Valacyclovir

Adults: Varicella zoster virus (VZV) infections, herpes zoster: Patients should start treatment as soon as possible after a diagnosis of herpes zoster, since there are no data on treatment started more than 72 hours after the zoster rash appears. In immunocompetent adults, the dose is Valacyclovir 1000mg (1 Valacyclovir 1000mg tablet) three times daily for 7 days, giving a total daily dose of 3000mg. In immunocompromised adults, the dose is Valacyclovir 1000mg (1 Valacyclovir 1000mg tablet) 3 times daily for at least 7 days, again a total daily dose of 3000mg, continued for 2 days after the lesions have crusted over. In immunocompromised patients, antiviral treatment is recommended for those presenting within one week of vesicle formation or at any point before the lesions have fully crusted. For treatment of herpes simplex virus (HSV) infections in adults and adolescents aged 12 years and older who are immunocompetent, the dose is Valacyclovir 500mg (1 Valacyclovir 500mg tablet) taken twice daily, for a total daily dose of 1000mg; this dose should be reduced according to creatinine clearance. Recurrent episodes should be treated for 3 to 5 days, while initial episodes, which can be more severe, may need treatment extended to 10 days. Dosing should begin as early as possible, and for recurrent episodes of herpes simplex this is ideally during the prodromal period or as soon as the first signs or symptoms appear, since Valacyclovir can prevent a lesion from developing if taken at that point. For herpes labialis (cold sores), an effective treatment in adults and adolescents is Valacyclovir 2000mg (2 Valacyclovir 1000mg tablets) twice daily for one day, with the second dose taken about 12 hours (no sooner than 6 hours) after the first; this dose should also be reduced according to creatinine clearance. With this regimen, treatment should not continue beyond one day, since going longer has not been shown to give any extra benefit, and therapy should be started at the earliest symptom of a cold sore, such as tingling, itching or burning. In immunocompromised adults, the dose for herpes labialis is Valacyclovir 1000mg (1 Valacyclovir 1000mg tablet) twice daily for at least 5 days, with the duration guided by an assessment of how severe the condition is and the patient's immune status; initial episodes, which can be more severe, may need treatment extended to 10 days. Dosing should begin as early as possible and be reduced according to creatinine clearance, and for the best clinical benefit treatment should start within 48 hours, with the lesions monitored closely as they evolve. For suppression of recurrent herpes simplex virus (HSV) infections in immunocompetent adults and adolescents aged 12 years and older, the dose is Valacyclovir 500mg (1 Valacyclovir 500mg tablet) once daily. Patients with very frequent recurrences, 10 or more a year without therapy, may get extra benefit from splitting this into 250mg twice daily instead. Treatment should be reviewed after 6 to 12 months. In immunocompromised adults, the dose for suppression is Valacyclovir 500mg (1 Valacyclovir 500mg tablet) twice daily, again reviewed after 6 to 12 months. For prophylaxis of cytomegalovirus (CMV) infection and disease in adults and adolescents aged 12 years and older, the dose is Valacyclovir 2000mg (2 Valacyclovir 1000mg tablets) four times a day, started as early as possible after transplant and reduced according to creatinine clearance. Treatment usually lasts 90 days, though this may need to be extended in patients at high risk.