Concurrent Use of Acyclovir Cream and Valacyclovir Tablets

Introduction to Treatment Guidelines

The American College of Physicians and other medical societies recommend that topical antiviral therapy is substantially less effective than systemic therapy for herpes simplex virus infections, and therefore, the combination of acyclovir cream and valacyclovir tablets provides minimal additional benefit 1

Systemic therapy alone, such as valacyclovir tablets, is the standard of care for all HSV infections requiring treatment, whether genital herpes, oral herpes, or herpes zoster, as recommended by the Centers for Disease Control and Prevention 1, 3
The combination of acyclovir cream and valacyclovir tablets adds unnecessary cost without improving clinical outcomes, since topical therapy contributes negligibly when systemic therapy is already providing adequate antiviral coverage, according to the American Academy of Family Physicians 1
No safety concern exists with using both formulations simultaneously, as there are no documented drug-drug interactions between topical and oral acyclovir formulations, as stated by the Centers for Disease Control and Prevention 2

Antiviral drugs active against herpesviruses, including acyclovir and valacyclovir, might reduce the efficacy of live attenuated varicella vaccine, and should be discontinued >24 hours before administration of varicella vaccine, if possible, as recommended by the Centers for Disease Control and Prevention 2

Renal function monitoring is critical when using systemic antivirals, particularly in patients with pre-existing renal impairment, as neurotoxicity can occur mainly in patients with advanced age and impaired renal function, and dose adjustments are mandatory to prevent acute renal failure, according to the National Kidney Foundation 1