Monday, September 19, 2022

Valtrex Dosing For Herpes Simplex

Treating Cold Sores With Valtrex

Valacyclovir Tablets for herpes infections

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.

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.

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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Overdose: What Happens If I Take Too Much Valtrex

If you take too much Valtrex, it can lead to acute kidney damage. This is a medical emergency that can cause toxicity in your body and the inability to make urine.

Hemodialysis is a procedure that helps your body eliminate toxins and balance fluidthis may be necessary until your kidney function is restored.

Patients With Renal Impairment

The Treatment of Herpes Simplex Infections

Dosage recommendations for adult patients with reduced renal function are provided in Table 1. Data are not available for the use of VALTREX in pediatric patients with a creatinine clearance less than 50 mL/min/1.73 m2.

Table 1. VALTREX Dosage Recommendations for Adults with Renal Impairment

Indications

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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.

Prevention And/or Blocking Of Cold Sores

Increases in the proportion of subjects in whom cold sore lesion development was prevented and/or blocked were observed with both treatment regimens when compared to placebo .4). In study 1, a greater proportion of subjects experienced prevention and/or blockage of cold sore lesions than those in the placebo group, but the treatment differences were not statistically significant at the two-sided 5% level. In study 2, a greater proportion of subjects in both treatment groups experienced prevention and/or blockage of cold sore lesions than those in the placebo group . However, after adjustment for multiple comparisons, neither treatment difference was statistically significant at the 5% level. Figure Figure22 shows the difference in proportion of subjects in whom cold sore lesion development was prevented and/or blocked for the 1- and 2-day valacyclovir treatment regimens in each study.

Plot of the difference in proportion of subjects in whom cold sore lesion development was prevented and/or blocked with 1-day treatment and 2-day treatment from placebo within each study. 95% CI, 95% confidence interval.

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When You Must Not Take Them

  • Do not take Valtrex tablets if you have ever had an allergic reaction to valaciclovir, aciclovir or any of the ingredients listed at the end of this leaflet.
  • Symptoms of an allergic reaction may be mild or severe. They usually include some or all of the following: wheezing, swelling of the lips/mouth, difficulty in breathing, hay fever, lumpy rash or fainting.
  • Do not take Valtrex tablets if you are pregnant, trying to become pregnant or breast-feeding, unless your doctor says you should.
  • Your doctor will discuss the risks and benefits of using Valtrex tablets when pregnant and during breast-feeding.
  • Do not take Valtrex tablets after the expiry date printed on the pack.
  • If you take it after the expiry date has passed, it may not work as well.
  • Do not take Valtrex tablets if the packaging is torn or shows signs of tampering.
  • If you are not sure whether you should be taking Valtrex, talk to your doctor.

The Virus And Pathogenesis

Valtrex (Valacyclovir) – Uses, Dosing, Side Effects

HSV is a double-stranded DNA virus that may enter the host through abraded skin or intact mucous membranes.1 Epithelial cells are the initial targets. Once infected, these cells die, releasing clear fluid intradermally to form vesicles and merging with other cells to create multinucleated giant cells.

Retrograde transport through adjacent neural tissue to sensory ganglia leads to lifelong latent infection.1 Reactivation of the virus is triggered by local or systemic stimuli such as immunodeficiency, trauma, fever, menstruation, ultraviolet light and sexual intercourse.13 Although emotional stress is assumed to trigger HSV recurrence, recent research fails to show a definite causative role.4 Once reactivated, the virus is transported by the neuron back to the epithelium, where more replication occurs, and another outbreak ensues.

HSV exists as two separate types, labeled 1 and 2, which have affinities for different body sites.2 Ninety percent of infections caused by HSV-2 are genital, and 90 percent of those caused by HSV-1 are oral the reason for this division is unknown.5 In addition, oral HSV-1 infection recurs more frequently than oral HSV-2, and genital HSV-2 recurs more often than genital HSV-1.

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Treatment Of Primary Infection

Antiviral therapy is recommended for an initial genital herpes outbreak, especially if the patient has systemic symptoms or is immunocompromised.2 Oral acyclovir is effective in reducing symptoms1. Intravenous administration may be required in immunocompromised patients and those with severe disseminated infection.1 Topical acyclovir reduces the duration of viral shedding and the length of time before all lesions become crusted, but this treatment is much less effective than oral or intravenous acyclovir.1

Symptom/sign

How Much Valacyclovir Should You Take For A Recurrent Genital Herpes Outbreak

After the primary outbreak, genital herpes enters a latent stage. During this period, the virus lays dormant in the body , with no clear symptoms or signs of an infection.

Over time, many people with genital herpes will experience recurrent outbreaks of the virus that cause herpes sores to develop. Outbreaks affect people with HSV-1 and HSV-2, although they tend to be more common in people with the HSV-2 type of the herpes virus.

Recurrent outbreaks are usually less intense than the initial outbreak. Most people only notice the development of herpes sores on the genitals, with few or none of the flu-like symptoms that can make a primary outbreak so unpleasant.

During a recurring outbreak, you normally wont need to take as much as you did for the primary outbreak. A standard valacyclovir dosage for recurrent genital herpes outbreaks is 500 mg twice per day for three days.

If you have particularly severe genital herpes outbreaks or the herpes sores you develop during an outbreak take longer than normal to recover, your doctor may adjust your dosage to provide extra relief from symptoms and faster healing. In any case, follow your doctors instructions.

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About Herpes Suppressive Therapy

If you opt for suppressive therapy, one of the most common antiviral medications is Valtrex, or valacyclovir. Another commonly prescribed medication goes by the name of Zovirax, or acyclovir. Valacyclovir and acyclovir can be considered close cousins as they are chemically similar.

Read on for the details about how effective suppressive therapy is and how it can affect transmission rates. Well also go over dosing and side effects of this medication. Note: This isnt a substitute for medical advice. You should always consult your doctor to determine whats right for your health.

Table 2 Oral Antiviral Therapy Dosing4

Valtrex Dose For Herpes Labialis â Herpes Free Me

Dendritic Epithelial Keratitis Antiviral *Antiviral treatment is prophylactic since patients are also treated with a therapeutic dose of topical steroid. **Limited dose of topical steroid plus therapeutic dose of antiviral.***Therapeutic dose of topical steroid and therapeutic dose of antiviral. Oral antiviral agent is reduced to prophylactic dose after seven to 10 days and maintained as long as steroid is in use.

HSV stromal keratitis without epithelial ulceration is the more common of the two HSV stromal infections. As its name implies, stromal keratitis without ulceration is thought to occur due to viral proteins that remain in the cornea even after the infection has resolved.17 In response to these remaining proteins, the body produces an inflammatory response, which results in a stromal keratitis without necrosis. Patients will generally present with symptoms of blurry vision, photophobia and halos around lights brought on by edema of the stroma.15

Clinical signs include stromal edema, anterior chamber reaction, stromal opacity and neovascularization.13 This significant inflammatory response, in combination with recurrent disease, often makes stromal keratitis the instigator of irreversible damage and significant scarring. Stromal keratitis without ulceration requires the use of a topical corticosteroid along with an oral antiviral.

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Valacyclovir May Interact With Other Medications

An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. To help prevent interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs youre taking.

To find out how valacyclovir oral tablet might interact with something else youre taking, talk to your doctor or pharmacist.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that youre taking.

This drug comes with several warnings.

Hsvk Or A Masquerader

The initial presentation of ocular HSV may or may not represent primary infection by the virus. In one study of 108 adult patients with primary ocular HSV, 84% of patients had moderate to severe conjunctivitis, 38% had moderate to severe blepharitis, 35% had a concomitant upper respiratory infection and 31% had generalized symptoms. Only 15% of patients had dendritic ulcers, while 2% had HSV endothelial keratitis and 19% had bilateral disease.14

Because of its variable presentation and ability to affect all corneal layers, HSVK has several masqueraders and differential diagnoses. For example, any keratitis that creates a dendriform lesion could be mistaken for HSV epithelial keratitis. Infectious masqueraders include Acanthamoeba keratitis, VZVK, adenovirus epithelial keratitis, Epstein-Barr epithelial keratitis, chlamydial keratitis and other varying microbial keratitis.4,12 Non-infectious differentials include Thygesons superficial punctate keratopathy, exposure keratopathy, epithelial defects from topical medications , epithelial defects due to contact lens wear, epithelial regeneration lines, epithelial basement membrane disease and recurrent corneal erosions.4,12 Appropriate patient history, demographics and a comprehensive workup will help you sift through masqueraders.

Here is an example of the classic HSVK epithelial dendrite with terminal bulbs.

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Extemporaneous Preparation Of Oral Suspension

Ingredients and Preparation per USPNF

VALTREX tablets 500 mg, cherry flavor, and Suspension Structured Vehicle USP-NF . Valacyclovir oral suspension should be prepared in lots of 100 mL.

Instructions for Preparing Suspension at Time of Dispensing

Transfer the suspension to an amber glass medicine bottle with a child-resistant closure.
The prepared suspension should be labeled with the following information Shake well before using. Store suspension between 2°C to 8°C in a refrigerator. Discard after 28 days.

*The amount of cherry flavor added is as instructed by the suppliers of the cherry flavor.

What Is In This Leaflet

Valtrex

This leaflet answers some common questions about Valtrex tablets. It does not contain all of the available information.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Valtrex tablets against the benefits this medicine is expected to have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

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How Much Valacyclovir Should You Take For A Primary Herpes Outbreak

Most people find out that they have the herpes virus during the primary outbreak. The first outbreak of herpes tends to be the most intense, with a person developing both the physical symptoms of herpes as well as a variety of other symptoms.

During a primary outbreak, many people experience muscle aches, chills, fever, swelling of the glands around the neck and pelvic area, headaches and other flu-like symptoms. If youre going through a primary outbreak, its normal to feel fatigued and lacking in energy.

A painful, burning feeling when urinating is a common symptom in both sexes. Women going through initial outbreaks may experience unusual vaginal discharge and pain in the cervix due to the virus.

Our guide to the signs and symptoms of genital herpes goes into more detail about the most common symptoms people experience during initial outbreaks. Outbreaks of oral herpes can include similar physical effects, although the herpes sores are isolated to the lips and mouth.

One of the biggest reasons a primary herpes outbreak is so intense is that the virus is relatively strong during this period. Over time, your body will develop its own immune response to HSV-1 or HSV-2 — depending on your infection type — allowing it to suppress the virus.

Both oral and genital herpes primary outbreaks tend to last for two to three weeks, with the most intense symptoms during the first one to two weeks of the outbreak.

Herpes Suppressive Therapy: 6 Points To Know About Daily Valtrex

Unfortunately, there isnt a cure for herpes. However, doctors sometimes prescribe Valtrex to be taken every day in order to prevent outbreaks and lower transmission rates. Using antiviral medications like Valtrex every day is known as herpes suppressive therapy.

Medically reviewed by Gerard Sison, PharmD on Nov. 26, 2018

Depending on the severity of a case of herpes, doctors may prescribe one of two methods for managing symptoms:

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  • Intermittent treatment consists of taking an antiviral drug when you experience an outbreak to lessen the severity of symptoms and shorten their duration.
  • Suppressive therapy consists of taking a regular dose of antivirals every day whether you have an outbreak or not. The purpose is to not only prevent outbreaks, but also to reduce the likelihood of transmitting herpes to a sexual partner.

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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.

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