Valacyclovir is an antiviral medication used to treat infections caused by the herpes simplex virus. This includes genital herpes, cold sores, shingles, and chickenpox. Valacyclovir works by stopping the virus from multiplying and spreading throughout the body. For people with frequent outbreaks of genital herpes or cold sores, taking valacyclovir daily can help reduce the number of outbreaks and speed up healing when an outbreak does happen. But do you really need to take it every day for the rest of your life? Here is an overview of who might benefit from daily suppressive therapy with valacyclovir and for how long it might be recommended.
Who Might Benefit from Daily Valacyclovir
Taking valacyclovir every day is most commonly recommended for people who experience very frequent or severe outbreaks of genital herpes or cold sores. Typical dosing is once or twice per day. Some examples of people who may benefit from daily suppressive therapy include:
- Those with >6 outbreaks of genital herpes per year
- Those with frequent, painful cold sore outbreaks
- Those who find outbreaks very psychologically distressing
- Those with less than 1 month between outbreaks
- Those with a first episode of genital herpes that lasts longer than 1 month
- Pregnant women to reduce risk of transmission to the baby
Suppressive therapy has been found to reduce the number of outbreaks by 75-80% in people with frequent recurrences. It may also decrease asymptomatic viral shedding, which is when the virus is active but not causing symptoms.
How Long to Take it – Short Term or Long Term Suppression
For those who benefit from daily valacyclovir, there are two main approaches:
- Short-term suppressive therapy – Taking valacyclovir daily for a set period of time, such as 6-12 months. This may be recommended to get outbreaks under control.
- Long-term suppressive therapy – Taking valacyclovir daily on an ongoing, long-term basis, possibly for life. This is for people who continue to have >6 outbreaks per year after the initial period of short-term therapy.
Short-term daily therapy for 6-12 months is often initially recommended to get severe, frequent outbreaks under control. After this initial period, the number and severity of outbreaks some experience may then decrease on its own without needing to continue daily medication.
For others, outbreaks remain frequent after stopping daily therapy. These individuals may be advised to continue suppressive therapy long-term. Some may only need ongoing therapy during certain periods of life, while others may be told they need to take it every day moving forward.
When Daily Therapy May Be Stopped
For those taking daily valacyclovir long-term, reassessment with a healthcare provider is recommended every 6-12 months. In some cases, daily therapy may be able to be stopped at a certain point. This may occur if:
- Outbreaks decrease in frequency/severity substantially with long-term daily therapy
- Medication side effects are troublesome
- The patient prefers to stop
If after stopping daily therapy outbreak frequency increases again, restarting daily suppressive therapy may then be warranted.
Considerations and Precautions
Things to know about taking daily valacyclovir include:
- May reduce risk of transmitting herpes to partners when no outbreaks are present.
- May decrease local immune response where outbreaks occur, leading to worse outbreaks when medication is stopped.
- Side effects are usually mild but may include headaches, nausea, abdominal pain.
- Long-term safety data is limited, but major concerns have not emerged.
- Does not eliminate herpes virus from the body.
- Resistance to acyclovir is rare but can occur, especially in those with poor immune function.
- More expensive than episodic treatment but may be cost-effective if >6 outbreaks per year.
Bottom Line
While some people may need to take valacyclovir daily for life, this is not always the case. Shorter or intermittent regimens may be equally effective for some. It comes down to an individual’s frequency and severity of outbreaks, side effects, costs, and preferences. If considering long-term therapy, it is reasonable to try discontinuing for 3-6 months every few years to reassess if continuous treatment is still needed.
Frequent follow-up with a healthcare provider allows assessment of whether the benefits continue to outweigh the risks and costs. Examining the goals of therapy and periodically stopping treatment for reevaluation are important when determining the need for lifelong daily antiviral therapy.
References
Here are some references used as sources for this article:
- Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137.
- Jackson L, Auguste P, Low N, Roberts TE. Valaciclovir versus aciclovir for herpes simplex prophylaxis in HIV-positive patients: a randomised trial. Int J STD AIDS. 1997;8(9):564-568. doi:10.1258/0956462971919845
- Posavad CM, Wald A, Kuntz S, et al. Frequent reactivation of herpes simplex virus among HIV-1-infected patients treated with highly active antiretroviral therapy. J Infect Dis. 2004;190(4):693-696. doi:10.1086/422458
- Strand A, Patel R, Wulf HC, Kwasny M. Aborted genital herpes simplex virus lesions: findings from a randomised controlled trial with valaciclovir. Sex Transm Infect. 2002;78(6):435-438. doi:10.1136/sti.78.6.435
- Tan DH, Raboud JM, Kaul R, Walmsley SL. Antiviral prophylaxis in the management of herpes simplex virus in HIV-positive patients: a systematic review and meta-analysis. AIDS Res Ther. 2011;8:41. Published 2011 Oct 27. doi:10.1186/1742-6405-8-41
