Valacyclovir Web

Valacyclovir

Disclaimer: This is not medical advice. You and your physician will determine if (and potentially how) you should take Valacyclovir.

The Basics

What is valacyclovir
(generic Valtrex)?

Valacyclovir (generic for Valtrex) is a medication approved by the FDA to treat cold sores and genital herpes, which are caused by HSV-1 and HSV-2. It is also used to treat shingles (herpes zoster), which is caused by the Varicella Zoster Virus (VZV). Valacyclovir comes in 500 mg and 1000 mg tablets.

There are four different ways that herpes medications can be used to treat genital herpes (HSV-1 and HSV-2):

  1. To Treat Or Abort An Outbreak When There Are Early Symptoms (Prodrome):

For both genital and oral herpes, people can take medication when their specific prodrome tells them an outbreak is about to occur. The medication will stop an outbreak cold (often) and when it does not, it can shorten the outbreak and make it milder than it might have been otherwise.

  1. To Prevent Outbreaks When There Are No Symptoms But Outbreaks Are More Likely:

Patients also learn the life circumstances or behaviors that lead to more outbreaks. For some, a lack of sleep, increased alcohol, another illness, stress, too much sunlight, irritation, or anything that can affect one’s immunity can spur an outbreak. That means that some patients can know not just when they feel an outbreak coming on but can know when they are more likely to have an outbreak due to their circumstances. They might be under stress, having more sex therefore causing more physical irritation, drinking a bit more than they should, or missing sleep over an extended period. They will know that they should avoid those triggers and do their best to do so, but they also might want to take medication preventatively knowing they are more vulnerable at that time. Essentially they might take the medication for a week or two until the stress that is making them more susceptible to an outbreak has resolved.

  1. To Suppress Outbreaks For An Extended Period:

Another way patients can take the medication is when they know they absolutely would like to do all they can to reduce their chance of having an outbreak at a pivotal time. The classic example would be during a honeymoon but taking medication to suppress outbreaks on a daily basis can be prudent when going on vacation, starting a new job, in a new relationship, or at any time a patient feels it is how they want to approach their condition. The key is to learn everything you can. Do not worry about using the medication in the way that suits you best. It may change as your circumstances change, or as the condition changes, or even as your mind changes. Follow the guidelines and remember we are here to answer any of your questions.

  1. To Prevent Transmission to An Uninfected Partner:

One of the most important advances in herpes treatment came with the knowledge that transmission from an infected person to their uninfected partner could be reduced by the use of valacyclovir. Valacyclovir not only reduces the number of outbreaks a person experiences when using the medication every day but it reduces the number of days that someone sheds the virus asymptomatically. That results in fewer uninfected partners catching herpes. If a condom is worn and the medication used, the chances are reduced at least in half compared to using a condom alone. Fewer outbreaks and fewer episodes of shedding mean fewer people become infected.

For oral herpes (HSV-1), medications can be used to abort an outbreak. At that earliest sign that an outbreak is about to occur, take two tablets of Valacyclovir 1000 mg, for a total of 2000 mg, as the first dose. Then, 12 hours later, take 2 tablets of 1000 mg of Valacyclovir, for a total of 2000 mg, as the second and final dose. The second dose can be taken sooner than 12 hours but never before 6 hours have passed. Adequate hydration makes sure the medicine is cleared through the kidneys as it should be.

How it works?

The first highly effective medication was Acyclovir. It works in a very targeted way against Herpes DNA. In reality, there isn’t much more to a virus than its DNA and the proteins that cover it. Acyclovir attacks herpes virus DNA. DNA is made up of four repeating chemicals called nucleosides. How they are put together in a sequence determines everything, and we mean everything. It is the code of life. So, anything that stops a virus from making more of its DNA, stops the virus from making more of itself. Acyclovir is almost an identical copy of one of those nucleosides (Guanine) that makes the code of life—almost an identical copy. When acyclovir is added to the growing DNA change, it makes it impossible to add the next link in the growing chain and DNA synthesis is stopped.

One limitation was that acyclovir was limited in how much could be absorbed through the intestines. Only 20% of it was ever used by the body. This limitation was overcome by creating something called a prodrug of acyclovir. Valacyclovir was created by modifying the acyclovir molecule slightly. This makes the drug absorb much better in the digestive tract. Once absorbed, valacyclovir is converted to acyclovir in the body where it is effective at combating the herpes virus. Twice a day, or even once a day, valacyclovir works better than 3–5 times/day of acyclovir. Another drug, famciclovir, uses the same concept to help penciclovir enter the body.

Some Basics: There are several regimens available to take valacyclovir depending on whether the patient has oral herpes (cold sores) or genital herpes—and whether it is being taken to abort an outbreak, or to prevent outbreaks, or decrease the risk of transmission to an uninfected partner (suppressive therapy). It’s important to drink enough water when taking valacyclovir to ensure that the medication is cleared effectively by the kidneys.

How does it work?

The first highly effective medication was Acyclovir. It works in a very targeted way against Herpes DNA. In reality, there isn’t much more to a virus than its DNA and the proteins that cover it. Acyclovir attacks herpes virus DNA. DNA is made up of four repeating chemicals called nucleosides. How they are put together in a sequence determines everything, and we mean everything. It is the code of life. So, anything that stops a virus from making more of its DNA, stops the virus from making more of itself. Acyclovir is almost an identical copy of one of those nucleosides (Guanine) that makes the code of life—almost an identical copy. When acyclovir is added to the growing DNA change, it makes it impossible to add the next link in the growing chain and DNA synthesis is stopped.

One limitation was that acyclovir was limited in how much could be absorbed through the intestines. Only 20% of it was ever used by the body. This limitation was overcome by creating something called a prodrug of acyclovir. Valacyclovir was created by modifying the acyclovir molecule slightly. This makes the drug absorb much better in the digestive tract. Once absorbed, valacyclovir is converted to acyclovir in the body where it is effective at combating the herpes virus. Twice a day, or even once a day, valacyclovir works better than 3–5 times/day of acyclovir. Another drug, famciclovir, uses the same concept to help penciclovir enter the body.

Some Basics: There are several regimens available to take valacyclovir depending on whether the patient has oral herpes (cold sores) or genital herpes—and whether it is being taken to abort an outbreak, or to prevent outbreaks, or decrease the risk of transmission to an uninfected partner (suppressive therapy). It’s important to drink enough water when taking valacyclovir to ensure that the medication is cleared effectively by the kidneys.

 

IMPORTANT SAFETY INFORMATION

VALACYCLOVIR (GENERIC VALTREX)

What are valacyclovir tablets?

Valacyclovir tablets are a prescription antiviral medicine. Valacyclovir tablets lower the ability of herpes viruses to multiply in your body.

Valacyclovir tablets are used in adults:

  • to treat cold sores (also called fever blisters or herpes labialis)
  • to treat shingles (also called herpes zoster)
  • to treat or control genital herpes outbreaks in adults with normal immune systems
  • to control genital herpes outbreaks in adults infected with the human immunodeficiency virus (HIV) with CD4 + cell count greater than 100 cells/mm3
  • with safer sex practices to lower the chances of spreading genital herpes to uninfected partners. Even with safer sex practices, it is still possible to spread genital herpes. Valacyclovir tablets used daily with the following safer sex practices can lower the chances of passing genital herpes to your partner.
    • Do not have sexual contact with your partner when you have any symptom or outbreak of genital herpes.
    • Use a condom made of latex or polyurethane whenever you have sexual contact.

Valacyclovir tablets are used in children:

  • to treat cold sores (for children ≥ 12 years of age)
  • to treat chickenpox (for children 2 to < 18 years of age)

Valacyclovir tablets do not cure herpes infections (cold sores, chickenpox, shingles or genital herpes). The efficacy of valacyclovir tablets has not been studied in children who have not reached puberty.

What are cold sores, chickenpox, shingles and genital herpes?

Cold sores are caused by a herpes virus that may be spread by kissing or other physical contact with the infected area of the skin. They are small, painful ulcers that you get in or around your mouth. It is not known if valacyclovir tablets can stop the spread of cold sores to others.

Chickenpox is caused by a herpes virus called Varicella Zoster Virus (VZV). It causes an itchy rash of multiple small, red bumps that look like pimples or insect bites usually appearing first on the abdomen or back and face. It can spread to almost everywhere else on the body and may be accompanied by flu-like symptoms.

Shingles is caused by the same herpes virus that causes chickenpox. It causes small, painful blisters to appear on your skin. Shingles occurs in people who have already had chickenpox. Shingles can be spread to people who have not had chickenpox or the chickenpox vaccine by contact with the infected areas of the skin. It is not known if valacyclovir tablets can stop the spread of shingles to others.

Genital herpes is a sexually transmitted disease. It causes small, painful blisters on your genital area. You can spread genital herpes to others, even when you have no symptoms. If you are sexually active, you can still pass herpes to your partner, even if you are taking valacyclovir tablets. Valacyclovir tablets, taken every day as prescribed and used with the following safer sex practices, can lower the chances of passing genital herpes to your partner.

  • Do not have sexual contact with your partner when you have any symptom or outbreak of genital herpes.
  • Use a condom made of latex or polyurethane whenever you have sexual contact. Ask your healthcare provider for more information about safer sex practices.

Who should not take valacyclovir tablets?

Do not take valacyclovir tablets if you are allergic to any of its ingredients or to acyclovir. The active ingredient is valacyclovir.

Before taking valacyclovir tablets, tell your healthcare provider: About all your medical conditions, including:

  • if you have had a bone marrow transplant or kidney transplant, or if you have advanced HIV disease or “AIDS”. Patients with these conditions may have a higher chance for getting a blood disorder called thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS). TTP/HUS can result in death.
  • if you have kidney problems. Patients with kidney problems may have a higher chance of side effects or more kidney problems with valacyclovir tablets. Your healthcare provider may give you a lower dose of valacyclovir tablets.
  • if you are 65 years of age or older. Elderly patients have a higher chance of certain side effects. Also, elderly patients are more likely to have kidney problems. Your healthcare provider may give you a lower dose of valacyclovir tablets.
  • if you are pregnant or planning to become pregnant. Talk with your healthcare provider about the risks and benefits of taking prescription drugs (including valacyclovir tablets) during pregnancy.
  • if you are breast-feeding. Valacyclovir tablets may pass into your milk and it may harm your baby. Talk with your healthcare provider about the best way to feed your baby if you are taking valacyclovir tablets.
  • about all the medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Valacyclovir tablets may affect other medicines, and other medicines may affect valacyclovir tablets. It is a good idea to keep a complete list of all the medicines you take. Show this list to your healthcare provider and pharmacist any time you get a new medicine.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

How should I take valacyclovir tablets?

  • Take valacyclovir tablets exactly as prescribed by your healthcare provider. Your dose of valacyclovir tablets and length of treatment will depend on the type of herpes infection that you have and any other medical problems that you have.
  • Do not stop valacyclovir tablets or change your treatment without talking to your healthcare provider.
  • Valacyclovir tablets can be taken with or without food.If you are taking valacyclovir tablets to treat cold sores, chickenpox, shingles or genital herpes, you should start treatment as soon as possible after your symptoms start. Valacyclovir tablets may not help you if you start treatment too late.
  • If you miss a dose of valacyclovir tablets, take it as soon as you remember and then take your next dose at its regular time. However, if it is almost time for your next dose, do not take the missed dose. Wait and take the next dose at the regular time.
  • Do not take more than the prescribed number of valacyclovir tablets each day. Call your healthcare provider right away if you take too much valacyclovir tablets.

What are the possible side effects of valacyclovir tablets?

Kidney failure and nervous system problems are not common, but can be serious in some patients taking valacyclovir tablets. Nervous system problems include aggressive behavior, unsteady movement, shaky movements, confusion, speech problems, hallucinations (seeing or hearing things that are really not there), seizures and coma.

Kidney failure and nervous system problems have happened in patients who already have kidney disease and in elderly patients whose kidneys do not work well due to age. Always tell your healthcare provider if you have kidney problems before taking valacyclovir tablets.

Call your doctor right away if you get a nervous system problem while you are taking valacyclovir tablets.

Common side effects of valacyclovir tablets in adults include headache, nausea, stomach pain, vomiting and dizziness. Side effects in HIV-infected adults include headache, tiredness and rash. These side effects usually are mild and do not cause patients to stop taking valacyclovir tablets.

Other less common side effects in adults include painful periods in women, joint pain, depression, low blood cell counts and changes in tests that measure how well the liver and kidneys work. The most common side effect seen in children < 18 years of age was headache.

Talk to your healthcare provider if you develop any side effects that concern you. These are not all the side effects of valacyclovir tablets. For more information ask your healthcare provider or pharmacist.

Keep valacyclovir tablets and all medicines out of the reach of children. General information about valacyclovir tablets Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use valacyclovir tablets for a condition for which it was not prescribed. Do not give valacyclovir tablets to other people, even if they have the same symptoms you have. It may harm them.

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see the full Prescribing Information for complete safety information.

Frequently asked questions

What are the specific regimens for using valacyclovir for different purposes?

FOR GENITAL HERPES

To Treat Or Abort An Outbreak When There Are Early Symptoms (Prodrome)
Some patients use the medication to abort an outbreak. Whether oral or genital, people can take medication when their specific prodrome tells them an outbreak is on the horizon. The medication will stop an outbreak cold (often) and when it does not, it can shorten and make an outbreak milder than it might have been otherwise.

To Prevent Outbreaks When There Are No Symptoms But Outbreaks Are More Likely
Patients also learn the life circumstances or behaviors that lead to more outbreaks. For some, a lack of sleep, increased alcohol, another illness, stress, too much sunlight, irritation, or anything, in fact, that can affect one’s immunity can spur an outbreak. They know when they are more likely to have an outbreak due to their circumstances. They can avoid their triggers but they also might want to take medication preventatively knowing when they are more vulnerable. Essentially they might take the medication for a week or two until the circumstance that is making them more susceptible to an outbreak has resolved.

To Suppress Outbreaks For An Extended Period

Patients can take medication when they would like to do all they can to reduce their chance of having an outbreak. The classic example would be during a honeymoon, going on vacation, starting a new job, in a new relationship, or at any time a patient feels it is how they want to keep the chance of having an attack as low as possible.

To Prevent Transmission to An Uninfected Partner

One of the most important advances in herpes treatment came with the knowledge that transmission from an infected person to their uninfected partner could be reduced. Valacyclovir not only reduces the number of outbreaks a person experiences but it reduces asymptomatic shedding. That results in fewer uninfected partners catching herpes. If a condom is worn and the medication used, the chances are reduced at least in half compared to using a condom alone. Fewer outbreaks and fewer episodes of shedding means fewer people become infected.

FOR ORAL HERPES

To abort an outbreak at the earliest sign or symptom (Prodrome)
At that earliest sign, two tablets of Valacyclovir 1000 mg for a total of 2000 mg is taken by mouth as the first dose. Then, 12 hours later, 2 tablets of 1000 mg of Valacyclovir, for a total of 2000 mg, is taken as the second and final dose. The second dose can be taken sooner than 12 hours but never before 6 hours have passed. Adequate hydration makes sure the medicine is cleared through the kidneys as it should be.

The medication is only approved for two doses and there is no evidence for the use of medication once lesions have appeared.

How does Valacyclovir Work?

Valacyclovir works by interfering with the herpes virus’ ability to make more copies of its DNA. Since the herpes virus is basically just DNA wrapped in a protein coat, the inability to make more DNA means that the virus can’t replicate. The clinical outcome of this is that taking valacyclovir appropriately is effective at aborting outbreaks of oral and genital herpes, shortening the duration of an initial episode of genital herpes, suppressing outbreaks of genital herpes, and decreasing the risk of transmitting genital herpes to an uninfected partner.

Are there any special groups?

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 an untreated or inadequately treated condition.”

See here for other special groups, warnings, and precautions

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