• See Also
  1. Acyclovir
  2. Famciclovir
  • Indications
  1. Herpes Zoster (Shingles)
  2. Genital Herpes (initial, recurrent or prophylaxis)
  3. Herpes Labialis (Oral Herpes)
  • Mechanism
  1. See Acyclovir
  • Dosing
  1. Herpes Labialis (Cold Sores)
    1. Adults (and age >12 years): 2 grams orally every 12 hours for 1 day (2 doses)
  2. Herpes Zoster (Shingles)
    1. Adult: 1 gram orally three times daily for 7 days
  3. Genital Herpes
    1. Initial: 1 gram orally twice daily for 10 days
    2. Recurrent
      1. Take 500 mg orally twice daily for 3 days (FDA approved) OR
      2. Take 1000 mg orally daily for 5 days (off label)
    3. Prophylaxis (for up to 1 year)
      1. Immunocompetent (<9 episodes/year): 500 mg orally daily
      2. Immunocompetent (9 or more per year): 1000 mg orally daily
      3. HIV with CD4>100: 500 mg orally twice daily
  4. Chicken Pox (immunocompetent)
    1. Age 2 to 12 years: 20 mg/kg/dose (max 1000 mg) orally three times daily for 5 days
  5. Renal Dosing
    1. Reduce dose if eGFR <50 ml/min
  • Adverse Effects
  1. Nausea or Vomiting
  2. Headache
  3. Dizziness
  4. Thrombotic Thrombocytopenic Purpura (rare)
    1. Has been associated with very high doses (8 g/day)
  • Safety
  1. Pregnancy Category B
  2. Considered safe in Lactation
  • Resources
  1. Valacyclovir Tablet
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f8e0d8f8-cb73-4206-a484-88f5c4fbd719
  • References
  1. (2013) Med Lett Drugs Ther 11(127): 19-30 [PubMed]