Valtrex dosing?

[danawhite]

Hello,

I recently started taking 500mg/daily as a suppressive treatment. I've had HSV-2 for 11 years, but have never taken Valtrex suppressively. My doctor put on the instructions to take 2x500mg pills twice daily for outbreaks. Everything I've read online suggests this should only be the dose for the initial outbreak. I've read recurrent outbreaks should only be dosed at 500mg twice daily. What have you been recommended? Did my doctor make a mistake?

I thought maybe I felt an outbreak coming on so I started taking the 1000mg twice daily as he wrote on the label, as well as 1000mg Lysine 3x daily. My stomach has not been feeling great since. I haven't taken Valtrex in quite some time, but this dose seems like it is too high?

I can't even talk to my doctor over the phone. I'd have to make an appointment to go in to see him again...

[mr_hopp]

Hi @danawhite, that dosage is in alignment with what I've seen. (And this is just as peer-to-peer info; I'm no doctor.) However, when Valtrex is used as daily suppressive therapy, it should only be *once* per day, not twice. You only take Valtrex 2x/day for 3 days for episodic treatment (when you're having an outbreak to lessen the severity of the outbreak). FYI, Acyclovir for daily suppressive therapy is twice daily (once in the morning, once at night). 

Also, as far as the stomach stuff goes, are you taking it after you've eaten something? Don't take on an empty stomach. 

Here are some reputable sources to check out:

• This article from NIH talks about taking 500mg daily of valacyclovir (Valtrex) brings down the chance of passing it to your partner by around 50%: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687913/
• Similarly on the CDC website: https://www.cdc.gov/std/treatment-guidelines/herpes.htm#:~:text=Treatment with valacyclovir 500 mg daily decreases the rate of HSV-2 transmission for discordant heterosexual couples in which a partner has a history of genital HSV-2 infection (also shows helpful "recommended regimens" sections)

[danawhite]

7 hours ago, mr_hopp said:

Hi @danawhite, that dosage is in alignment with what I've seen. (And this is just as peer-to-peer info; I'm no doctor.) However, when Valtrex is used as daily suppressive therapy, it should only be *once* per day, not twice. You only take Valtrex 2x/day for 3 days for episodic treatment (when you're having an outbreak to lessen the severity of the outbreak). FYI, Acyclovir for daily suppressive therapy is twice daily (once in the morning, once at night). 

Also, as far as the stomach stuff goes, are you taking it after you've eaten something? Don't take on an empty stomach. 

Here are some reputable sources to check out:

• This article from NIH talks about taking 500mg daily of valacyclovir (Valtrex) brings down the chance of passing it to your partner by around 50%: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687913/
• Similarly on the CDC website: https://www.cdc.gov/std/treatment-guidelines/herpes.htm#:~:text=Treatment with valacyclovir 500 mg daily decreases the rate of HSV-2 transmission for discordant heterosexual couples in which a partner has a history of genital HSV-2 infection (also shows helpful "recommended regimens" sections)

 

Yes, 500mg/daily for suppression.

I think you may have misread my post regarding the outbreak dosing. The instructions say to take 2x500mg pills, twice daily. This is a total of 4 pills (2000mg). Everything I read online says it should be 500mg twice daily (total of 1000mg/day).

I may need to see my doctor again, but I think this is wrong.

[mr_hopp]

Ah, I thought you saying 2x500 twice a day meant just taking 500mg twice a day! Sorry, I indeed misread. 1000mg twice a day is definitely not right for daily suppressive therapy. To suppress, Valtrex should only be once daily @ 500mg (only once because Valtrex has a longer half-life, so it stays in the body longer than other meds like acyclovir).

What your doctor prescribed seems to be the same regimen that is usually suggested for an initial outbreak, which should only be followed for the first 10 days. So definitely talk to them about it for clarification on what a/he is prescribing to you. 

Good luck and let us know how it goes!

[danawhite]

He prescribed 500mg once daily for suppression. I believe this is correct. But he wrote on the bottle to take 2x500mg twice daily for outbreaks (2000mg daily) for 5 days. This is the part that I'm questioning. Shouldn't it be 500mg twice daily (total 1000mg) and for only 3 days, not 5?

[mr_hopp]

That’s the correct dose for suppression using Valtrex. And you’re correct about episodic treatment: Valtrex 500 mg orally 2 times/day for 3 days (per CDC link above)