Valacyclovir 500mg
Cold Sores Treatment Plan
Daily therapy to suppress outbreaks and reduce the risk of transmission to an uninfected partner
Not a Ro member yet? Learn more about valacyclovir here.
How to use your treatment
Your Ro-affiliated healthcare provider has prescribed 500 mg valacyclovir to prevent cold sore (oral herpes) outbreaks. Take one pill (500 mg) daily to reduce the frequency of outbreaks and reduce the chance of transmitting the virus to an uninfected partner.
If you continue to experience cold sore outbreaks even when using your medication, reach out to your Ro-affiliated healthcare provider. They may be able to adjust your dose so it’s more effective.
Below, we’ll cover who shouldn’t use this medication, potential interactions with your medication, potential side effects, as well as how to handle those side effects, what to do if you are not getting the results you expected from your treatment, and the follow up plan for ongoing treatment. If you have any questions or concerns, please reach out to your Ro-affiliated provider or to our Care team at [email protected]
Treatment Info
Side Effects
Valacyclovir 500 mg daily is typically well tolerated. Some people who use this medication may report headaches. Other common side effects can include: nausea, abdominal pain, dizziness, vomiting, diarrhea, skin reaction after exposure to sunlight (photosensitivity), rash, or itching. Let your Ro-affiliated healthcare provider know if these symptoms do not resolve on their own.
Rarely, people using valacyclovir report feeling confused, seeing or hearing things that aren’t there (hallucinations), feeling very drowsy, tremors, or feeling agitated and these side effects are typically more common in people with reduced kidney function. Additional uncommon side effects include shortness of breath, stomach pain, rash, sometimes itchy, hive-like rash, low back pain, or blood in the urine. If you experience any of these symptoms, stop your medication immediately and seek urgent medical attention.
IMPORTANT: If you are experiencing any unusual side effects, please reach out to your Ro-affiliated provider. If you are experiencing a medical emergency, seek immediate medical attention or call 9-1-1. Symptoms such as chest pain, shortness of breath, severe headache, fainting, visual changes, or any other severe side effect warrant a visit to the ER.
Contraindications, treatment interactions, and warnings
Allergic reactions: If you have ever had an allergic reaction to valacyclovir, or similar medications such as acyclovir, famciclovir, ganciclovir, penciclovir, or valganciclovir, do not use this medication. If you take this medication and experience the following symptoms, they may be a sign of an allergic reaction and require immediate medical attention: flushing, itchy skin rash, swelling of the lips, face, neck, and throat causing difficulty in breathing, or loss of consciousness. If you experience these symptoms, stop using your medication and seek immediate medical attention.
Let your Ro-affiliated healthcare provider know if you have any kidney issues, including kidney failure or kidney transplant, as this can require a dosage adjustment. Also, tell your provider about any and all medications and supplements you are taking since these treatments can influence how valacyclovir affects your body. When taking valacyclovir, it’s important to stay hydrated as dehydration can result in kidney damage.
The medication has been prescribed to you only. Do not share your medication with other people, especially not children or infants. Keep this and all medications out of reach of children.
You should not take valacyclovir if you are pregnant or trying to become pregnant, unless recommended by your obstetrician/gynecologist or other healthcare provider. Let your healthcare provider know if you are nursing as the medication may enter the breast milk. Your provider can determine if the benefits of treatment outweigh any potential risks.
If you have a history of HIV, or if you have ever received a bone marrow or kidney transplant, tell your Ro-affiliated healthcare provider, since these circumstances can increase the risk of a condition called TTP/HUS (thrombotic thrombocytopenic purpura/hemolytic uremic syndrome).
Let your healthcare provider know if you have recently received or plan to soon receive the Varicella Zoster (chickenpox/shingles) vaccine or MMR (measles/mumps/rubella) vaccine, or any other live attenuated vaccine as valacyclovir can make these important preventative treatments less effective.
To learn more about valacyclovir (Valtrex) for the treatment of cold sores, you can explore the PDR (Physicians Drug Reference) website here.
What to do if you’re not getting the results you expected
The goal of suppressive treatment with valacyclovir for cold sores is to prevent outbreaks and reduce the chance of transmission to an uninfected partner. The dosage you’ve been prescribed, 500 mg daily, is typically prescribed to people who have 9 or fewer outbreaks per year. If you feel an outbreak starting, contact your Ro-affiliated healthcare provider to understand if you should adjust your treatment. If you find that the medication does not reduce the frequency of your outbreaks, your Ro-affiliated healthcare provider can adjust your treatment accordingly (either by adjusting your dose or by changing your dosing regimen when you feel an outbreak coming on).
How to know if an outbreak is starting
While symptoms can be different for everyone, there are a number of symptoms that people with cold sores typically describe right before an outbreak appears, which is known as a prodrome. These can include: tingling, itching, pain, redness or numbness on your lip, nose or the area of your face where the outbreak typically appears. Use our guide to learn more about identifying outbreaks.
How to avoid infecting a partner with herpes
The first step to avoiding infecting a partner with cold sores is to avoid contact as soon as you notice the prodrome starting. Avoid contact when the sores appear, too. Keep in mind that even if you are not experiencing a prodrome or an outbreak, there can still be asymptomatic viral shedding, which is when the virus is contagious even when you aren’t symptomatic.
Avoid kissing and oral sex during and around outbreaks. Check out our guide to sex with herpes.
Another thing to keep in mind is that even if a person has never had an outbreak, they still might carry the herpes virus. Estimates say that between 50-80% of adults in the United States have oral herpes but only about 1 in 3 people have outbreaks.
Taking daily suppressive therapy with 500 mg valacyclovir has been shown to reduce asymptomatic viral shedding and therefore the risk of transmission to an uninfected partner. Still, remember that outbreaks and viral shedding can still occur so discuss your status with any new partner, and if outbreaks continue to occur, reach out to your Ro affiliated provider to discuss adjusting your treatment regiment.
Other steps you can take to avoid outbreaks
Some people find that there are certain behaviors or factors that can trigger a cold sore outbreak. These can include excessive sun exposure, stress, lack of sleep, dry lips, as well as hormonal changes (like getting your period). Some people find that alcohol can also precipitate an outbreak. Try to keep track of the things that happen around the time of your outbreaks to see if a pattern emerges. Use our guide to learn more about what causes herpes outbreaks.
Identifying avoidable triggers may help curb outbreaks. For example, if sunlight is a trigger, try wearing a hat when outdoors and use a lip balm with SPF. Using additional treatments like Abreva (docosanol) which is available over-the-counter at the first sign of an outbreak may also be beneficial at reducing the intensity and duration of a cold sore outbreak.
Next steps
In about three months, we’ll reach out to ask how you’re doing with your medication. If you have any questions or concerns before then, be sure to reach out to us either through the chat with your provider or by sending an email to [email protected].