Question about Suppression

[hope]

I have been on 500mg of Valtrex once a day for six and a half years. For six years, it worked just fine. I only had 1 outbreak every 1 1/2 years or so. However, I had a child in late 2014, and my outbreaks have not been the same. I have had 2 in the last 6 months (while on suppression) and the location of the outbreaks has changed. I have an appointment with my doctor, but would like some information before I go in.

Is 1g or 1000mg an okay dosage for suppression therapy? If so, is it better to take 1g once a day or 500mg twice a day? Will I ever be able to go back down to 500 mg a day or once I start 1g a day, will that be forever?

Also, can someone become resistant to valtrex like an antibiotic or is this change in my outbreaks just due to the overwhelming stress of childbirth and all the changes that go with it?

[Terri Warren]

It is fine to increase your dose to 1 gram per day, thought you may do better with 500 mg twice a day (morning and night) to keep you antiviral levels more even with fewer peaks and valleys. The first FDA approved dose of Valtrex was 1 gram and the 500 mg dose was a secondary approval.

Resistance is really rare and it occurs at equal rates in people who have taken antiviral therapy and who have not, so I would not be too concerned about this.

It’s hard to say what your future with this might be in terms of recurrences, I think it will just have to play out and see what happens, but it is not unusual, in my experience, for hormone changes to impact outbreak frequency. By the way, 400 mg of acyclovir twice per day has been shown to work as well as 500 mg of Valtrex once a day, so if money is at all an issue, the acyclovir is way cheaper.

Terri

[hope]

Thank you! Just a couple of follow-ups–

If I do need to be on 1000mg of Valtrex a day, what would the acyclovir equivalent be? Four times a day?

Also, currently, if I have an outbreak while on 500 mg, I take 1000mg for five days to stop the outbreak. If I go up to 1000mg a day, what would I do if I had an outbreak? Go up to 1500 or 2000?

Thank you so much for your insight. I can’t tell you how helpful this is. My doctor is understanding and tries to give me good information, but he just isn’t as knowledgeable about all this as you are!

[Terri Warren]

I think 400 mg of acyclovir three times a day would be the approximate equivalent.

The recommendation for treatment of cold sores with valacyclovir is 2 grams, then 12 hours later, 2 grams again for one day. I personally like that dose for people who feel an outbreak coming on or first notice it. It’s a big hit and we find it to be very effective. It can be repeated the next day if needed. These are not genital herpes FDA approved doses, for the record, just doses that our practice has found to be very effective.

Glad the forum is helpful for you.

Terri

[Author]

Posts