Valacyclovir

Background

• Also known as Valtrex
• Prodrug of acyclovir but with easier dosing

Dosing

• HSV
  • Mucocutaneous
    • Immunocompetent
      • Initial episode: 1 g p.o. twice daily for 7 to 10 days (may be extended)
      • Recurrent episode: 1 g po. daily for 5 days
      • Suppressive therapy: 500 to 1000 mg p.o. daily
    • Immunocompromised
      • Episode: 1 g p.o. twice daily for 5 to 10 days
      • Suppressive therapy: 500 mg p.o. twice daily
  • Orolabial (cold sores)
    • Initial episode: 1 g p.o. twice daily for 7 to 10 days
    • Recurrent episode: 2 g p.o. twice daily for 2 doses
  • Prophylaxis in transplant: 500 mg p.o. twice daily
• VZV
  • Localized shingles (within 72 hours of onset): 1 g p.o. three times daily for 7 to 10 days
  • Disseminated zoster: 1 g p.o. three times daily to complete 10 to 14 days
  • Opthalmicus: 1 g p.o. three times daily for 7 days
  • Uncomplicated varicella (chickenpox) (within 24 hours of onset): 1 g p.o. three times daily for 5 to 7 days until lesions have crusted
  • Prophylaxis in transplant: 500 mg p.o. twice daily

Renal Dosing

CrCl (mL/min)	Usual Dose
	500 mg q24h	1 g q24h 500 mg q12h	1 g q12h	1 g q8h	2 g q12h x2
≥50	Usual
30 to <50	Usual			1 g q12h	1 g q12h x2
10 to <30	500 mg q48h	500 mg q24h	1 g q24h	1 g q24h	500 mg q12h x2
<10	500 mg q48h	500 mg q24h	500 mg q24h	500 mg q24h	500 mg x1