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Acyclovir , Zovirax®
Nucleoside Analog DNA Polymerase Inhibitor. M.W. 225.2.

  • Initial Genital Herpes Simplex * [1]:
     400 mg orally three times a day for 7 -10 days
         OR
    200 mg orally 5 times a day for 7 -10 days .
  • Suppressive Therapy for Recurrent Genital Herpes [1]
    400 mg orally twice a day
  • Episodic Therapy for Recurrent Genital Herpes [1]
    400 mg orally three times a day for 5 days
    OR
    800 mg orally twice a day for 5 days
    OR
    800 mg orally three times a day for 2 days
  • Daily Suppressive Therapy in Persons with HIV [1]
    400 to 800 mg orally 2 to 3 times a day
  • Episodic Infection in Persons with HIV [1]
    400 mg orally three times a day for 5 -10 days
  • Suppressive Therapy of Pregnant Women with Recurrent Genital Herpes [1,2]
    400 mg orally three times a day starting at 36 weeks gestational age and taken until delivery.
  • Severe Disease (complicated disease -e.g. disseminated infection, pneumonitis, hepatitis, meningitis or encephalitis) [1]
    5–10 mg/kg  IV every 8 hours for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy HSV encephalitis requires 21 days of intravenous therapy..

* Treatment may be extended if healing is incomplete after 10 days.
Adjust dose in patients with acute or chronic renal impairment

(200, 400, 800 mg tablets; 200 mg /5 mL suspension -Bottle of 1 pint -473 mL)
For full prescribing information see  Acyclovir package insert. Teva Pharmaceuticals USA Inc 1/2015
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f0d8278e-f521-451b-9093-16571eccd284

Breastfeeding : "Even with the highest maternal dosages, the dosage of acyclovir in milk is only about 1% of a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. " LACTMED 12/12/2015

 

Valacyclovir (Valtrex®)
 Nucleoside Analog DNA Polymerase Inhibitor M.W. 324.3 .After oral administration, valacyclovir hydrochloride is rapidly absorbed from the gastrointestinal tract and nearly completely converted to acyclovir  

  • Genital Herpes Initial Episode* [1]:
    1 gram orally twice a day  for 7-10 days. Therapy is most effective when administered within 48 hours of the onset of signs and symptoms.
  • Suppressive Therapy for Recurrent Genital Herpes[1]:
    500 mg orally once a day **
    OR
    1 gram orally once a day
  • Episodic Therapy for Recurrent Genital Herpes [1]:
    500 mg orally twice a day for 3 days
    OR
    1 gram orally once a day for 5 days
  • Daily Suppressive Therapy in Persons with HIV [1]
    500 mg orally twice a day
  • Episodic Infection in Persons with HIV [1]
    1 gram orally twice a day for 5-10 days
  • Suppressive Therapy of Pregnant Women with Recurrent Genital Herpes [1,2]
    500 mg orally twice a day from 36 weeks gestation and taken  until delivery
  • Cold Sores (Herpes Labialis) :
         2 grams orally every 12 hours for one day. Therapy should be initiated at the earliest symptom of a cold sore.

* Treatment may be extended if healing is incomplete after 10 days.

** Valacyclovir 500 mg once a day might be less effective than other valacyclovir or acyclovir dosing regimens in persons who have very frequent recurrences
Adjust dose in patients with acute or chronic renal impairment

(500 mg, 1 gram caplets)
For full prescribing information see Valtrex package insert GlaxoSmithKline 12/2013. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f8e0d8f8-cb73-4206-a484-88f5c4fbd719

Breastfeeding

REFERENCES
 1. Workowski KA, Bolan GA; Centers for Disease Control and Prevention.Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137. PMID: 26042815
2. Management of herpes in pregnancy. ACOG Practice Bulletin No. 82. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007; 109:1489–98PMID: 17569194
3. Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 9th edition,Baltimore, MD: Williams & Wilkins,2011 p 1083 -84,1596 -1597 , 19 -23,1533 -15354.
4.Kang SH,et al., Safety of antiviral medication for the treatment of herpes during pregnancy.Can Fam Physician. 2011 Apr;57(4):427-8. PMID:21490353

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