Formulary
Valaciclovir: Indications, Dosing, Side Effects and Interactions
Valaciclovir clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Valaciclovir: Indications, Dosing, Side Effects and Interactions
Valaciclovir clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Post-exposure prophylaxis of varicella zoster infection**
- **Adult** (By Mouth): 1000 mg 3 times a day for 7 days, start course on day 7 after exposure; if the patient presents after this, the course may be started up to day 14 after exposure.
**Herpes zoster infection, treatment**
- **Adult** (By Mouth): 1 g 3 times a day for 7 days.
**Herpes zoster infection, treatment in immunocompromised patients**
- **Adult** (By Mouth): 1 g 3 times a day for at least 7 days and continued for 2 days after crusting of lesions.
**Herpes simplex, treatment of first infective episode**
- **Adult** (By Mouth): 500 mg twice daily for 5 days (longer if new lesions appear during treatment or healing is incomplete).
**Herpes simplex infections treatment of first episode in immunocompromised or HIV-positive patients**
- **Adult** (By Mouth): 1 g twice daily for 10 days.
**Herpes simplex, treatment of recurrent infections**
- **Adult** (By Mouth): 500 mg twice daily for 3-5 days.
**Treatment of recurrent herpes simplex infections in immunocompromised or HIV-positive patients**
- **Adult** (By Mouth): 1 g twice daily for 5-10 days.
**Herpes labialis treatment**
- **Adult** (By Mouth): Initially 2 g, then 2 g after 12 hours.
**Herpes simplex, suppression of infections**
- **Adult** (By Mouth): 500 mg daily in 1-2 divided doses, therapy to be interrupted every 6-12 months to reassess recurrence frequency-consider restarting after two or more recurrences.
**Herpes simplex, suppression of infections in immunocompromised or HIV-positive patients**
- **Adult** (By Mouth): 500 mg twice daily, therapy to be interrupted every 6-12 months to reassess recurrence frequency-consider restarting after two or more recurrences.
**Genital herpes, reduction of transmission (administered on expert advice)**
- **Adult** (By Mouth): 500 mg once daily, to be taken by the infected partner.
**Prevention of cytomegalovirus disease following solid organ transplantation when valganciclovir or ganciclovir cannot be used**
- **Adult** (By Mouth): 2 g 4 times a day usually for 90 days, preferably starting within 72 hours of transplantation.
**Post-exposure prophylaxis of varicella zoster infection for valaciclovir**
- **Child 2-17 years** (By mouth): 20 mg/kg 3 times a day (max. per dose 1000 mg) for 7 days, start course on day 7 after exposure; if the patient presents after this, the course may be started up to day 14 after exposure.
**Herpes zoster infection, treatment in immunocompromised patients for valaciclovir**
- **Child 12-17 years** (By mouth): 1 g 3 times a day for at least 7 days and continued for 2 days after crusting of lesions.
**Herpes simplex, treatment of first infective episode for valaciclovir**
- **Child 12-17 years** (By mouth): 500 mg twice daily for 5 days (longer if new lesions appear during treatment or healing is incomplete).
**Herpes simplex infections treatment of first episode in immunocompromised or HIV-positive patients for valaciclovir**
- **Child 12-17 years** (By mouth): 1 g twice daily for 10 days.
**Herpes simplex, treatment of recurrent infections for valaciclovir**
- **Child 12-17 years** (By mouth): 500 mg twice daily for 3-5 days.
**Treatment of recurrent herpes simplex infections in immunocompromised or HIV-positive patients for valaciclovir**
- **Child 12-17 years** (By mouth): 1 g twice daily for 5-10 days.
**Herpes labialis treatment for valaciclovir**
- **Child 12-17 years** (By mouth): Initially 2 g, then 2 g after 12 hours.
**Herpes simplex, suppression of infections for valaciclovir**
- **Child 12-17 years** (By mouth): 500 mg daily in 1-2 divided doses, therapy to be interrupted every 6-12 months to reassess recurrence frequency-consider restarting after two or more recurrences.
**Herpes simplex, suppression of infections in immunocompromised or HIV-positive patients for valaciclovir**
- **Child 12-17 years** (By mouth): 500 mg twice daily, therapy to be interrupted every 6-12 months to reassess recurrence frequency-consider restarting after two or more recurrences.
**Prevention of cytomegalovirus disease following solid organ transplantation when valganciclovir or ganciclovir cannot be used for valaciclovir**
- **Child 12-17 years** (By mouth): 2 g 4 times a day usually for 90 days, preferably starting within 72 hours of transplantation.
Cautions
Elderly (risk of neurological reactions); maintain adequate hydration (especially with high doses)
Side effects
Common or very common Diarrhoea; dizziness; headache; nausea; photosensitivity reaction; skin reactions; vomiting Uncommon Abdominal discomfort; agitation; confusion; dyspnoea; haematuria; hallucination; leucopenia; level of consciousness decreased; renal pain; thrombocytopenia; tremor Rare or very rare Angioedema; ataxia; coma; delirium; dysarthria; encephalopathy; nephrolithiasis; psychosis; renal impairment; seizure Frequency not known Microangiopathic haemolytic anaemia Side-effects, further information Neurological reactions more frequent with higher doses.
Interactions
**Other interactions (10):**
- The combination of valaciclovir with nephrotoxic medicinal products should be made with caution, especially in subjects with impaired renal function, and warrants regular monitoring of renal function.
- This applies to concomitant administration with aminoglycosides, organoplatinum compounds, iodinated contrast media, methotrexate, pentamidine, foscarnet, ciclosporin, and tacrolimus.
- Aciclovir is eliminated primarily unchanged in the urine via active renal tubular secretion.
- Following 1000 mg valaciclovir, cimetidine and probenecid reduce aciclovir renal clearance and increase the AUC of aciclovir by about 25% and 45%, respectively, by inhibition of the active renal...
- Cimetidine and probenecid taken together with valaciclovir increased aciclovir AUC by about 65%.
- Other medicinal products (including e.g.
Pregnancy
Not known to be harmful-manufacturers advise use only when potential benefit outweighs risk.
Breast feeding
Significant amount in milk after systemic administration-not known to be harmful but manufacturer advises caution.
Hepatic impairment
Manufacturer advises caution with doses of 4 g or more per day (no information available).
Renal impairment
Prescribing in renal impairment . Maintain adequate hydration. Dose adjustments Consider dose reduction. For herpes zoster , 1 g every 12 hours if eGFR 30-50 mL/ minute/1.73 m 2 (1 g every 24 hours if eGFR 10- 30 mL/minute/1.73 m 2 ; 500 mg every 24 hours if eGFR less than 10 mL/minute/1.73 m 2 ). For treatment of herpes simplex , 500 mg (1 g in immunocompromised or HIV-positive patients) every 24 hours if eGFR less than 30 mL/minute/1.73 m 2 . For treatment of herpes labialis , if eGFR 30-50 mL/minute/1.73 m 2 , initially 1 g, then 1 g 12 hours after initial dose (if eGFR 10-30 mL/minute/1.73 m 2 , initially 500 mg, then 500 mg 12 hours after initial dose; if eGFR less than 10 mL/minute/1.73 m 2 , 500 mg as a single dose). For suppression of herpes simplex , 250 mg (500 mg in immunocompromised or HIV-positive patients) every 24 hours if eGFR less than 30 mL/minute/1.73 m 2 . For reduction of genital herpes transmission , 250 mg every 24 hours if eGFR less than 15 mL/minute/1.73 m 2 . Reduce dose according to eGFR for cytomegalovirus prophylaxis following solid organ transplantation (consult product literature).
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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