2002 https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2RydWcvdmFsdHJleC12YWxhY3ljbG92aXItMzQyNjMx

Diseases & Conditions The efficacy and safety of VALTREX have not been established in immunocompromised patients other than for the suppression of genital herpes in HIV-1−infected patients. FDA-approved dosage adjustments in adults: CrCl 50 mL/min and higher: No dosage adjustment needed.



The dosage of Valtrex is 2000 mg four times a day, to be initiated as early as possible post-transplant. 1 g PO q8hr for 7 days (no data on efficacy if started 72 hours after rash)Recurrent episodes: 500 mg PO q12hr for 3 days (no data on efficacy if started >24 hours after lesion onset)Suppressive therapy (immunocompetent patients): 1 g/day POSuppressive therapy (immunocompetent patients with ≤9 recurrences annually): 500 mg/day PO; transmission reduction for source partner, 500 mg/day POSuppressive therapy (HIV-infected patients): 500 mg PO q12hr>2 years: 20 mg/kg PO q8hr for 5 days; not to exceed 1 g PO q8hr Monitor renal function; dosage may have to be adjusted, depending on renal statusThrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) reported in patients with advanced HIV disease and in allogenic bone marrow transplant and renal transplant recipientsAcute renal failure (ARF) may occur, especially in elderly patients or those with underlying renal impairment receiving higher than recommended doses; use with caution in patients with renal impairment, the elderly, and/or patients receiving nephrotoxic drugsTreatment should begin with the earliest symptom (tingling, burning, itching) in cold sores; for genital herpes, it should begin at the first signs and symptoms (within 72 hours of onset of first diagnosis or 24 hours of onset of recurrent episodes); for herpes zoster, it should begin within 72 hours of onset of rash; for chicken pox, it should begin with the earliest sign or symptomCentral nervous system (CNS) effects may occur (eg, agitation, hallucinations, confusion, encephalopathy); risk of CNS adverse effects is higher in elderly patientsAdequately hydrate patient; decreased precipitation in renal tubules may occurClinical data over several decades with valacyclovir and its metabolite, acyclovir, in pregnant women, have not identified a drug associated risk of major birth defects; there are insufficient data on use of valacyclovir regarding miscarriage or adverse maternal or fetal outcomes; there are risks to fetus associated with untreated herpes simplex during pregnancyCo-infection with HSV increases risk of perinatal HIV transmission in women who had a clinical diagnosis of genital herpes during pregnancyAlthough there is no information on presence of drug in human milk, its metabolite, acyclovir, is present in human milk following oral administration of drug; based on published data, a 500-mg maternal dose twice daily would provide a breastfed child with an oral acyclovir dosage of approximately 0.6 mg/kg/day; there is no data on effects of drug on breastfed child or on milk productionConsider developmental and health benefits of breastfeeding along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal conditionA: Generally acceptable.
Valacyclovir and acyclovir can be considered close cousins as they are chemically similar.Read on for the details about how effective suppressive therapy is and how it can affect transmission rates.

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This website also contains material copyrighted by 3rd parties. 2002 Suppression of recurrences of herpes simplex virus (HSV) infections in adults and adolescents (≥12 years) Immunocompetent Adults and Adolescents (≥12 years) The dose is 500 mg of Valtrex to be taken once daily.

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