valacyclovir and Headache

Genital herpes is prevalent and sometimes debilitating. Likewise, herpes zoster ('shingles') can be painful and often disabling. The treatment of these conditions has been advanced over the past two decades by the introduction of guanosine nucleoside antivirals such as valacyclovir (Valtrex), Glaxo Wellcome), the highly bioavailable prodrug of acyclovir (Zovirax), Glaxo Wellcome). This review describes the pharmacology, pharmacokinetics, clinical efficacy and tolerability of valacyclovir and considers its clinical attributes in the context of those of the antivirals, acyclovir and famciclovir (Famvir), SmithKline Beecham). The data demonstrate that valacyclovir is more effective than placebo and as effective as other antivirals in the episodic and suppressive treatment of recurrent genital herpes. Valacyclovir is the only antiviral shown to be effective with a short (3-day) course in the episodic treatment of recurrent genital herpes, as well as with once-daily dosing for daily suppressive therapy. In herpes zoster, valacyclovir is as effective as famciclovir and more effective than either placebo or acyclovir at facilitating cutaneous healing and healing of zoster-associated pain and post-herpetic neuralgia. Valacyclovir is well tolerated, with convenient dosing frequencies for the treatment of genital herpes or herpes zoster, it also has the option for use as a short course therapy in the episodic treatment of recurrent genital herpes, all of which are important benefits in the management of these conditions.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Headache; Herpes Genitalis; Herpes Zoster; Humans; Nausea; Secondary Prevention; Tissue Distribution; Treatment Outcome; Valacyclovir; Valine

Oral valacyclovir's efficacy and tolerability as suppressive therapy versus episodic therapy were compared for recurrent herpes labialis (RHL). Subjects with a history of at least 3 RHL episodes in the past year were randomized to receive 6 months of oral valacyclovir episodic therapy at the first sign of prodrome (two 2-g doses separated by 12 hours) and 6 months of oral valacyclovir suppressive therapy (1 g once daily) for 6 months in open-label, crossover fashion. The mean +/- SE number of recurrences per 120 days of follow-up (primary endpoint) was lower with suppressive therapy (0.30 +/- 0.41) than episodic therapy (0.71 +/- 0.79) (P < .005). The probability of remaining recurrence free over 6 months was significantly higher with suppressive therapy than episodic therapy. The median time to first recurrence was 81 days with episodic therapy and was not calculable (> 180 days) for suppressive therapy (P = 0.021). Data for secondary efficacy endpoints (pain severity score, mean duration of recurrences, maximal total lesion area) showed approximately a 30% to 50% reduction in mean values with suppressive therapy compared with episodic therapy, but results were statistically significantly different between the regimens for pain severity only. The percentage of subjects with at least one adverse event over 6 months of treatment that was considered to be drug related was 3% with suppressive therapy and 6% with episodic therapy. Suppressive therapy with oral valacyclovir was more effective than episodic therapy with oral valacyclovir in reducing the frequency of recurrences of herpes labialis and prolonging the time to first recurrence and was also similarly well-tolerated.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Cross-Over Studies; Drug Administration Schedule; Female; Headache; Herpes Labialis; Humans; Lip Diseases; Male; Middle Aged; Recurrence; Sinusitis; Time Factors; Treatment Outcome; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Gastrointestinal Diseases; Headache; Herpes Zoster; Humans; Middle Aged; Nausea; Neuralgia; Pain; Prospective Studies; Time Factors; Treatment Outcome; Valacyclovir; Valine

Bilateral facial nerve paralysis is an uncommon presentation and even more so in children. There are reports of different causes of bilateral facial nerve palsy. It is well-established that hypertension and chickenpox causes unilateral facial paralysis and the importance of checking the blood pressure in children with facial nerve paralysis cannot be stressed enough. The authors report a boy with bilateral facial nerve paralysis in association with hypertension and having recently recovered from chickenpox. The authors review aspects of bilateral facial nerve paralysis as well as hypertension and chickenpox causing facial nerve paralysis.

Topics: Acyclovir; Antihypertensive Agents; Antiviral Agents; Chickenpox; Child; Cooperative Behavior; Diagnosis, Differential; Facial Paralysis; Follow-Up Studies; Headache; Humans; Hypertension, Renal; Interdisciplinary Communication; Losartan; Male; Neurologic Examination; Valacyclovir; Valine

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Aspirin; Diagnosis, Differential; Female; Headache; Humans; Meningitis, Viral; Middle Aged; Photophobia; Recurrence; Spinal Puncture; Valacyclovir; Valine

We present the case of a 38-yr-old woman who required an epidural blood patch in the context of acute varicella (chickenpox). The unique risks in this case include the possible triggering of central nervous system complications after the introduction of viremic blood into the epidural or intrathecal space. However, the risk was believed to be acceptable because the patient was receiving antiviral coverage. She enjoyed complete relief of her headache but experienced transient back and leg pain. Leptomeningeal irritation caused by acute varicella infection may put patients at increased risk for pain after epidural blood patch.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Blood Patch, Epidural; Chickenpox; Female; Headache; Humans; Magnetic Resonance Imaging; Pain; Spinal Cord; Valacyclovir; Valine

Topics: Acute Disease; Acyclovir; Aged; Anticonvulsants; Antiviral Agents; Carbamazepine; Diagnosis, Differential; Female; Headache; Herpes Zoster; Humans; Oxcarbazepine; Time Factors; Trigeminal Neuralgia; Valacyclovir; Valine

Topics: Acyclovir; Digestive System; Exanthema; Headache; Herpes Labialis; Humans; Randomized Controlled Trials as Topic; Valacyclovir; Valine