24 hours after lesion onset) Suppressive therapy (immunocompetent patients): 1 g/day PO Suppressive therapy (immunocompetent patients with ≤9 recurrences annually): 500 mg/day PO; transmission reduction for source partner, 500 mg/day PO Suppressive therapy (HIV-infected patients): 500 mg PO q12hr Thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) reported in patients with advanced HIV disease and in allogenic bone marrow transplant and renal transplant recipients Acute renal failure (ARF) may occur, especially in elderly patients or those with underlying renal impairment receiving higher than recommended doses; use with caution in patients with renal impairment, the elderly, and/or patients receiving nephrotoxic drugs Treatment should begin with the earliest symptom (tingling, burning, itching) in cold sores; for genital herpes, it should begin at the first signs and symptoms (within 72 hours of onset of first diagnosis or 24 hours of onset of recurrent episodes); for herpes zoster, it should begin within 72 hours of onset of rash; for chicken pox, it should begin with the earliest sign or symptom Central nervous system (CNS) effects may occur (eg, agitation, hallucinations, confusion, encephalopathy); risk of CNS adverse effects is higher in elderly patients Adequately hydrate patient; decreased precipitation in renal tubules may occur Metabolized by liver; valacyclovir is rapidly and nearly completely converted to acyclovir and L-valine via first-pass effect; acyclovir is hepatically metabolized to a very small extent by aldehyde oxidase and by alcohol and aldehyde dehydrogenase (inactive metabolites) The above information is provided for general informational and educational purposes only. 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