Dosage for HSV2 Suppressive Therapy

[JohnB5000]

Standard-dose valaciclovir is usually 500mg daily for suppressive therapy - but the benefit of higher doses seems significant. Is a higher dosage worth the risk of side effects or complications? Are there any drawbacks to as much as a 3g daily dose over the long term?

The study below showed greater reduction of viral shedding using valaciclovir 1 g three times daily (43% reduction in frequency vs. standard dosage).

This would be highly suggestive of a significant further reduction in transmission risk - but shedding frequency reduction does not equate to reduced acquisition risk in a linear way . . . is there a way to estimate what benefit the reduced shedding at this higher dosage might have on transmission risk (all else equal)?

Thanks in advance.


-------------------
Study published 1/5/12 in The Lancet indicated: "shedding was less frequent in the high-dose valaciclovir group than in the standard-dose valaciclovir group (164 [3·3%] vs 292 [5·8%]; 0·54, 0·44—0·66). The number of episodes per person-year did not differ significantly for standard-dose valaciclovir (22·6) versus high-dose aciclovir (20·2; p=0·54), and standard-dose valaciclovir (14·9) versus high-dose valaciclovir (16·5; p=0·34), but did for no medication (28·7) and standard-dose aciclovir (10·0; p=0·001). . . 80% of episodes were subclinical in all study groups. Except for a higher frequency of headaches with high-dose valaciclovir (n=13, 30%) than with other regimens, all regimens were well tolerated."

"Short bursts of subclinical genital HSV reactivation are frequent, even during high-dose antiherpes therapy, and probably account for continued transmission of HSV during suppressive antiviral therapy. More potent antiviral therapy is needed to eliminate HSV transmission."

Study:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961750-9/fulltext

[Life360_Dave]

This is recommended dose by a very experienced person as terri warren.

[JohnB5000]

Thank you - Is is safe to assume that there is no adverse effect (aside from cost) from the higher dosage?

[Life360_Dave]

Hi, per terri warren, an expert in herpes recommends 1000 mg once a day for people who have 10 or more outbreaks per year and 500 mg once a day for people who have 9 or fewer per year and doses are taken every day.