Herpes Simplex Medication

Updated: Mar 09, 2017
  • Author: Folusakin O Ayoade, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Antivirals

Class Summary

Nucleoside analogs are phosphorylated initially by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit herpes simplex virus (HSV) polymerase with 30-50 times the potency of human alpha-DNA polymerase.

Penciclovir (Denavir)

Inhibitor of DNA polymerase in HSV-1 and HSV-2 strains, inhibiting viral replication. Only topical preparations available, and they are well suited for herpes labialis (cold sores).

Acyclovir (Zovirax)

Synthetic purine nucleoside analogue with activity against a number of herpes viruses, including herpes simplex and varicella-zoster. Highly selective for virus-infected cells because of its high affinity for viral thymidine kinase enzyme. This effect serves to concentrate acyclovir monophosphate into virus-infected cells. The monophosphate then is metabolized into the triphosphate active form by cellular kinases.

Double dose is suggested for herpes simplex proctitis or ocular infections. Ocular infections also can be treated with topical acyclovir. Oral suspension available (40 mg/mL).

Valacyclovir (Valtrex)

Prodrug rapidly converted to the active drug acyclovir by intestinal and hepatic metabolism. Better absorbed than acyclovir and more expensive but has a more convenient dosing regimen.

Famciclovir (Famvir)

Prodrug that when biotransformed into active metabolite, penciclovir, may inhibit viral DNA synthesis/replication. Similarly to valacyclovir but has better bioavailability than acyclovir. Used against herpes simplex and varicella-zoster viruses.

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