Westover Heights Clinic - Medications

Antiviral Therapy

There are now three antiviral medicines available in the US: acyclovir, Valtrex and Famvir. All three drugs work equally well when taken as directed. There may, however, be compliance advantages for medicines requiring less frequent dosing. There are also signficant differences in price.  The antivirals may be taken in one of three ways:

• First outbreak therapy
• Episodic therapy (taking of medication with outbreaks only)
• Suppressive therapy (taking medicine every day). 

The first two uses of these drugs attempt to shorten the length and severity of a specific outbreak. Taking medication with outbreaks, either first or future ones, has not been shown to impact future recurrence rates of herpes.  It also does nothing to reduce the frequency of outbreaks nor the transmission to sex partners.  It may be the most appropriate choice for people who are not bothered by the frequency of their outbreaks, has a partner who is already infected with their same type, or a person who has herpes, is not bothered by outbreaks, and does not have a sexual partner.

The third use of these drugs, for suppression of outbreaks (i.e., to prevent outbreaks from coming), is recommended for anyone who has frequent outbreaks, who is bothered by their outbreaks, or who has an uninfected partner. Studies with these drugs have found that 80-90% of the people who take the drug for suppression have greatly reduced frequency of outbreaks or do not have outbreaks while taking the drug. The virus is still present in the body, and after the drug is stopped, the outbreaks and shedding come back to a regular level. While the risk of asymptomatic shedding is significantly reduced by these medicines, it is not stopped altogether.

acyclovir (generic)
This anti-viral medication was first FDA approved as a topical treatment for first-time outbreaks. The topical form of the medicine was shown to shorten the first outbreak very slightly, but had no effect on recurrent disease, and the topical form has no place in the treatment of recurrent genital herpes.
Oral acyclovir is indicated for use in one of three ways:

First time outbreaks: 400 mg three times a day for 7-10 days.
Recurrences: 400 mg three times a day for 5 days or 800 mg three times a day for two days.
Suppression: 400 mg twice a day, every day.

Acyclovir is also available for intravenous use in babies and adults for whom more aggressive treatment is necessary.  It is available in a liquid form for people who have difficulty swallowing pills.

Valtrex (valacyclovir)
This FDA approved medicine may be used for first outbreaks, recurrent outbreaks and suppression and is also approved to reduce transmission of genital herpes from an infected person to an uninfected one.

First time outbreaks: 1000 mg twice a day for ten days.
Recurrent outbreaks: 500 mg twice a day for three days.
Suppression: 1000 mg once a day for people who have 10 or more outbreaks per year. 500 mg once a day for people who have 9 or fewer outbreaks per year.

Famvir (famciclovir)
This antiviral medication has been FDA approved for recurrent disease and suppression. The FDA has not approved Famvir for first episode treatment, though the CDC does describe a dosing regimen for this purpose:
First time outbreaks:  250 mg three times a day for ten days.
Recurrent outbreaks: 1000 mg twice a day, 12 hours apart, for one day
Suppression: 250 mg twice a day every day.