Dosing may vary depending indication and if patient is immunocompetent versus immunocompromised.Therapy should be initiated as soon as possible (ideally 72 hr) after diagnosis of herpes zoster, or at first sign or symptoms of an outbreak of oral or genital herpes (tingling, itching, burning).
Herpes Zoster (Shingles)Genital Herpes (Initial)Genital Herpes (Recurrence)Herpes Labialis (Cold Sores) Immunocompetent: 1000 mg PO q8h x 7 days
Immunocompromised: 1000 mg PO q8h x 7-14 days depending on distribution and severity of lesions. May require initial treatment with IV acyclovir.1000 mg PO q12h x 7-10 days
Severe disease in immunocompromised patients may require initial treatment with IV acyclovir or extended duration of therapy if lesions slow to resolveImmunocompetent: 500 mg PO q12h x 3 days
Immunocompromised: 1 g twice daily for 7 to 10 days
Severe disease in immunocompromised patients may require initial treatment with IV acyclovir2000 mg PO q12h x 2 doses
Immunocompromised: 1 g PO twice daily for 5 to 10 days
CrCl Greater Than 50 mL/minCrCl 30-49 mL/minCrCl 10-29 mL/minCrCl Less Than < 10 mL/min1000 mg q8h1000 mg q12h1000 mg q24h500mg q24h
CrCl Greater Than 30 mL/minCrCl 10-29CrCl Less Than 10 mL/min1000 mg q12h1000 mg q24h500 mg q24h
CrCl 30 mL/min or moreCrCl Less Than 30 mL/min500 mg q12h500 mg q24h
CrCl Greater Than 50 mL/minCrCl 30-49 mL/minCrCl 10-29 mL/minCrCl Less Than 10 mL/minIntermittent Hemodialysis (HD), Peritoneal Dialysis2000 mg q12h x 2 doses1000 mg q12h x 2 doses500 mg q12h x 2 doses500 mg single doseDose for CrCL less than 10 mL/min
Give dose after dialysis session for HD patients
For the treatment of herpes zoster (shingles).
For the treatment or suppression of genital herpes in immunocompetent individuals and for the suppression of recurrent genital herpes in HIV infected individuals.
To reduce the risk of transmission of genital herpes with the use of suppressive therapy.
For the treatment of cold sores (herpes labialis).
Acute kidney injury
Increased AST and ALT
CNS effects (agitation, hallucinations, confusion and encephalopathy)
Thrombotic Thrombocytopenia Purpura/Hemolytic Uremic Syndrome (TTP/HUS)
No clinically significant interactions have been identified. Screen drug specific interactions for interactions via CYP 1A2 and pharmacodynimc adverse effects.
Increased risk of nephrotoxicity when used concomitantly with other nephrotoxic agents.
EH Prescribing Restrictions
Tablets can be crushed for NG administration
No liquid formulation available
ValACYclovir is a prodrug of the antiviral acyclovir.
ValACYclovir is rapidly and nearly completely converted to acyclovir