Acyclovir vs Valacyclovir

What you need to know about the two most common drugs to treat herpes.

A herpes outbreak can be an unpleasant experience to deal with. Sadly, there is no cure or vaccine against the herpes simplex (HSV) or herpes zoster virus. But there are a few different medical treatment options from which you can choose.

The most common drugs to treat herpes are antivirals such as acyclovir, valacyclovir, and famciclovir. Among them, acyclovir and valacyclovir are the most frequently prescribed medications. Let’s find out how they work and what the differences between them are.

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What are Acyclovir and Valacyclovir?

When you suffer a herpes outbreak (cold sores, genital herpes or shingles) your doctor may prescribe oral medications such as acyclovir and valacyclovir.

The drugs work in a similar way by preventing HSV from replicating and spreading to control a herpes outbreak and help heal symptoms faster. They are effective against HSV-1, HSV-2 and herpes zoster.  

Both acyclovir and valacyclovir can be used for the immediate treatment of HSV outbreaks or long-term suppression therapy. Suppression therapy benefits patients who have frequent recurrences of herpes.

In addition, studies have shown that both drugs lower the risk of orally or sexually spreading the herpes simplex virus to others.

 

What is Acyclovir?

Acyclovir (aciclovir) has been around since the 1970s. It is one of the oldest herpes treatments and is also prescribed against chickenpox.

Typical dosage and duration for acyclovir depend on the severity of symptoms and whether your immune system is normal or severely compromised.

Most adults are ordered to take 200 mg of the drug 5 times a day for 5 days. Patients usually experience some relief of symptoms after 2 days, but blisters and sores can take up to 2 weeks to heal.

The medication has a half-life of 2.5 to 3.3 hours which means that the drug will stay in your system for around 24 hours.

Acyclovir is also available as a cream to heal cold sores. 

Although many doctors still prescribe acyclovir, valacyclovir is preferred for long-term management of HSV.

 

What is Valacyclovir?

Valacyclovir (valaciclovir) has been around since the 1990s. It is a pro-drug, which means it converts into its active form once inside the body. The active ingredient of valacyclovir is acyclovir.

The benefit of valacyclovir is that it has a higher bioavailability, so more of the active ingredient reaches the target organs.

Because of this, patients usually only need to take one 500 mg tablet 1 to 3 times per day, depending on the type of virus. For herpes zoster, patients take 500 mg 3 times daily.

It has the same half-life of 2.5 to 3.3 hours once converted into acyclovir.

Studies have shown that both antiviral medications are useful in suppressing genital viral shedding and reduce the frequency of genital herpes outbreaks.

 

Acyclovir versus Valacyclovir

The action, efficacy, and safety of acyclovir and valacyclovir are highly similar. Both medications are useful in treating HSV infections and minimizing the recurrence of outbreaks.

Acyclovir has been extensively tested in clinical trials and is deemed safe for long-term use and use during pregnancy. Because the active ingredient in valacyclovir is acyclovir, the same applies.

To help you decide which one to choose, here’s an overview of the two antiviral drugs:

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Both acyclovir and valacyclovir are useful for the treatment of HSV. Speak to your doctor about the best treatment option if you think you may have herpes, shingles or chickenpox.

 

References

  1. Razonable R. R. (2011). Antiviral drugs for viruses other than human immunodeficiency virus. Mayo Clinic proceedings, 86(10), 1009–1026. doi:10.4065/mcp.2011.0309
  2. Gupta, R., Wald, A., Krantz, E., Selke, S., Warren, T., Vargas?Cortes, M., … Corey, L. (2004). Valacyclovir and Acyclovir for Suppression of Shedding of Herpes Simplex Virus in the Genital Tract. The Journal of Infectious Diseases, 190(8), 1374–1381. https://doi.org/10.1086/424519
  3. Schuster, A. K., Harder, B. C., Schlichtenbrede, F. C., Jarczok, M. N., & Tesarz, J. (2016). Valacyclovir versus acyclovir for the treatment of herpes zoster ophthalmicus in immunocompetent patients. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd011503.pub2
  4. Kang, S. H., Chua-Gocheco, A., Bozzo, P., & Einarson, A. (2011). Safety of antiviral medication for the treatment of herpes during pregnancy. Canadian family physician Medecin de famille canadien, 57(4), 427–428.

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