Acyclovir and alcohol

Many prescription medications can cause side effects and potetntially interact with other medication, over-the-counter drugs or substances. Drinking alcohol while taking certain drugs can increase the risk or severity of side effects, or interfere with the efficacy of the medication.

Consuming alcohol while taking medication is a choice, but it can be hard to say no to a glass of wine or a beer at a big social event.  Is it worth the risk? Let’s first take a look at what acyclovir is and what side effects it can cause. 

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What is Acyclovir?

Acyclovir is an antiviral drug used to treat infections caused by the herpes simplex virus (HSV). There are 2 types of HSV: HSV type 1 and HSV type 2.   

HSV is spread through contact with skin or bodily fluids such as saliva, vaginal secretions or semen.

Acyclovir works by suppressing the replication of viral DNA, thereby stoping the virus from spreading.

HSV 1 is the most common among the general population, and carriers may suffer outbreaks of cold sores (or fever blisters).  HSV can lay dormant however, so that some carriers who never develop outbreaks can nonetheless transmit the virus.  

HSV 2 is less common and linked to genital herpes, although HSV I can lead to genital lesions if contracted via oral sex.  

Herpes simplex lesions usually go away by themselves after 2 to 4 weeks, but many patients seek treatment to hasten recovery or suppress outbreaks, as the symptoms can be very uncomfortable.

In addition to treating or preventing herpes outbreaks, acyclovir is also prescribed for chickenpox and shingles. There is some evidence that acyclovir is an effective treatment for Bell’s palsy as well, as facial nerve paralysis may be linked to HSV infection.

How to take Acyclovir?

Acyclovir is available as 200 mg oral tablets. The exact dosage and duration of treatment will depend on how severe your symptoms are.

To treat genital herpes, individuals are usually prescribed 200 mg, 5 times a day at 4-hour intervals. The minimum duration of treatment is 5 days, but treatment can be extended if symptoms are more severe.

In patients with suppressed or compromised immune systems, a higher (400mg) dose may be prescribed.

For treating cold sores, you may be prescribed a cream that contains acyclovir. This can be applied 5 times a day for at least 4 days. Alternatively, oral acyclovir may also be prescribed at a higher dose for 24 hours only. 

Make sure you begin treatment with acyclovir as soon as you notice signs of an infection. In the case of cold sores, you may notice tingling and itching around your lips or a slight reddening of the area surrounding your mouth before blisters emerge. Early genital herpes symptoms include a tingling or itching sensation on or near your genital or anal region.

The sooner you start treatment, the faster the drug can act and speed up recovery. Patient trials have shown that acyclovir can accelerate healing of genital blisters by 1 to 2 days.

Acyclovir can also be prescribed to manage recurrent herpes outbreaks. This is referred to as suppressive therapy. Studies have shown that taking a low dose of acyclovir is safe for at least 1 year.

Acylovir will not cure HSV however, and even patients who take the drug for 5 years are likely to have recurrent outbreaks when the medication is stopped. 

Side effects of Acyclovir

Antiviral drugs are generally well-tolerated, but you may notice some mild side effects. These include:

• Headaches
• Nausea and vomiting
• Dizziness
• Diarrhea

Uncommon, but serious side effects which require urgent medical attention include:

• Skin rash, swollen skin
• Shortness of breath or wheezing
• Swelling of the lips, tongue or throat
• Chest tightness
• Confusion
• Hallucinations
• Jaundice (yellowing of the skin and eyes)

Is Drinking Safe While Taking Acyclovir?

There are no broad clinical studies that have addressed this issue, and it may be safe to drink alcoholic beverages (in moderation) while taking acyclovir.

You should however, avoid heavy drinking when taking antiviral medications for the following reasons:

• Alcohol is an immune system suppressant and HSV outbreaks often occur during times when your immune system is weak.
• Alcohol can amplify side effects. If you drink (even moderately) and take acyclovir you may feel dizzier or more nauseas for example.
• Because alcohol alters the immune response, heavy and frequent drinking could make you more prone to recurrent herpes outbreaks and other viral infections.

So, should you drink alcohol while taking acyclovir? Probably not. If you must have a glass (1-2 units) of an alcohol beverage, it’s likely safe to do so, but avoid drinking heavily or frequently.

References

1. Cernik, C. (2008). The Treatment of Herpes Simplex Infections<subtitle>An Evidence-Based Review</subtitle>. Archives of Internal Medicine, 168(11), p.1137.
2. Medicines.org.uk. (2018). Aciclovir 200 mg Tablets - Summary of Product Characteristics (SmPC) - (eMC). [online] Available at: https://www.medicines.org.uk/emc/product/4334/smpc.
3. Nato, N., Honda, N., Gyo, K., Aono, H., Murakami, S. and Yanagihara, N. (2000). Treatment of Bell’s Palsy with Acyclovir and Prednisolone. Nippon Jibiinkoka Gakkai Kaiho, 103(2), pp.133–138.
4. Tyring, S.K. (1998). A Randomized, Placebo-Controlled Comparison of Oral Valacyclovir and Acyclovir in Immunocompetent Patients With Recurrent Genital Herpes Infections. Archives of Dermatology, 134(2), p.185.
5. Baker, DA (1994) Long-term suppressive therapy with acyclovir for recurrent genital herpes. Journal of Internal Medical Research 22 (Suppl. 1): 24A–32A.
6. Szabo, G., & Saha, B. (2015). Alcohol's Effect on Host Defense. Alcohol research : current reviews, 37(2), 159–170.

Information

Reviewed by Dr Roy Kedem, MD

Information last reviewed 10/13/21

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