Valcivir (Valacyclovir Hydrochloride)
Also sold as: Valcivir, Valtrex, Valherp, Valaciclovir (Cipla), Vacivir
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Tablet 500mg, 1000mg
Indications
- Herpes zoster (shingles) — treatment and prevention of post-herpetic neuralgia
- Genital herpes — first episode (treatment) and recurrent (episodic or suppressive)
- Herpes labialis (cold sores) — treatment and suppression
- Herpes simplex encephalitis (IV acyclovir preferred; valacyclovir for step-down)
- CMV prophylaxis in transplant recipients
Adult Dosing
Herpes zoster (shingles)
1000 mg PO TDS for 7 days
Start within 72 hours of rash onset (or until new lesions forming). Most effective when started early. Reduces viral shedding and post-herpetic neuralgia severity.
Genital herpes — first episode
1000 mg PO BD for 10 days
Genital herpes — recurrent (episodic)
500 mg PO BD for 3–5 days; start at prodrome
Start at earliest sign/symptom
Suppressive therapy (frequent recurrences ≥6/year)
500 mg PO once daily (or 1000 mg OD if ≥10 recurrences/year or HIV+)
Continuous — reassess after 12 months
Herpes labialis (cold sores)
2000 mg PO BD for 1 day (total 2 doses, 12 hours apart)
Pediatric Dosing
Oral suspension available for paediatric use
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 30–49 mL/min (shingles) | 1000 mg BD (not TDS) |
| CrCl 10–29 mL/min (shingles) | 1000 mg once daily |
| CrCl < 10 mL/min (shingles) | 500 mg once daily |
| CrCl < 30 mL/min (genital herpes) | 500 mg once daily |
Hepatic Adjustment
No dose adjustment required for mild-moderate hepatic impairment
Pregnancy & Lactation
Pregnancy: Category B
Generally considered safe in pregnancy — used for genital herpes suppression from 36 weeks (reduces neonatal herpes risk via caesarean). First-line antiviral for VZV (chickenpox) in pregnancy (life-threatening). Acyclovir registry data (valacyclovir converts to acyclovir) shows no increase in birth defects.
Lactation: Safe
Acyclovir (active metabolite) in breast milk at levels well below therapeutic — considered compatible. WHO compatible list.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Nephrotoxic drugs (NSAIDs, aminoglycosides, contrast dye) | Increased risk of acyclovir-induced nephrotoxicity — ensure good hydration | Moderate |
| Probenecid / cimetidine | Reduce renal clearance of acyclovir — elevated levels | Minor |
| Mycophenolate mofetil | Both compete for renal tubular secretion — increased levels of both | Moderate |
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Side Effects
Common
- Headache (most common)
- Nausea
- Diarrhoea
- Dizziness
- Abdominal pain
Serious / Discontinue If
- Nephrotoxicity (crystalluria — especially with high doses, poor hydration; ensure adequate fluid intake)
- Thrombotic thrombocytopenic purpura/haemolytic uraemic syndrome (TTP/HUS — rare, high doses in immunocompromised)
- Neuropsychiatric effects (agitation, hallucinations — high doses, renal impairment)
Contraindications
- Hypersensitivity to valacyclovir or acyclovir
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Valcivir 500mg | Cipla | 10 tab ₹285 |
| Valcivir 1000mg | Cipla | 10 tab ₹485 |
| Valherp 500mg | Hetero | 10 tab ₹255 |
| Vacivir 500mg | Sun Pharma | 10 tab ₹265 |
Monitoring Required
- Renal function (serum creatinine) — especially high dose, elderly, CKD
- Hydration status (high fluid intake during treatment)
- Clinical response (lesion healing, pain reduction)
- Frequency of herpes recurrences (suppressive therapy — review annually)
Patient Counseling Points
- Start as soon as possible for shingles — ideally within 72 hours of rash appearance
- Drink plenty of water throughout treatment — prevents crystals forming in kidneys
- For genital herpes suppression: take daily even without symptoms — reduces transmission risk by ~50%
- Inform partner of herpes status — condoms further reduce (but don't eliminate) transmission
- Cold sores: take both doses on the same day (2g at first sign, 2g 12 hours later)
- Valacyclovir reduces but does not eliminate herpes transmission or frequency
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Clinically reviewed by: Dr. Rajesh Kulkarni, MD (Infectious Diseases), Consultant Infectious Disease Specialist
Last reviewed: 2026-04-01
References
- IDSA Herpes Zoster Guidelines
- CDC STI Treatment Guidelines 2021
- BNF — Valacyclovir
- Acyclovir Pregnancy Registry