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Valacyclovir

KEY POINTS

  • Valacyclovir (Valtrex) is an antiviral agent and pro-drug that is converted to acyclovir in vivo by intestinal and hepatic metabolism
    • Works by inhibiting DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase
  • Can be used for herpes simplex virus (HSV) 1 or HSV-2, cytomegalovirus (CMV) and varicella zoster virus (VZV)
  • Only available oral and doses can range from 500mg to 2gm given between one and four times per day, depending on the indication
    • Dosing with valacyclovir is less frequent and therefore more convenient as compared to acyclovir
    • Requires dose adjustment for renal dysfunction but not for hepatic dysfunction
    • Comes as 500mg and 1000mg tablets for oral administration
    • Intravenous acyclovir is the injectable counterpart to oral valacyclovir
  • In general it is best to begin therapy when tingling, itching or burning starts (i.e., before visual manifestations)
  • Adverse effects may include…
    •  CNS effects (e.g., headache, agitation, confusion, delirium, seizures), particularly in elderly patients
    • Renal toxicity
      • Best to drink plenty of water when taking valacyclovir
    • Thrombotic thrombocytopenia purpura / hemolytic uremic syndrome
    • Hepatic effects such as increased liver enzymes (AST/ALT)
    • Nausea and abdominal discomfort
  • Pregnancy category B

RESOURCES

  • Valacyclovir Package Insert
  • 2015 CDC STD Guideline
  • IDSA Practice Guidelines




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