What's the maximum dose of Valtrex you can safely take?

[Cliff]

A couple of weeks ago I felt a herpes outbreak coming on, but did not take any Valtrex at the time, (UK doctor recently took me off maintenance therapy, that I have pretty much been on since my HIV diagnosis).  Unfortunately, this outbreak seems worse than normal.  For a week now, I've been taking Valtrex, 5 to 6 pills a day (I think that's 2.5-3 grams/day) with no significant change.  I'd like to take more to get this under control.  How much Valtrex can you safely take?  Is there any likelihood the virus is now resistant to Valtrex?

[gerry]

Max dose in people with normal kidney function is 3 g/day (which is usually the shingles dose);  HSV outbreak dose is generally 1 g twice daily.

[Robert]

I use Acyclovir (Zovirax) that's proscribed at 3 or 4 times/day, if needed.  They're 400mg tablets so I guess that's 4 grams, right?  I needed them a few weeks ago and after the 1st day they cleared right up.

robt

[fearless]

Cliff,
For shingles you normally take 2 tablets 3 times a day - 6 500mg tablets = 3g per day.

I'm not sure that upping the dose now will help much. I know with shingles that you really need to start the Valtrex within the first 72 hours for it to be of much use as this is when the virus is most active.

From memory it is the same with herpes, you need to strike early to stop the virus in its active phase. You may have missed the boat this time. I did this with my first outbreak, not realising it was herpes, so the outbreak lasted for about 3-4 weeks and was very very intense.

[Robert]

Clif:

Whenever I'm about to break out with herpes, I know it.  My penis just starts to itch along the side.  It's a very unique itch and from past experience I know exactly what it is.  Fortunately, I have a bottle full of  acyclovir (from May 04) and the minute I feel that itch, I'm taking the pills.  Within 24 hours, it's gone.

robert

[Rob P]

anyone ever get shingles blisters on the sole of the foot?  I can handle the leg pain and burning, but the foot blisters are driving me NUTS.
I sit with my leg proped and ice packs on the bottom of my foot.  What happens when the blisters pop?   OUCH

Taking Valtrex 1gram 3x a day and it's been almost 48 hours

[Luke]

With herpes, my attitude is maintenance or nothing. Treating an outbreak that has already started never seems have any noticeable effect at all; whereas, for me, I have never had a single outbreak whilst I have been on a maintenance regime.   

Out of interest, why did you doctor stop you taking it as a preventative?

[Ann]

Rob,

I've never heard of someone getting herpes on their foot. However, a blistery rash on the soles of the feet and/or palms of the hands could be secondary syphilis. I'd get your feet checked out by a doctor if I were you.

Ann

[risred1]

I spoke to my doctor about Valtrex as a possible treatment for HIV. The theory is that suppressing one virus might assist the body in fighting HIV.

However, the thought at Penn Hospital is that is at best a temporary treatment and that resistance to Herpes is indeed a possibility.

The idea of daily dose of Valtrex might be considered somewhat dubious. Long term results for folks with HIV may not have been studied. And with many folks, outbreaks subside with time.

I would do exactly what Anne said, and get to the doctor. Folks with HIV who are sexually active should be screened regularly for all testable STD's. I have a good friend who was suffering vision problems and it was later uncovered that he had syphilis, which behaved more aggressively and unusually because he is HIV positive. His doctor didn't test immediately because the symptoms were not indicative of syphilis, and it took him over a year to fully recover his vision.

So if your not responding to Valtrex, best to get professional advice as soon as possible.

[Ann]

I would do exactly what Anne said, and get to the doctor. Folks with HIV who are sexually active should be screened regularly for all testable STD's. I have a good friend who was suffering vision problems and it was later uncovered that he had syphilis, which behaved more aggressively and unusually because he is HIV positive. His doctor didn't test immediately because the symptoms were not indicative of syphilis, and it took him over a year to fully recover his vision.

Ris, I was directing my comments to Rob, who said he has blisters on his feet, which is a classic symptom of secondary syphilis. I once had a sensitivity reaction to an athlete's foot cream, which caused blisters on my feet. My doc insisted we test for syphilis, just to be safe. It wasn't syphilis, thank goodness. I stopped using the cream and the blisters went away.

I should have quoted Rob when I answered him. Sorry!

anyone ever get shingles blisters on the sole of the foot?  I can handle the leg pain and burning, but the foot blisters are driving me NUTS.
I sit with my leg proped and ice packs on the bottom of my foot.  What happens when the blisters pop?   OUCH

Taking Valtrex 1gram 3x a day and it's been almost 48 hours

[Ann]

Cliff,

I went off my prophylactic daily acyclovir once, and the outbreaks I subsequently had were horrendous - like yours, they seemed worse than "normal". It's like the herpes came back with a vengeance once it was no longer being suppressed and, like yours, it didn't seem to want to respond to the meds. I went back on the daily dose and haven't had any problems since then.

I had a long discussion with Tim Horn years ago, when I was first thinking of going the prophylactic route. I was worried about resistance, but he reassured me that it's very rare - pretty much unheard of. My only regret is that I didn't start sooner.

Ann

[Luke]

Exactly the same here, Ann.

When I had been on acyclovir for a year I stupidly decided, without first speaking to my doctor, to see how I got on without it. Within a month I had the most viscous outbreak I've ever had. Treating the outbreak had no effect at all.

I spoke to my doctor about it afterwards and he pretty much said that this was exactly what he would expect and that he wouldn't even consider suggesting dropping the prophylaxis until I had been free of outbreaks for at least 3 years.

He also explained that whilst those on prophylaxis can, and regularly do, develop a limited resistance to acyclovir; the resistance isn't such that it tends to affect its effectiveness in suppressing herpes when used as a daily prophylaxis.

risred, Valtrex is only a prodrug version of acyclovir, which has been used extensively by HIV-positive patients for as long as any antiretrioviral drug has (in fact, it is an antiretroviral in its own right).

[Ann]

risred, Valtrex is only a prodrug version of acyclovir, which has been used extensively by HIV-positive patients for as long as any antiretrioviral drug has (in fact, it is an antiretroviral in its own right).

Thanks for catching that, Luke, and making me go back and re-read Risred's post because...

And with many folks, outbreaks subside with time.

That's not usually true in people who also have hiv. I had herpes for seventeen years before hiv and the outbreaks did indeed subside to maybe one or two mild ones a year - until I became positive. Within a year or two of having hiv, I started getting more and more outbreaks until they were happening pretty much every two weeks and were getting increasingly bigger, more painful and longer-lasting. That's when I took the plunge and started prophylaxis. I know many other pozzies who had similar experiences.

Ann

[risred1]

I've been fortunate enough to to have my attacks reduce according to the "normal" pattern and rarely have an outbreak.

As it is a proper anti-viral, resistance, which is rare, is something that is in the back of the mind of at least some, and therefore should be used according to the need of the patient.

I have used valtrex for occasional outbreaks and it has worked well for me. My confusion with how its being promoted for daily use is linked to the fear based marketing plan for the product to induce folks to take it daily to prevent transmission.

Even rare resistance can ultimately be a real problem for all if the mutation is transferable. A non treatable virus ultimately can be a real cause of concern.

What you and your doctors decide ultimately should be custom to your needs of course. My intent is to share my conversation with my doctor and reflects the consensus thoughts of the U of P hospital. The question I asked my doctor was the connection to reports that using Valtrex may lower VL of HIV. Perhaps my doctors concerns were simply in that light, and not about treating chronic issues with Herpes. For that I apologize for not being clearer.

And as for screening "more regularly" for STD's, simply seems like good advice, as infections may take on non typical behavior patterns, or act more aggressively, or create environments for other infections to become more pronounced.

[natthai]

anyone ever get shingles blisters on the sole of the foot?

I think I had it on my foot but on the top not the sole. It came at the same time as a cold sore on my lip, was about the same size (very small). It didn't hurt but it looked almost identical to the oral sore. It took about a week longer than the oral sore to clear up. It hasen't returned.