Which herpes medicine is best

The benefits may be greater for those whose outbreaks tend to last longer. Also, episodic therapy has its best results when treatment begins at the very first sign of prodrome. If lesions are already present, therapy may offer little benefit.

Because the medications differ in their absorption rate and duration of effectiveness, dosages vary with episodic therapy treatment ranging from one to five pills every day for three to five days during an outbreak. Also, for some, taking an antiviral on a daily basis can prevent outbreaks altogether. While antivirals can be successful in controlling herpes symptoms, researchers also have turned their attention to the important issue of antiviral therapy and asymptomatic shedding.

Does suppressive therapy lower the risk of unrecognized herpes reactivation as well as curb recognized outbreaks? This type of study has also been done with famciclovir and valacyclovir, with similar reductions seen in both men and women.

Suppressive therapy has been studied in thousands of patients and it appears to be both safe and effective. Because the medications differ in their absorption rate and duration of effectiveness, dosages vary with suppressive therapy treatment ranging from one to two pills every day.

The antiviral medications available in pill form acyclovir, valacyclovir, famciclovir have been specifically developed for the treatment of genital herpes. However, it is not uncommon for healthcare providers to prescribe the antiviral drugs to those who have frequent or severe outbreaks of oral herpes. A recent study found valacyclovir to be effective for treating oral herpes in a one-day treatment of 2 grams taken at the first sign of a cold sore, and then again about 12 hours later.

There are two topical antiviral medications prescribed for the treatment of oral HSV symptoms: acyclovir ointment and penciclovir cream. Both work to speed up the healing process and reduce the viral activity. These topical drugs are put directly on the lesions themselves, but can also be used at the onset of prodrome. Other topical treatments for oral herpes are available over-the-counter OTC , but are not antiviral compounds like acyclovir and penciclovir.

Some to consider include:. Prescription antiviral medication is often used to treat genital herpes infection. Like the OTC antiviral cream Abreva, they inhibit the proliferation of the virus, but they do not rid the body of it. If you have a first episode or a recurrence, a short course of one of the three options available is recommended. Those with frequent episodes may need to take one of these drugs daily on an ongoing basis, which is known as suppressive therapy. Taking herpes medication when you do not have symptoms has been shown to reduce the risk of sexual transmission to a partner.

The following recommendations for adults with genital herpes are from the Centers for Disease Control CDC herpes treatment guidelines, but your healthcare provider will decide which of these options is best for you. Usually, treatment of cold sores is not needed unless the symptoms are severe and persistent, in which case acyclovir is generally used.

Alternative therapies for herpes with some supporting research include:. Several other alternative options have been investigated for the treatment or suppression of genital herpes, including lysine , zinc , echinacea , eleuthero, and bee products. There is no evidence to show that any of these options are beneficial for these purposes.

Resolve Herpes, an alternative therapy said to be a "detox therapy," is marketed for herpes. So far, there does not appear to be evidence that this product can cure or treat herpes infections. The key to successfully treating any herpes outbreak is a timely response. The sooner you recognize the signs and access treatment, the shorter and less severe the outbreak is likely to be.

Treatment should be started within 48 hours of the first appearance of symptoms. If your primary care provider is unable to see you, do not hesitate to access treatment through a telehealth provider. If you have health insurance, the visit may be partially or fully covered. If applied before a blister develops, it may reduce the duration of an outbreak to as few as two and a half days. Herpes viruses are treated with antivirals.

There are three commonly used to treat oral and genital herpes:. All three antivirals are effective in reducing the severity and duration of a herpes outbreak. However, some authorities recommend Valtrex over Zovirax for the treatment of genital herpes.

Studies have shown that, if started within 48 hours of the first appearance of lesions, antivirals can reduce the duration of oral herpes by one to two days. Although evidence on the benefits of complementary and alternative medicines for treating herpes is scant, several natural compounds have shown promise, including:.

There have been some promising trials of herpes vaccines. The primary efficacy endpoint was healing, defined by loss of crust and re-epithelialization, of the primary vesicular lesion. The secondary efficacy variables were time to healing of all vesicular lesions primary and secondary , time to return to normal skin for all lesions vesicular and aborted , and duration of pain.

Both famciclovir arms significantly decreased median time to healing of primary vesicular lesions vs. All lesions healed a median of 2. Healing time was not significantly different between the two treatment arms. Incidence of headache and nausea in the treatment groups was similar to that of placebo. Headache was experienced by 9. Nausea occurred in 2.

Efficacy of single-day famciclovir compared to single-day valacyclovir in the treatment of recurrent orolabial herpes. Rapidly absorbed and hydrolyzed into acyclovir and L-valine, valacyclovir has three to five times the bioavailability of traditional oral acyclovir Ormrod and Goa ; Spruance et al Two large double-blind, randomized, placebo-controlled studies demonstrated that 2 g of valacyclovir twice a day for 1 day single-day treatment and 2 g of valacyclovir given twice a day for 1 day followed by 1 g twice a day for 1 day 2-day treatment both significantly shortened the time to healing of cold sore lesions and duration of pain compared to placebo.

Patients initiated treatment at the first sign of prodromal symptoms and appeared in clinic within 24 hours for evaluation. The primary efficacy measure in Study 1 was the duration of the episode, measured from the start of treatment until healing, as defined by loss of crust on vesicular lesions and return to normal skin on non-vesicular lesions.

The primary efficacy measure in Study 2 was the proportion of subjects in which cold sore development was prevented. There was no added benefit in treating for 2 days vs 1 day.

Development of new lesions was decreased in the treated groups, but not to a statistically significant amount compared to placebo. These two studies show that single-day high dose 2 g bid course of valacyclovir safely and effectively reduces healing time of cold sores by an average of 1 day compared to placebo. There is no additional benefit in treating for 2 days. While clinical trials show that topical agents are efficacious, patients in the real world are unlikely to comply with the frequent dosing schedule required for optimal results, making oral antiviral agents the most convenient option for patient-initiated episodic therapy.

Although no head-to-head comparisons of orolabial herpes therapies exist, oral famciclovir and valacyclovir appear to offer similar reductions in duration of lesions and associated pain Table 3.

Mucocutaneous infections caused by herpes simplex viruses in immunocompetent patients are usually self-limiting, although their impact on patient quality of life can range from minor annoyance to severe disability. There are several well-recognized treatment strategies in existence, but single-day oral antiviral therapy for episodic treatment of recurrences is a new practice that has only recently been validated by several well-designed, large-scale clinical trials.

While there are no studies that directly compare the efficacy of different oral antivirals, available safety and efficacy data support famciclovir mg once a day or valacyclovir 2 g bid for 1 day in recurrent orolabial herpes as suitable first-line therapies for maximizing patient convenience and minimizing cost.

Likewise in recurrent genital herpes, famciclovir mg bid for 1 day appears to produce similar or better reductions in time to lesion healing and resolution of symptoms than the currently prescribed 2- to 5-day antiviral regimens. Additionally, single-day famciclovir is effective at preventing progression to a full genital herpes outbreak and is well-tolerated.

These characteristics indicate single-day famciclovir to be appropriate as a first-line therapy. Single-day treatment for recurrent orolabial and genital herpes introduces a high load of antiviral agent into the body during the time of maximal viral replication, limiting progression of disease. With single-day therapy, patients experience faster healing time, shorter duration of symptoms, while simultaneously regaining control over their disease through patient-initiated therapy.

Disclosures Dr. Tyring has conducted research and been a consultant for Novartis and GlaxoSmithKline. He has also received honoraria and grants from the same. National Center for Biotechnology Information , U. Ther Clin Risk Manag. Published online Apr. Author information Copyright and License information Disclaimer.

All rights reserved. This article has been cited by other articles in PMC. Abstract Herpes simplex virus HSV infection is a highly prevalent condition responsible for significant morbidity and occasional mortality each year. Keywords: famciclovir, genital herpes, orolabial herpes, patient-initiated episodic therapy, single-day, antiviral.

Introduction Herpes simplex virus HSV causes an incurable viral infection that affects over 40 million people in the United States, with over , cases diagnosed each year Nadelman and Newcomer Mechanism of action Activation of acyclovir and penciclovir is dependent on viral thymidine kinase found in cells infected with herpesvirus.

Selectivity After absorption, penciclovir and acyclovir are taken up into both infected and uninfected cells. Discussion Treatment options for genital herpes Acyclovir was the first antiviral agent to be used in the treatment of genital herpes, and as such, is the most extensively studied of the antiviral agents currently available.

Oral agents The current standard of therapy is oral medication. Single-day treatment Based on the recent successes of high-dose acyclovir and valacyclovir regimens and the unique pharmacokinetic profile of famciclovir, an international, multicenter, randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of single-day famciclovir as a patient-initiated treatment for recurrent genital herpes in immunocompetent patients Aoki et al Table 1 Efficacy of single-day famciclovir compared to standard 2- to 5-day antiviral regimens in the treatment of recurrent genital herpes.

Antiviral agent Dosage regimen Duration of treatment Median time days to Percentage of aborted lesions Lesion healing Symptom resolution Famciclovir mg bid vs PL 1 1 day 4.

Open in a separate window. Abbreviation: PL, placebo. Comparison of therapies Although no head-to-head trials have compared single-day famciclovir to the currently prescribed 2- to 5-day antiviral regimens, it appears to produce similar or better reductions in time to lesion healing and resolution of symptoms Table 1.

Table 2 Comparison of retail cost 1 of standard dosing of antiviral agents. Treatment options for orolabial herpes Topical agents The first antiviral agents used for the treatment of recurrent orolabial herpes were formulated in creams.

Oral agents Compared to topical treatments, oral agents offer the benefit of less frequent dosing and increased bioavailability. Single-day treatments Famciclovir Oral famciclovir given as a single mg dose was FDA approved for the treatment of recurrent orolabial herpes in immunocompetent patients after the seminal work by Spruance and coworkers in Spruance et al Table 3 Efficacy of single-day famciclovir compared to single-day valacyclovir in the treatment of recurrent orolabial herpes.

Valacyclovir Rapidly absorbed and hydrolyzed into acyclovir and L-valine, valacyclovir has three to five times the bioavailability of traditional oral acyclovir Ormrod and Goa ; Spruance et al Comparison of therapies While clinical trials show that topical agents are efficacious, patients in the real world are unlikely to comply with the frequent dosing schedule required for optimal results, making oral antiviral agents the most convenient option for patient-initiated episodic therapy.

Conclusion Mucocutaneous infections caused by herpes simplex viruses in immunocompetent patients are usually self-limiting, although their impact on patient quality of life can range from minor annoyance to severe disability. Footnotes Disclosures Dr. Single-day, patient-iniated famciclovir therapy for recurrent genital herpes: a randomized, double-blind, placebo-controlled trial.

However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to acyclovir.

Do not let anyone else take or use your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Acyclovir pronounced as ay sye' kloe veer. Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow?

What should I do if I forget a dose? What side effects can this medication cause? What should I know about storage and disposal of this medication? Brand names Other names. To use buccal acyclovir, follow these steps: Find the area on the upper gum above your left and right incisor teeth the teeth just to the left and right of your two front teeth. With dry hands, remove one delayed-release tablet from the container.