Acyclovir (Zovirax®) vs Docosanol (Abreva®)
Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch
Difference between topical Acyclovir and Docosanol
- Docosanol (Abreva®) cream is an acceptable OTC alternative to prescription topical acyclovir (Zovirax®). The only advantage of docosanol is that it is available without a prescription.
- In practice, docosanol cream is hardly any effective than an excipient in treating cold sores4.
- In experimental research5 acyclovir demonstrated more potent antiviral activity than n-docosanol.
|• Synthetic nucleoside analogue active against herpes simplex virus (HSV)||• 22-carbon saturated aliphatic alcohol|
|• Topical cream 5%||• Topical cream 10%|
|• Treatment of recurrent herpes labialis (cold sores) in immunocompetent adults and adolescents 12 years of age and older|
|•Treatment of recurrent herpes labialis (cold sores) in immunocompetent adults and adolescents 12 years of age and older||• Treatment of recurrent herpes labialis (perioral herpes, cold sores, fever blisters).|
|• 5 times per day for 4 days.||• 5 times per day until healed (maximum 10 days)|
|Mechanism of action|
|• Acyclovir is an antiviral drug which is highly active against herpes viruses.
• Acyclovir interferes with viral DNA polymerase and inhibits the replication of virus.
|• Docosanol is not a true antiviral medication because this agent has no direct virucidal activity by itself.
• The antiviral effects of docosanol are due to its inhibition of the viral entry into the cell 3.
|• Hypersensitivity to acyclovir, valacyclovir or any component of the formulation||• Hypersensitivity to docosanol or component of the formulation|
|• Burning, stinging or other local skin reactions at the application site|
|• B||• Not available|
|• Reduces the duration of cold sores episode by one-half day1.
||• Reduces the duration of cold sores episode by one-half day1.|
|• No effects on prevention of progression of herpes lesions.|
- 1. Prescribing Information for Zovirax® (Acyclovir) PDF
- 2. Prescribing Information for Abreva® (Docosanol) PDF
- 3. Pope LE, Marcelletti JF, Katz LR, Lin JY, Katz DH, Parish ML, Spear PG. The anti-herpes simplex virus activity of n-docosanol includes inhibition of the viral entry process.Antiviral Res. 1998 Dec;40(1-2):85-94.
- 4. Docosanol: new drug. Herpes labialis: barely more effective than an excipient. Prescrire Int. 2009 Jun;18(101):106-7. PubMed
- 5. McKeough MB, Spruance SL.Comparison of new topical treatments for herpes labialis: efficacy of penciclovir cream, acyclovir cream, and n-docosanol cream against experimental cutaneous herpes simplex virus type 1 infection. Arch Dermatol. 2001 Sep;137(9):1153-8.
Published: September 20, 2018
Last reviewed: September 20, 2018
- Topical treatments for cold sores are less effective than oral antiviral medications.
- Topical medications decrease healing time and pain duration by less than a day, but require multiple daily applications.