor may keep you on the drugs longer if the sores dont heal in that time.
After the first treatment, work with your doctor to come up with the best way to take antiviral therapies. There are two options:
- Intermittent treatment. Your doctor may prescribe an antiviral drug for you to keep on hand in case you have another flare-up this is called intermittent therapy. You can take the pills for two to five days as soon as you notice sores or when you feel an outbreak coming on. Sores will heal and disappear on their own, but taking the drugs can make the symptoms less severe and make them go away faster.
- Suppressive treatment. If you have outbreaks often, you may want to consider taking an antiviral drug every day. Doctors call this suppressive therapy. For someone who has more than six outbreaks a year, suppressive therapy can reduce the number of outbreaks by 70% to 80%. Many people who take the antiviral drugs daily have no outbreaks at all.
There is no set number of outbreaks per year that doctors use to decide when someone should start suppressive therapy. Rather, more important factors are how often the outbreaks happen and if they are severe enough to interfere with your life.
Continued
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How Much To Take
Your doctor will decide what dose you should take, how often you should take it and what strength Valtrex tablets you should use. The dosage may vary depending on your medical history.
Acute treatment of genital herpes:If you have had a herpes infection before, you should start to take Valtrex tablets as early as possible if you think you are about to have another recurrence . Dosing should ideally start just before, or straight after the first signs of HSV infection appear.
If you have been prescribed Valtrex 500 mg tablets for the treatment of HSV infection, the usual dose to take is one tablet with water twice daily.
Suppressive treatment of genital herpes:If you have been prescribed Valtrex 500 mg tablets to prevent the herpes infection appearing again, the usual dose to take is 500 mg once daily. Your doctor may recommend that you take this as a divided dose .
If you previously have had more than 10 recurrences in one year, your doctor may recommend that you take 1000 mg of Valtrex once daily to prevent recurrences.
If you think you have been advised to take a different dose, talk to your doctor or pharmacist.
Valtrex For Cold Sores: Everything You Need To Know
Valtrex is an antiviral medication used to treat viral infections like cold sores. Cold sores are caused by the highly contagious herpes simplex virus .
Cold sores are also called fever blisters and appear as small clustered lumps around the lip or mouth. Theyre usually itchy, tingly, painful, and filled with fluid.
If you have cold sores, Valtrex is one of the treatment options for you.
In this article, Ill discuss what cold sores are and how Valtrex works to treat and prevent them. Ill explain the dosage for Valtrex and the side effects of taking it.
Ill talk about the risks and interactions that come with taking Valtrex. Finally, Ill explore Valtrexs effectiveness for cold sores.
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Dosage: How Much Valtrex Should I Take
The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form :
- For treatment of chickenpox:
- Adults and children below 2 years of ageUse and dose must be determined by your doctor.
- Children 2 to 18 years of ageDose is based on body weight and must be determined by your doctor. The usual dose is 20 milligrams per kilogram of body weight, taken three times a day for 5 days. However, the dose is usually not more than 1000 mg three times a day.
- For treatment of cold sores:
- Adults2000 milligrams every 12 hours for one day.
- Children 12 years of age and above2000 milligrams every 12 hours for one day.
- Children below 12 years of ageUse and dose must be determined by your doctor.
- For treatment of genital herpes, first outbreak:
- Adults1000 milligrams two times a day for ten days.
- ChildrenUse and dose must be determined by your doctor.
Carcinogenesis Mutagenesis Impairment Of Fertility
The data presented below include references to the steadystate acyclovir AUC observed in humans treated with 1 gram of Valtrex given orally 3 times a day to treat herpes zoster. Plasma drug concentrations in animal studies are expressed as multiples of human exposure to acyclovir .
Carcinogenesis
Valacyclovir was noncarcinogenic in lifetime carcinogenicity bioassays at single daily doses of valacyclovir giving plasma acyclovir concentrations equivalent to human levels in the mouse bioassay and 1.4 to 2.3 times human levels in the rat bioassay. There was no significant difference in the incidence of tumors between treated and control animals, nor did valacyclovir shorten the latency of tumors.
Mutagenesis
Valacyclovir was tested in 5 genetic toxicity assays. An Ames assay was negative in the absence or presence of metabolic activation. Also negative were an in vitro cytogenetic study with human lymphocytes and a rat cytogenetic study.
In the mouse lymphoma assay, valacyclovir was not mutagenic in the absence of metabolic activation. In the presence of metabolic activation , valacyclovir was mutagenic.
Valacyclovir was mutagenic in a mouse micronucleus assay.
Impairment of Fertility
Valacyclovir did not impair fertility or reproduction in male or female rats at acyclovir exposures 6 times higher than in humans given the MRHD. Testicular atrophy occurred in male rats and was reversible.
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Warnings For People With Certain Health Conditions
For people with kidney problems: Your kidneys clear this drug from your body. If you have kidney problems or a history of kidney disease, you may not be able to clear it from your body. This may increase the levels of the drug in your body and cause more side effects. This drug can also make your kidney function worse. To help prevent these problems, your doctor may prescribe a lower dosage of this drug for you.
For people with advanced HIV or a history of transplant: If you have advanced HIV or a history of bone marrow or kidney transplant, you may be at a higher risk of certain blood disorders. These conditions are called thrombocytopenic purpura and hemolytic uremic syndrome . They can result in severely low red blood cells and platelets in your body. TTP or HUS can cause death.
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Dosage For Genital Herpes
Adult dosage
- First episode: 1 g, taken twice per day for 10 days. This drug works best if its started within 48 hours of when the first symptom appears.
- Repeating episodes: 500 mg, taken twice per day for 3 days. Treatment should be started when the first symptom appears.
- For preventing flare-ups in people with a normal immune system: 500 mg to 1 g, taken once per day.
- For preventing flare-ups in people with HIV: 500 mg, taken twice per day.
- For reducing the risk of transmission to a sexual partner: 500 mg, taken once per day.
Child dosage
This drug has not been studied for the treatment of genital herpes in children younger than 18 years.
Senior dosage
The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.
Your doctor may start you on a lowered dosage or a different treatment schedule. This can help keep levels of this drug from building up too much in your body.
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Treating Cold Sores With Valtrex
Cold sores typically start to heal on their own within about four to six days. Although, the first cold sore you get will likely last longer.
Most people dont require treatment for their cold sores, but, in some cases, a doctor may prescribe an antiviral medication such as Valtrex. This may be because you get cold sores often or if youre at high risk of serious complications, such as from a weakened immune system.
To treat a cold sore, you take Valtrex on the day you notice a cold sore forming. Valtrex works by preventing the herpes virus from growing and spreading.
Your doctor may also prescribe Valtrex to help prevent future cold sores, which is an off-label use. In that case, you and your doctor would work together to create the best treatment plan for you.
Valtrex is an oral caplet. It comes in 500-milligram and 1-gram strengths. Its available as a brand-name product as well as a generic medication . The generic product is an oral tablet which comes in the same strengths.
Can You Take Famciclovir Daily
Yes, famciclovir can be taken daily for herpes suppression, to lower the risk of genital herpes or shingles outbreaks.
You may be prescribed 250 mg of the medicine to be taken twice a day for 12 months.
Suppression therapy is also advised during pregnancy to avoid viral shedding and transmission of HSV infection to the baby.
Studies have shown that famciclovir is safe when administered over a period of 1 year. Speak to your doctor if you plan to take famciclovir for longer than 52 weeks.
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Suppressive Therapy For Recurrent Hsv
Suppressive therapy reduces frequency of genital herpes recurrences by 70%80% among patients who have frequent recurrences . Persons receiving such therapy often report having experienced no symptomatic outbreaks. Suppressive therapy also is effective for patients with less frequent recurrences. Long-term safety and efficacy have been documented among patients receiving daily acyclovir, valacyclovir, and famciclovir . Quality of life is improved for many patients with frequent recurrences who receive suppressive therapy rather than episodic treatment . Providers should discuss with patients on an annual basis whether they want to continue suppressive therapy because frequency of genital HSV-2 recurrence diminishes over time for many persons. However, neither treatment discontinuation nor laboratory monitoring is necessary because adverse events and development of HSV antiviral resistance related to long-term antiviral use are uncommon.
Valacyclovir 500 mg orally 2 times/day for 3 daysOR
Valacyclovir 1 gm orally once daily for 5 days
*Acyclovir 400 mg orally 3 times/day is also effective, but are not recommended because of frequency of dosing.
Clinical Trials Experience In Adult Subjects
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Cold Sores
In clinical trials for the treatment of cold sores, the adverse reactions reported by subjects receiving Valtrex 2 grams twice daily or placebo for 1 day, respectively, included headache and dizziness . The frequencies of abnormal ALT were 1.8% for subjects receiving Valtrex compared with 0.8% for placebo. Other laboratory abnormalities occurred with similar frequencies in the 2 groups.
Genital Herpes
Initial Episode: In a clinical trial for the treatment of initial episodes of genital herpes, the adverse reactions reported by greater than or equal to 5% of subjects receiving Valtrex 1 gram twice daily for 10 days or oral acyclovir 200 mg 5 times daily for 10 days , respectively, included headache and nausea . For the incidence of laboratory abnormalities see Table 2.
Recurrent Episodes: In 3 clinical trials for the episodic treatment of recurrent genital herpes, the adverse reactions reported by greater than or equal to 5% of subjects receiving Valtrex 500 mg twice daily for 3 days , Valtrex 500 mg twice daily for 5 days , or placebo , respectively, included headache and nausea . For the incidence of laboratory abnormalities see Table 2.
Herpes Zoster
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How Can I Stay Healthy While Taking Valtrex
There are several considerations that you must keep in mind to stay healthy while you are taking Valtrex:
- Maintain hydration: Valtrex is more likely to cause kidney damage if you are dehydrated.
- Pain control for shingles: Shingles can cause substantial pain. Your healthcare provider may prescribe a pain-control medication for you as your condition is resolving.
- Rest and fever control for chicken pox: Chicken pox infection can cause high fevers and sometimes fatigue. If your child has this infection, maintain rest, and follow their providers advice regarding management of fevers.
Herpes viruses are highly contagious, so its important to avoid infecting others while you are recovering.
Tips to avoid the spread of the following infections:
- Cold sores: Dont share cups, utensils, lipstick, or kiss others while a cold sore is present
- Genital herpes: Practice safe sex.
- Chicken pox and shingles: Avoid contact with people who are immunosuppressed , people who are pregnant, and babies until your infection has fully resolved.
When Acute Becomes Chronic
A maintenance dose of systemic antiviral therapy may help some patients with HSVK. In the HEDS II study, a maintenance dose of either 400mg of acyclovir BID or 500mg valacyclovir QD for 12 months after resolution of the initial episode significantly decreased the probability of recurrence.18 Patients who have had more than one episode of HSVK and those with HSV stromal keratitis are prime candidates for a maintenance course of antiviral medication, which can often spare patients significant scarring and loss of vision.
HSVK is the most frequent cause of corneal blindness in the United States and the most common source of infectious blindness in the Western world.2 A detailed, targeted history and meticulous clinical work-up are essential to proper diagnosis, effective treatment and preservation of visual function. With timely, aggressive treatment, the prognosis in HSVK is generally favorable.
Dr. Leon is an optometrist at the South Texas Eye Institute. She is a graduate of the Rosenberg School of Optometry at the University of the Incarnate Word, where she completed a residency in primary care optometry.
Dr. Pizzimenti is a full-time faculty member at the University of the Incarnate Word in San Antonio, Texas, where he coordinates the Primary Care Residency Program. He is also a contributing editor for Review of Optometry.
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