More on Herpes Drugs
Comparison of Herpes Antiviral Drugs
Herpes Medications
Acyclovir (Zovirax) Medical Facts
Acyclovir (Zovirax) versus Other Medications
Valacyclovir (Valtrex) Medical Facts
Valacyclovir (Valtrex) versus Other Medications

Antiviral Medications For Herpes Treatment And Prevention

Antiviral medications

Antiviral medications are used to prevent or treat herpes infections, they stop the growth of the herpes simplex virus. Antiviral medications may significantly lessen the severity of a primary outbreak and reduce the time it takes genital herpes outbreaks to heal. The medication also decreases the number of days of painful symptoms and for some people, the number of days you can spread the virus.

Currently, there is no cure for herpes. However, there are three antiviral medications approved by the Food and Drug Administration (FDA) for the treatment of herpes: Zovirax® (acyclovir), Famvir® (famciclovir), and Valtrex® (valacyclovir). In the US antiviral medications are only available by prescription.

The drugs differ in their chemical structure, how often you take them, price and FDA licensed indications. (Yuo should know that not every area where a drug is effective receives an FDA indication.)

How do antiviral medications work?

All three drugs disrupt the process by which the virus makes copies of itself and spreads to new cells. They do this by inhibiting an enzyme that the virus has but human cells do not and then interrupting the viruses' ability to synthesize DNA. None of the therapies cures the viral infection. HSV-1 and HSV-2 will remain dormant in the body in the nerve ganglia.

Effectiveness of antiviral medications

Antiviral medications may:

  • Lessen the severity of a primary outbreak
  • Reduce the time it takes for herpes outbreak to heal
  • Decrease the number of days you can spread the virus
  • Reduce the frequency and duration of recurrent outbreaks by 70% to 80%

The effectiveness of the acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) are equal in studies done so far.

Why antiviral medications are used

Antiviral medications are indicated for:

  • treatment of initial genital herpes
  • treatment of recurrent genital herpes
  • chronic suppressive therapy of recurrent genital herpes
  • reduction of transmission of genital herpes
  • treatment of cold sores (herpes labialis)
  • acute treatment of herpes zoster (shingles)
  • treatment of chickenpox (varicella)

Acyclovir (Zovirax®)

Acyclovir was the first successful drug for genital herpes and was originally licensed in the early 1980s for the treatment and suppression of genital herpes. It is sold under the brand name Zovirax® but is now available as a generic from many manufacturers and is by far the cheapest of the available antivirals. Acyclovir is a safe and extremely well-tolerated drug.

The Acyclovir in Pregnancy Registry has documented prenatal exposures in more than 850 women (with 578 first-trimester exposures) without any adverse outcomes. However, the total number of pregnancies monitored to-date may not be enough to detect defects that occur only infrequently.

The topical form of acyclovir (Zovirax ointment) offers little benefit in the treatment of genital herpes and is not recommended.

Valaciclovir (Valtrex®)

Valacyclovir, a new antiviral agent. Valacyclovir is a prodrug converted to acyclovir in the intestine and liver. It has an oral bioavailability three to five times greater than that of acyclovir. Some people have called it intravenous acyclovir in pill form.

The better absorption allows less frequent dosing. Valacyclovir has the advantage of once-daily dosing.

Valtrex, when taken daily (suppressive therapy) by a person with recurrent genital herpes, can reduce the risk of transmission to a partner.

Famciclovir (Famvir®)

Famciclovir, another new antiviral medication, is the oral form of penciclovir, a purine analog similar to acyclovir. The drug is quickly converted to its active form. Mechanism and efficacy are similar to those of acyclovir.

This was the second drug FDA approved for the treatment of genital herpes. Famciclovir has also been shown to be effective for both episodic and suppressive therapy of genital herpes. Difference dosages are used for different treatment goals.

Famciclovir, despite its favorable intracellular pharmacokinetics, must be given twice daily to be effective.

Safety Issues

A large volume of research suggests that the medications are safe and have few or no side effects. These medications have never been noted to cause any long-term side effects.

All three antivirals mentioned earlier are Pregnancy Category B.

All these drugs can have renal toxicity, and their dosage schedules must be reduced in patients with renal failure.

Brief comparison table
 
  Acyclovir (Zovirax®) Valacyclovir (Valtrex®) Famciclovir (Famvir®)
FDA approval date December 15, 1995
Pharmaceutical Forms 200 mg, 400 mg, 800 mg tablets
oral, injected, and topical
500 mg, 1000 mg caplets 125 mg, 250 mg, 500 mg tablets
Activity against herpes simplex virus types 1 (HSV-1) and 2 (HSV-2)
varicella-zoster virus (VZV)
herpes simplex virus types 1 (HSV-1) and 2 (HSV-2)
varicella-zoster virus (VZV)
herpes simplex virus types 1 (HSV-1) and 2 (HSV-2)
varicella-zoster virus (VZV)
FDA approved indications for genital herpes - treatment of initial genital herpes
- treatment of recurrent genital herpes
- chronic suppressive therapy for recurrent genital herpes
- treatment of initial genital herpes
- treatment of recurrent genital herpes
- chronic suppressive therapy for recurrent genital herpes
- reduction of transmission of genital herpes
- treatment of recurrent genital herpes
- chronic suppressive therapy for recurrent genital herpes
Most common side effects nausea
vomiting
diarrhea
headache
nausea
vomiting
dizziness
abdominal pain
headache
nausea
diarrhea
fatigue
abdominal pain
Less common side effects headache
malaise
renal failure
dysmenorrhea
arthralgia
renal failure
vomiting
dysmenorrhea
flatulence
migraine
renal failure
Bioavailability 10% - 20% 55% 77%
Major route of elimination Mainly renally excreted unchanged Renal Renally excreted
Pregnancy Pregnancy Category B Pregnancy Category B Pregnancy Category B
Generic avalability Yes No No