Cold sores

Valacyclovir (generic Valtrex®)

Quarterly plan: $14.00 / month Pay $42 every three months

An antiviral medication used to treat oral herpes caused by herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).

  • Valacyclovir is the generic form of the branded medication Valtrex®
  • FDA-approved to treat initial and recurrent outbreaks of oral herpes
  • Disclaimer: The information provided on this page is not a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns about your health, please talk to a doctor. 

Do not take valacyclovir tablets if you are allergic to any of its ingredients or to acyclovir. The active ingredient is valacyclovir. Before taking valacyclovir tablets, tell your healthcare provider about all your medical conditions. For a complete list of interactions and potential side effects, please read the risks and benefits in important safety information.

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Valacyclovir

How Valacyclovir can help you

You know your body better than anyone. And when it comes to oral herpes, your ability to recognize when an outbreak is about to occur helps you know precisely when you need treatment. Let’s explore how valacyclovir can help you catch a break from outbreaks.

I am very sensitive to the early symptoms of an outbreak.   
If you can detect your early symptoms, the medication can stop the outbreak before it happens. And if valacyclovir can’t stop the outbreak, it may reduce a more moderate outbreak than you might have had otherwise.


More on Cold Sores


Herpes Simplex Virus type 1 (HSV-1) is the virus that causes oral herpes. In very rare cases, Herpes Simplex Virus type 2 can also cause oral herpes. The transmission of oral herpes is through oral contact. From sharing a drink to a kiss, it’s pretty easy to pass along. And it’s important to note that without physical symptoms, oral herpes can still be spread. 

Seventy percent of the world’s population is infected with HSV-1, making it extremely common. And about 50% of Americans between the ages of 14-49 are living with HSV-1.

Frequently Asked Questions

What is valacyclovir?

Valacyclovir is an antiviral medicine that is used to treat herpes viruses, including oral herpes (cold sores) and genital herpes. For more information on valacyclovir see the Prescriber’s Digital Reference (PDR).

How do I use valacyclovir

Your doctor will recommend dosing and instructions, but the following is a general guideline for patients with no other health issues. Taking two 1,000 mg tablets of valacyclovir at the first sign of symptoms and two more 12 hours later is recommended. Valacyclovir is not FDA approved for suppression of oral herpes. You may need to take a lower dose of valacyclovir if you have HIV or kidney disease or if you’re elderly, and valacyclovir might not be safe for you at all if you have certain conditions. For HIV-infected patients, the guidelines recommend 1,000 mg of valacyclovir every 12 hours for 5–10 days. Talk to your doctor about your health and always follow your doctor’s instructions.

Who shouldn’t use valacyclovir?

Valacyclovir should not be used if any of the following apply:

  • Hypersensitivity or allergy to valacyclovir, acyclovir, famciclovir, ganciclovir, or valganciclovir
  • Patients with HIV or kidney disease or dysfunction or who have had a kidney or bone marrow transplant should discuss this with their doctor before starting valacyclovir
  • Pregnant and breastfeeding women should discuss the use of valacyclovir with their maternity provider

For a full list of contraindications and precautions, see the PDR

What are the potential side effects of valacyclovir?

The most common side effects include: 

  • Headache
  • Feeling sick
  • Dizziness
  • Vomiting
  • Diarrhea
  • Skin reaction after exposure to sunlight (photosensitivity)
  • Rash
  • Itching (pruritus)

Valacyclovir may also cause kidney and nervous system problems in some patients. These side effects are uncommon but can be serious. For a full list of side effects, see the PDR.

When should I contact my Rory-affiliated physician?

Contact your Rory-affiliated physician, and all of your healthcare providers, if you experience any new symptoms after beginning valacyclovir. If you have any serious signs or symptoms like, but not limited to, fever, seizures, confusion, or swelling, please seek out emergency medical treatment. 

How does cold sores treatment with Rory work?

We use telemedicine technology to allow U.S. licensed doctors to provide cold sore treatments discreetly, conveniently, and inexpensively.

It starts with your online doctor visit. Your doctor needs to know about your health (e.g., your medications, lifestyle issues, prior surgeries) and how cold sores affect you.

They also need a personal ID so they know who they will be evaluating and treating. Your doctor will review your information, determine if you’re a candidate for treatment via telemedicine and, if so they will craft a personalized treatment plan.

Your treatment plan will include a great deal of information about oral herpes. It is important you take the time to read it all. You will be better prepared to manage your condition as a partner—and not just a patient.

What are the different ways to use valacyclovir?

To Abort An Outbreak At the Earliest Sign or Symptoms (Prodrome)

Your doctor will provide dosing and instructions, but the following are generally accepted guidelines for healthy patients. At that earliest sign, take two tablets of Valacyclovir 1000 mg (for a total of 2000 mg) by mouth as the first dose. Then, 12 hours later, take 2 tablets of 1000 mg of Valacyclovir (for a total of 2000 mg) by mouth as the second and final dose. The medication is only approved for two doses and there is no evidence that medication can stop an outbreak once a lesion (sore) has appeared. The second dose can be taken sooner than 12 hours after your first dose but never before 6 hours have passed. Be sure to drink plenty of water— adequate hydration makes sure the medicine is cleared through the kidneys.

You may need to take a lower dose of valacyclovir if you have HIV or kidney disease or if you’re elderly, and valacyclovir might not be safe for you at all if you have certain conditions. For HIV-infected patients, the guidelines recommend 1,000 mg of valacyclovir every 12 hours for 5–10 days. Talk to your doctor about your health and always follow your doctor’s instructions.

What type of cold sore medication do you prescribe?

Rory-affiliated physicians prescribe valacyclovir (generic Valtrex) to treat cold sores (oral herpes). When used properly, this medication can abort an outbreak at the first sign that one is coming on or lessen its severity. 

Valacyclovir is associated with a number of side effects, including rare but serious side effects impacting the kidneys and nervous system. To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

Is cold sore medication effective?

Valacyclovir is safe and effective for the treatment of oral herpes. But getting treatment right requires you to dedicate the time to learn about your condition and work with your physician to craft the ideal, personalized treatment plan. When you do, you’ll be able to identify your specific symptoms (prodrome) and use your medication to shorten or stop the outbreak from occurring.

Valacyclovir is associated with a number of side effects, including rare but serious side effects impacting the kidneys and nervous system. To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

What are the side effects of cold sore medication?

Please note: what follows is a summary and does not include every side effect possible.

Common side effects include headache, feeling sick, dizziness, vomiting, diarrhea, skin reaction after exposure to sunlight (photosensitivity), rash, or itching (pruritus).

Uncommon side effects include feeling confused, seeing or hearing things that aren’t there (hallucinations), feeling very drowsy, tremors, or feeling agitated, shortness of breath (dyspnea), stomach discomfort, rash, sometimes itchy, hive-like rash (urticaria), low back pain (kidney pain), blood in the urine (hematuria), reduction in the number of blood platelets which are cells that help blood to clot (thrombocytopenia), reduction in the number of white blood cells (leucopenia), increase in substances produced by the liver

Rare side effects include unsteadiness when walking and lack of coordination (ataxia), slow, slurred speech (dysarthria), fits (convulsions), altered brain function (encephalopathy), unconsciousness (coma), confused or disturbed thoughts (delirium), kidney problems where you pass little or no urine. Lastly, watch out for a severe allergic reaction (anaphylaxis). These are rare in people taking Valtrex. Anaphylaxis is marked by the rapid development of flushing, itchy skin rash, swelling of the lips, face, neck, and throat—causing difficulty in breathing (angioedema), fall in blood pressure leading to collapse. If any of these occur, get emergency treatment immediately

To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

Can a doctor treat cold sores remotely?

Yes. Rory-affiliated doctors can prescribe medication and help you dial in the most effective treatment plan for your unique needs.

Rory enables doctors to use telemedicine technologies to treat cold sores in the same way they treat patients in-person. Doctors ask you questions to evaluate your symptoms and make sure it’s safe and appropriate to prescribe cold sore medication. Your doctor will use your answers to assess your condition and create a treatment plan. That’s why it’s vital you answer each question to the best of your knowledge and ensure that every communication with your physician is truthful, accurate, and thorough.

Do I need to take a photo of my cold sore outbreak?

No.

Are there any special groups that shouldn’t take valacyclovir?

Yes. Certain people should not take valacyclovir and others should use decreased doses of valacyclovir. Below are some important examples.

Sensitivity or Allergies: Patients with sensitivity or an allergy to any of the following medications should not use Valacyclovir: Acyclovir, Famciclovir, ganciclovir, penciclovir, valacyclovir, or valganciclovir.

Kidney Issues: Dose adjustments should be made for those with kidney impairment or issues. Decreased doses are needed as kidney impairment slows the clearing from the body of valacyclovir. The degree of impairment determines the decrease in the dosage. The PDR states, “Acute renal failure and CNS (Nervous System) toxicity have been reported in patients with underlying renal (Kidney) dysfunction who have received inappropriately high doses of valacyclovir for their level of renal (Kidney) function. Patients receiving potentially nephrotoxic (Toxic to the Kidney) drugs together with valacyclovir may have an increased risk of renal dysfunction (impairment).”

The Elderly: The elderly are more likely to have impaired kidneys so they might not clear valacyclovir from their system as efficiently as they should. This can lead to inappropriately high levels of valacyclovir, which means the elderly may need lower doses of valacyclovir. The elderly are also more likely to experience neurological side effects, including: agitation, hallucinations, confusion, delirium, and other abnormalities of brain function termed encephalopathy.

Dehydration: When patients are dehydrated acyclovir can reform as a solid in the kidney leading to kidney damage. Patients should all remain well hydrated when taking valacyclovir.

Pregnancy: While a registry that collected data on the 756 pregnancies of women exposed to acyclovir in the first trimester showed no greater occurrence of birth defects than occurs in the general population, the study size was too small to guarantee safety during pregnancy.

You should not take Valacyclovir if you are pregnant or trying to become pregnant unless recommended by your obstetrician/gynecologist or other healthcare provider.

Breastfeeding: The PDR states, “According to the manufacturer, valacyclovir should be administered to a nursing mother with caution and only when indicated. Although the American Academy of Pediatrics (AAP) has not specifically evaluated valacyclovir, systemic maternal acyclovir is considered to be usually compatible with breastfeeding…Consider the benefits of breastfeeding, the risk of potential infant drug exposure, and the risk of untreated or inadequately treated condition.”

See here for other special groups, warnings, and precautions.