Valacyclovir

Valacyclovir is an antiviral medicine that is used to treat herpes viruses, including oral herpes (cold sores) and genital herpes. For more information on valacyclovir see the Prescriber's Digital Reference (PDR).

Your healthcare professional will recommend dosing and instructions, but the following is a general guideline for patients with no other health issues. Taking two 1,000 mg tablets of valacyclovir at the first sign of symptoms and two more 12 hours later is recommended. Valacyclovir is not FDA approved for suppression of oral herpes. You may need to take a lower dose of valacyclovir if you have HIV or kidney disease or if you're elderly, and valacyclovir might not be safe for you at all if you have certain conditions. For HIV-infected patients, the guidelines recommend 1,000 mg of valacyclovir every 12 hours for 5-10 days. Talk to your provider about your health and always follow their instructions.

Valacyclovir should not be used if any of the following apply:
• Hypersensitivity or allergy to valacyclovir, acyclovir, famciclovir, ganciclovir, or valganciclovir
• Patients with HIV or kidney disease or dysfunction or who have had a kidney or bone marrow transplant should discuss this with their doctor before starting valacyclovir
• Pregnant and breastfeeding women should discuss the use of valacyclovir with their maternity provider

For a full list of contraindications and precautions, see the PDR. 

Please note: what follows is a summary and does not include every side effect possible.

Common side effects include headache, feeling sick, dizziness, vomiting, diarrhea, skin reaction after exposure to sunlight (photosensitivity), rash, or itching (pruritus).

Uncommon side effects include feeling confused, seeing or hearing things that aren't there (hallucinations), feeling very drowsy, tremors, or feeling agitated, shortness of breath (dyspnea), stomach discomfort, rash, sometimes itchy, hive-like rash (urticaria), low back pain (kidney pain), blood in the urine (hematuria), reduction in the number of blood platelets which are cells that help blood to clot (thrombocytopenia), reduction in the number of white blood cells (leucopenia), increase in substances produced by the liver.

Rare side effects include unsteadiness when walking and lack of coordination (ataxia), slow, slurred speech (dysarthria), fits (convulsions), altered brain function (encephalopathy), unconsciousness (coma), confused or disturbed thoughts (delirium), kidney problems where you pass little or no urine. Lastly, watch out for a severe allergic reaction (anaphylaxis). These are rare in people taking Valtrex. Anaphylaxis is marked by the rapid development of flushing, itchy skin rash, swelling of the lips, face, neck, and throat-causing difficulty in breathing (angioedema), fall in blood pressure leading to collapse. If any of these occur, get emergency treatment immediately

To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

Contact your KHLOE provider, and all of your healthcare providers, if you experience any new symptoms after beginning valacyclovir. If you have any serious signs or symptoms like, but not limited to, fever, seizures, confusion, or swelling, please seek out emergency medical treatment. 

We use telemedicine technology to allows licensed healthcare professionals to provide cold sore treatments discreetly, conveniently, and inexpensively.

It starts with your online visit. Your doctor or nurse practitioner needs to know about your health (e.g., your medications, lifestyle issues, prior surgeries) and how cold sores affect you.

They also need a personal ID so they know who they will be evaluating and treating. They will review your information, determine if you're a candidate for treatment via telemedicine and, if so they will craft a personalized treatment plan.

Your treatment plan will include a great deal of information about oral herpes. It is important you take the time to read it all. You will be better prepared to manage your condition as a partner-and not just a patient.

Providers on the KHLOE platform prescribe valacyclovir (generic Valtrex) to treat genital herpes. When used properly, this medication can abort an outbreak at the first sign that one is coming on or lessen its severity. 

Valacyclovir is associated with a number of side effects, including rare but serious side effects impacting the kidneys and nervous system. To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

Valacyclovir is safe and effective for the treatment of genital herpes. But getting treatment right requires you to dedicate the time to learn about your condition and work with your provider to craft the ideal, personalized treatment plan. When you do, you'll be able to identify your specific symptoms (prodrome) and use your medication to shorten or stop the outbreak from occurring.

Valacyclovir is associated with a number of side effects, including rare but serious side effects impacting the kidneys and nervous system. To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

Yes. Healthcare professionals can prescribe medication and help you dial in the most effective treatment plan for your unique needs.

KHLOE enables doctors and nurse practitioners to use telemedicine technologies to treat cold sores in the same way they treat patients in-person. The provider will ask you questions to evaluate your symptoms and make sure it's safe and appropriate to prescribe cold sore medication. They will use your answers to assess your condition and create a treatment plan. That's why it's vital you answer each question to the best of your knowledge and ensure that every communication with your physician is truthful, accurate, and thorough.

No.

Yes. Certain people should not take valacyclovir and others should use decreased doses of valacyclovir. Below are some important examples.

Sensitivity or Allergies: Patients with sensitivity or an allergy to any of the following medications should not use Valacyclovir: Acyclovir, Famciclovir, ganciclovir, penciclovir, valacyclovir, or valganciclovir.

Kidney Issues: Dose adjustments should be made for those with kidney impairment or issues. Decreased doses are needed as kidney impairment slows the clearing from the body of valacyclovir. The degree of impairment determines the decrease in the dosage. The PDR states, “Acute renal failure and CNS (Nervous System) toxicity have been reported in patients with underlying renal (Kidney) dysfunction who have received inappropriately high doses of valacyclovir for their level of renal (Kidney) function. Patients receiving potentially nephrotoxic (Toxic to the Kidney) drugs together with valacyclovir may have an increased risk of renal dysfunction (impairment).”

The Elderly: The elderly are more likely to have impaired kidneys so they might not clear valacyclovir from their system as efficiently as they should. This can lead to inappropriately high levels of valacyclovir, which means the elderly may need lower doses of valacyclovir. The elderly are also more likely to experience neurological side effects, including: agitation, hallucinations, confusion, delirium, and other abnormalities of brain function termed encephalopathy.

Dehydration: When patients are dehydrated acyclovir can reform as a solid in the kidney leading to kidney damage. Patients should all remain well hydrated when taking valacyclovir.

Pregnancy: While a registry that collected data on the 756 pregnancies of women exposed to acyclovir in the first trimester showed no greater occurrence of birth defects than occurs in the general population, the study size was too small to guarantee safety during pregnancy.
You should not take Valacyclovir if you are pregnant or trying to become pregnant unless recommended by your obstetrician/gynecologist or other healthcare provider.

Breastfeeding: The PDR states, “According to the manufacturer, valacyclovir should be administered to a nursing mother with caution and only when indicated. Although the American Academy of Pediatrics (AAP) has not specifically evaluated valacyclovir, systemic maternal acyclovir is considered to be usually compatible with breastfeeding...Consider the benefits of breastfeeding, the risk of potential infant drug exposure, and the risk of untreated or inadequately treated condition.”

See here for other special groups, warnings, and precautions.