Ganciclovir Cidofovir And Foscarnet
In the last decade, alternatives to ACV for herpesvirus treatment have emerged and become commercially available as therapeutic drugs. Ganciclovir is a nucleic acid analog that does not require viral proteins for its activation in the cell . These compounds differ from each other either, in their molecular processing into an active form of an acyclic guanosine analog, or bioavailability which significantly determines the frequency of administration .
Ganciclovir is indicated for the treatment of CMV, particularly for systemic and ocular infections in immunosuppressed patients . However, ganciclovir has also been reported to have antiviral activity against HSV-1 and HSV-2 and may be used for the treatment of herpetic keratitis . At present, there is an ongoing clinical study that is recruiting patients for assessing the effects of oral ganciclovir, together with femtosecond laser-assisted corneal debridement in the treatment of herpes simplex virus epithelial keratitis . Of note, ganciclovir has been reported to produce considerable adverse side effects in a high percentage of individuals , such as nephrotoxicity, neutropenia, myelosuppression, confusion, altered mental status, anxiety, ataxia, tremors, convulsions, fever, abnormal levels of liver enzymes in serum, diarrhea, and nausea, among others .
Table 1. Approved and experimental antiviral drugs against HSV-1 and HSV-2 .
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
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Education Is An Integral Part Of Herpes Treatment
If you have genital herpes, its important for you to get educated about herpes and have the opportunity to ask questions in a supportive environment.
Becoming informed will help you learn to cope with the illness. It will also help you prevent sexual transmission of the illness, or transmission to an infant during a pregnancy.
Herpes has a tremendous psychosocial overlay. But knowledge about it and understanding about how well it can be managed can reduce that, says Handsfield.
Your doctor may be able to provide you with all the information you need, or you may choose to seek counseling from a mental health professional or at a clinic that specializes in sexual health, such as Planned Parenthood.
If you have a regular sexual partner, that person should also have the chance to learn about herpes and ask any questions they may have about it.
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Before Taking This Medicine
You should not use this medicine if you are allergic to valacyclovir or acyclovir .
To make sure valacyclovir is safe for you, tell your doctor if you have:
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kidney disease
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HIV/AIDS, or other conditions that can weaken the immune system or
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a history of kidney transplant or bone marrow transplant.
It is not known whether this medicine will harm an unborn baby. However, herpes virus can be passed from an infected mother to her baby during childbirth. If you have genital herpes, it is very important to prevent herpes lesions during your pregnancy, so that you do not have a genital lesion when your baby is born.
Valacyclovir can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Do not give valacyclovir to a child without medical advice.
How Should I Take Valacyclovir
Take valacyclovir exactly as it was prescribed for you. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Start taking valacyclovir as soon as possible after the first appearance of symptoms . This medicine might not be as effective if you first start taking it 1 or 2 days after the start of your symptoms.
Some herpes infections need to be treated for longer than others. Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may increase the risk of your virus becoming resistant to antiviral medicine.
You may take valacyclovir with or without food.
Tell your doctor if a child taking this medicine cannot swallow the valacyclovir tablet.
Drink plenty of water while you are taking valacyclovir to keep your kidneys working properly.
Lesions caused by herpes viruses should be kept as clean and dry as possible. Wearing loose clothing may help to prevent irritation of the lesions.
Store valacyclovir tablets at room temperature away from moisture and heat.
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Can Antivirals Prevent The Spread Of Viral Infections
Yes, antiviral drugs can keep you from getting certain viral infections after a suspected or known exposure. For instance, taking specific antivirals:
- During pregnancy lowers the risk of a mother passing HIV to her newborn .
- Daily lowers the risk of giving herpes or HIV to others or getting HIV from an infected partner.
- Within 72 hours of a potential HIV exposure can lower the chances of getting infected.
- Within 48 hours of exposure to the flu virus may keep you from getting sick.
What Are The Symptoms Of Genital Herpes
If you do notice symptoms, youll experience them differently depending on whether youre having your first herpes outbreak or a recurrent outbreak. Recurring symptoms are usually milder than the first outbreak. Symptoms dont last as long with later outbreaks. Some people may only have one or two outbreaks during their lifetime. Others may have as many as four or five outbreaks a year.
How do genital herpes first appear?
When symptoms occur, theyre usually worse during the first outbreak or flare-up . Symptoms typically appear within two to 20 days after infection. Active symptoms may last up to four weeks.
You may experience:
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What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to acyclovir.
Do not let anyone else take or use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Viruses And Host Cells
Viruses consist of nucleic acid and a protein coat. Because viruses do not have the enzymes that are needed to manufacture cellular components, they are obligate parasites, which means they must enter a cell for replication to occur. The nucleic acid of the virus instructs the host cell to produce viral components, which leads to an infectious virus. In some cases, as in herpes infections, the viral nucleic acid may remain in the host cell without causing replication of the virus and damage to the host . In other cases, the production of virus by the host cell may cause the death of the cell. A major problem in treating some viral diseases is that latent viruses can become activated.
Many factors account for the difficulty in developing antiviral agents. The structure of each virus differs, and specific therapy is often unsuccessful because of periodic changes in the antigenic proteins of the virus . The need for a host cell to support the multiplication of the virus makes treatment difficult because the agent must be able to inhibit the virus without seriously affecting the host cells.
An antiviral agent must act at one of five basic steps in the viral replication cycle in order to inhibit the virus: attachment and penetration of the virus into the host cell, uncoating of virus , synthesis of new viral components by the host cell as directed by the virus DNA, assembly of the components into new virus, and release of the virus from the host cell.
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Treatment Of Common Cutaneous Herpes Simplex Virus Infections
DAVID H. EMMERT, M.D., Lancaster General Hospital, Lancaster, Pennsylvania
Am Fam Physician. 2000 Mar 15 61:1697-1704.
Herpes simplex virus infection is increasingly common in the United States. New antiviral medications have expanded treatment options for the two most common cutaneous manifestations, orolabial and genital herpes. Acyclovir therapy remains an effective and often less expensive option. Famciclovir and valacyclovir offer improved oral bioavailability and convenient oral dosing schedules but are more expensive than acyclovir. Patients who have six or more recurrences of genital herpes per year can be treated with one of the following regimens: acyclovir, 400 mg twice daily valacyclovir, 1 g daily or famciclovir, 250 mg twice daily. These regimens are effective in suppressing 70 to 80 percent of symptomatic recurrences. Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. There is little evidence indicating benefit from treatment of recurrent orolabial herpes, which tends to be mild and infrequent.
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Herpes Causes And Risk Factors
Causes of herpes include acquiring the virus through sexual contact, coupled with immune system suppression and sometimes nutritional deficiencies.
HSV-1 is primarily transmitted by oral-oral contact. On the other hand, HSV-2 is considered a sexually transmitted disease and usually passed during oral or vaginal sex.
A scary finding is that more cases of genital herpes than ever before are now being caused by HSV-1 , and about 85 percent of people with genital herpes dont even know it. Studies show that about 50 percent of the new genital herpes infections in young adults are due to HSV-1 and about 40 percent in older adults. The fact that most people dont ever find out theyre infected is one of the reasons that transmission rates are steadily climbing.
Risk factors for acquiring herpes include:
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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.
Who Shouldnt Take Antiviral Medications
Antivirals are relatively safe medicines. Children as young as two weeks, as well as pregnant and breastfeeding individuals, can take certain antiviral medications. Guidelines for who shouldnt take antivirals vary depending on the drug. Your healthcare provider can determine whether an antiviral medicine is safe for you.
A note from Cleveland Clinic
Antiviral medications can treat certain viruses, putting an end to symptoms. For people with chronic viral infections, antiviral drugs can stop the virus from multiplying and causing problems. The medicine also lowers your chances of giving the virus to others. Your healthcare provider may prescribe an antiviral as a preventive measure if you have a known viral exposure. Taking antiviral medicines for a long time, or failing to take them as prescribed, can lead to antiviral resistance.
Last reviewed by a Cleveland Clinic medical professional on 05/11/2021.
References
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Talk With Your Doctor About Herpes Medications
Its important to first talk with your doctor before using over-the-counter products like docosanol or other home remedies.
If this is the first time you have symptoms of HSV with blisters or sores, your doctor will first diagnose if you have HSV, the type and discuss options to manage your condition. They will tell you about prescription and nonprescription alternatives to treat your HSV infection.
Tell your doctor if you have any serious health conditions including if you have a weakened immune system.
Your doctor will also tell you what you can expect with an HSV infection, how long it may last, and what do to prevent spreading HSV to others while you have an active infection.
Here are answers to a few commonly asked questions about herpes simplex virus.
Treatment For Oral Herpes
The antiviral medications available in pill form have been specifically developed for the treatment of genital herpes. However, it is not uncommon for healthcare providers to prescribe the antiviral drugs to those who have frequent or severe outbreaks of oral herpes.
A recent study found valacyclovir to be effective for treating oral herpes in a one-day treatment of 2 grams taken at the first sign of a cold sore, and then again about 12 hours later.
There are two topical antiviral medications prescribed for the treatment of oral HSV symptoms: acyclovir ointment and penciclovir cream. Both work to speed up the healing process and reduce the viral activity. These topical drugs are put directly on the lesions themselves, but can also be used at the onset of prodrome.
Other topical treatments for oral herpes are available over-the-counter , but are not antiviral compounds like acyclovir and penciclovir. Some also contain ingredients that numb the area and induce temporary relief from the discomfort of an outbreak. Unfortunately, some OTC treatments may actually delay the healing time of symptoms because they can further irritate the area with repeated applications. There is only one OTC FDA-approved cream, called Abreva®, which has been clinically proven to help speed the healing process.
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Order Herpes Medication On Your Terms
Need a prescription for herpes medication? We make it easy to buy valacyclovir online so you can treat genital herpes at home, safely and privately. It still isnt possible to get prescription medication for herpes without a doctor or order Valtrex without a prescription. But with wisp, you can message a doctor to get prescription medication for herpes whether you have insurance or not. We also ship the best over the counter herpes meds to help manage the frequency and severity of genital outbreaks.
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How Is Genital Herpes Treated
There is no cure for the herpes simplex virus. The blisters usually heal and go by themselves, so you may not always need treatment. There is antiviral medicines for herpes, which can: shorten outbreaks, relieve discomfort and stop symptoms from getting worse.
The antiviral treatment is most effective when you take it within the first five days of symptoms appearing. Avoid touching the blisters as this can also increase the risk of spreading the infection. If your herpes treatment requires you to apply cream to a sore, just gently pat the cream on, being careful not to rub around the surrounding area.
You can ease your symptoms by:
- keeping the affected area clean using plain or salt water to prevent blisters or ulcers from becoming infected
- applying petroleum jelly, such as Vaseline, to any blisters or ulcers to reduce the pain when passing urine
- asking a healthcare provider to recommend painkilling creams
- avoiding tight clothing because it may irritate the blisters and ulcers.
Dont have sex until you or your partner have finished your treatment, and the blisters or ulcers have gone. If its your first outbreak, its sometimes advised that you check back with a healthcare provider before having sex again, to ensure that your symptoms have gone.
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How Should I Take Valtrex
Take Valtrex exactly as it was prescribed for you. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Start taking Valtrex as soon as possible after the first appearance of symptoms . This medicine might not be as effective if you first start taking it 1 or 2 days after the start of your symptoms.
Some herpes infections need to be treated for longer than others. Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may increase the risk of your virus becoming resistant to antiviral medicine.
You may take Valtrex with or without food.
Tell your doctor if a child taking this medicine cannot swallow the tablet.
Drink plenty of water while you are taking Valtrex to keep your kidneys working properly.
Lesions caused by herpes viruses should be kept as clean and dry as possible. Wearing loose clothing may help to prevent irritation of the lesions.
Store Valtrex tablets at room temperature away from moisture and heat.
What Other Drugs Will Affect Valacyclovir
Valacyclovir can harm your kidneys. This effect is increased when you also use certain other medicines, including: antivirals, chemotherapy, injected antibiotics, medicine for bowel disorders, medicine for high blood pressure, medicine to prevent organ transplant rejection, injectable osteoporosis medication, and some pain or arthritis medicines .
Other drugs may interact with valacyclovir, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.
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