Has been used for topical treatment of initial episodes of genital herpes in immunocompromised or immunocompetent adults.
Topical antivirals generally not recommended for treatment of genital herpes. CDC and others recommend oral acyclovir, oral famciclovir, or oral valacyclovir as drugs of choice for treatment of initial episodes of genital herpes and for episodic treatment or chronic suppressive therapy of recurrent genital herpes.
Has not been effective for prevention of recurrent genital herpes when initiated immediately following development of prodromal symptoms (e.g., itching, burning, tingling, numbness).
No evidence that topical acyclovir prevents transmission of infection to other individuals.
Has been used for topical treatment of non-life-threatening, nongenital, mucocutaneous HSV infections in immunocompromised adults; efficacy of such treatment not established in immunocompetent individuals.
Systemic therapy (e.g., oral or IV acyclovir) usually recommended for treatment of mucocutaneous HSV infections.
Should not be used for prevention of recurrent HSV infections. No evidence that topical acyclovir prevents transmission of HSV or prevents recurrent HSV infections when applied in the absence of signs and symptoms of infection.
Dosage and Administration
Administration
Topical Administration
Apply topically to lesions of the lips and surrounding skin as a 5% cream or ointment, and apply to lesions of the skin as a 5% ointment.
Do not apply 5% cream or ointment in or near the eyes. For external use only; do not apply inside mouth or nose.
The 5% cream should be used only for treatment of herpes labialis (perioral herpes, cold sores, fever blisters) and should not be used to treat genital herpes.
After applying 5% cream, rub until the cream disappears. Do not use with occlusive dressings unless otherwise directed by clinician. Do not bathe, shower, or swim immediately after application.
When applying 5% ointment, use finger cot or rubber glove to prevent autoinoculation of other sites and transmission of herpes virus to other individuals.
Dosage
Pediatric Patients
Herpes Labialis
Topical
Children ≥12 years of age: Apply 5% cream to affected area 5 times daily for 4 days. Use sufficient quantity to adequately cover lesions or symptomatic area (e.g., area with tingling).
Initiate at the earliest sign or symptom of herpes labialis (i.e., during the prodrome or when lesions appear).
Do not exceed recommended dosage, frequency, and duration of therapy.
Adults
Herpes Labialis
Topical
Apply 5% cream to affected area times 5 times daily for 4 days. Use sufficient quantity to adequately cover lesions or symptomatic area (e.g., area with tingling).
Initiate at the earliest sign or symptom of herpes labialis (i.e., during the prodrome or when lesions appear).
Do not exceed recommended dosage, frequency, and duration of therapy.
Genital Herpes
Treatment of First Episodes
Topical
Rub 5% ointment gently into the affected area every 3 hours 6 times daily for 7 days. Use sufficient quantity to adequately cover all lesions; usual dose varies according to total lesion area but should approximate a 1.25-cm (0.5-inch) ribbon of ointment for a skin surface area of 2.5 cm2 (4 inch2).
Initiate at the earliest sign or symptom of genital herpes (i.e., during the prodrome or when lesions appear).
Do not exceed recommended dosage, frequency, and duration of therapy.
Immunocompromised adults: Rub 5% ointment gently into the affected area every 3 hours 6 times daily for 7 days. Use sufficient quantity to adequately cover all lesions; usual dose varies according to total lesion area but should approximate a 1.25-cm (0.5-inch) ribbon of ointment for a skin surface area of 2.5 cm2 (4 inch2).
Do not exceed recommended dosage, frequency, and duration of therapy.
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