Infectious Disease Compendium

Valacyclovir (Valtrex®)

Dosing

CrCl Formula

CrCl > 80: 500 mg - 1 g q 8 - 12 h.

Genital herpes simplex: initial episode, 1 g po twice a day for 7 to 10 days; most effective when started within 48 hrs of signs and symptom.

Genital herpes simplex: recurrent episode, 500 mg po twice a day for 3 days, or 1 g once a day for 5 days; start within 24 hrs after onset of signs and symptoms.

Genital herpes simplex: recurrent episode, HIV-infected patient, 1 g ORALLY twice a day for 5 to 10 days.

Herpes labialis: 2 g po twice a day for 1 day; separate doses by 12 hr; start at the earliest onset of symptoms.

Recurrent genital herpes simplex, Suppression and transmission reduction: suppressive therapy: 1 g po once a day; 9 or fewer recurrences/year, 500 mg once a day .

Recurrent genital herpes simplex, Suppression and transmission reduction: reduction of transmission: 9 or fewer recurrences/year, 500 mg once a day.

Recurrent genital herpes simplex, Suppression and transmission reduction: HIV-infected patient, 500 mg po twice a day.

Herpes zoster: 1 g po 3 times a day for 7 days; start within 48 hrs of the onset of rash.

CrCl 80-50: 500 mg - 1 g q 8 - 12 h.

CrCl 50-10: q 12 - 24 h.

CrCl < 10: q 24 h.

Hemodialysis:

Peritoneal dialysis:

Important side effects

Headache, hemolytic uremic syndrome, nausea, vomiting, thrombotic thrombocytopenic purpura.

Important drug interactions

Mycophenolate mofetil.

Rants and Screeds

Pearls

Treatment of choice

Use for

Herpes simplex and zoster.

Don't use for

CMV, although it it used for prophylaxis of CMV in transplant patients.

Class