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What Is the Best Treatment for Oral Herpes?

by Dr. Sharon Orrange on June 6, 2013 at 3:27 pm

It’s estimated there are 100 million episodes of oral herpes annually, so imagine the money we spend on herpes medications. Much of what I’m going to tell you will surprise you. Many patients with herpes lesions of their lips and mouth use topical creams or ointments to treat their sores. Turns out, they don’t work so well and they cost a lot. There is a lot going on here that you need to know.

What about topical herpes treatments?

Topical creams and ointments like Zovirax (acyclovir) and Denavir (penciclovir) are available and have been studied for oral herpes (herpes labialis). Turns out they don’t work so well, are really expensive and usually require frequent daily applications.

Now, there is a new topical medication for oral herpes that was just approved which may hold more promise, at a cost I’m sure. Sitavig is different and comes in a tablet you place on the gum which delivers a high concentration of acyclovir directly to the lip, the site of the cold sore infection. Sitavig used just once lessened healing time compared to doing nothing. The reason this is exciting is that previous studies show that antiviral creams and ointments are of moderate benefit at best. This is true for topical acyclovir, Denavir, and the over the counter medication Abreva.

So, what are you telling me?

Antiviral pills are your best choice for the treatment of oral herpes. They are more reasonably priced and work better. Antiviral therapy with acyclovir, famciclovir (Famvir), or valacyclovir (Valtrex) hastens the healing of lesions if treatment is initiated in the early stage. No studies compare the three, so think about which one is easier to take and at the best price.

Evidence shows that starting antiviral therapy with one of these three medications at the very start of a herpes outbreak on your mouth is your best chance to relieve pain and shorten the outbreak:

  Acyclovir (200 or 400 mg five times daily for five days)

  Famciclovir (750 mg twice daily for one day or 1500 mg as a single dose)

  Valacyclovir (2 g twice daily for one day)

Single-day dosing with either famciclovir or valacyclovir is more convenient, and may have an overall lower cost compared to five days of acyclovir.

Cleared up?

Dr O.

Depending on the dose, 25 pills of acyclovir (available as a capsule or a tablet) typically cost about $12 – $20, though some pharmacy generic discount programs have it available for less. Famciclovir runs about $20 and under for the 1500 mg dose (three 500 mg tablets), and from $20 – $25 for the 750 mg doses (two sets of one 500 mg tablet and one 250 mg tablet). Valacylovir may be the best combination of price and convenience in some cases, at around $15 at some pharmacies for the four 1 g tablets required for a full course.
All are typically considered Tier 1 prescriptions by insurance, meaning you’ll pay only your lowest copay.


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