Adult Dosing
Herpes labialis (cold sores)
Genital herpes
- Initial episodes: 1 g PO bid x 10 days; start within 48-72 hrs of onset
- Recurrent episodes: 500 mg PO bid x 3 days; start within 24 hrs of first sign or symptom
- Suppressive therapy of recurrent genital herpes:
- Immunocompetent patients: 1 gram PO daily; Alt: 500 mg PO daily if 9 or less recurrences/year
- Immunocompromised adults: 500 mg PO bid
- Reduction of transmission: 500 mg PO daily for source partner
Herpes zoster (shingles)
- 1 g PO tid x 7 days; start within 48-72 hrs of onset
Pharyngitis (Acute) [Non-FDA Approved]
- 500 mg PO bid x 3 days, or 1000 mg qd x 5 days
Pediatric Dosing
Herpes labialis (cold sores) Valtrex
- Child
12 yrs: 2 g PO bid x 1 day; begin therapy with symptoms onset
Chickenpox
- Child 2 -<18 yrs: 20 mg/kg PO tid x 5 days. Max: 1 g/dose; 3 g/day
[Outline]
Renal Dose Adjustment (Based on CrCl)
Treatment of Herpes labialis (Do not exceed 1 day of treatment)
- 50 mL/min: 2 g PO bid
- 30-49 mL/min: 1 g PO bid
- 10-29 mL/min: 500 mg PO bid
- <10 mL/min: 500 mg PO daily
Treatment of Initial episodes of genital herpes
- 50 mL/min: 1 g PO bid
- 30-49 mL/min: No reduction
- 10-29 mL/min: 1 g PO daily
- <10 mL/min: 500 mg PO daily
Treatment of Recurrent genital herpes
- 50 mL/min: 500 mg PO bid
- 30-49 mL/min: No reduction
- 10-29 mL/min: 500 mg PO daily
- <10 mL/min: 500 mg PO daily
Chronic suppressive therapy of recurrent genital herpes
- Immunocompetent adults:
- 50 mL/min: 1 g PO daily
- 30-49 mL/min: No reduction
- 10-29 mL/min: 500 mg PO daily
- <10 mL/min: 500 mg PO daily
- Immunocompetent adults with 9 or fewer recurrences per year:
- 50 mL/min: 500 mg PO daily
- 30-49 mL/min: No reduction
- 10-29 mL/min: 500 mg PO q48 hrs
- <10 mL/min: 500 mg PO q48 hrs
- Immunocompromised adults:
- 50 mL/min: 500 mg PO bid
- 30-49 mL/min: No reduction
- 10-29 mL/min: 500 mg PO daily
- <10 mL/min: 500 mg PO daily
Treatment of herpes zoster
- 50 mL/min: 1 g PO tid
- 30-49 mL/min: 1 g PO bid
- 10-29 mL/min:1 g PO daily
- <10 mL/min: 500 mg PO daily
Note: Patients on hemodialysis should receive the recommended dose of valacyclovir after dialysis
Hepatic Dosing Adjustment
- Hepatic impairment: No dose adjustment
- Fatal thrombotic thrombocytopenic purpura/hemolytic uremic syndrome may occur in immunocompromised patients on valacyclovir therapy
- Fatal renal failure may occur. Adjust dose while administering in patients with renal impairment
- Caution should be exercised when administering valacyclovir to patients receiving potentially nephrotoxic drugs
- Maintain adequate hydration to avoid precipitation of acyclovir in renal tubules
- Adverse reactions related to CNS like agitation, hallucinations, confusion, delirium, seizures and encephalopathy have been reported with valacyclovir use in patients with underlying renal disease
- Cautiously administer in elderly patients with renal impairment
Cautions: use cautiously in
- Renal impairment
- Dehydration
- Concommitant nephrotoxic agent use
- Advanced HIV disease
- Geriatric population
Pregnancy Category:B
Breastfeeding: The dosage of valacyclovir in breast milk averages less than 1% of a typical neonate dosage and thus would not be expected to cause any adverse effects in breast fed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 30 May 2011). Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Valtrex 1 GM TABS [Bottle] (GLAXO SMITH KLINE)
30 gm = $365.99
90 gm = $1050.46 - Valtrex 500 MG TABS [Bottle] (GLAXO SMITH KLINE)
30 mg = $235.98
90 mg = $660
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
