What is the right aciclovir dosage for you?

Aciclovir dose for local/topical treatment

When you’re using a 'local' treatment for a herpes infection, it refers to something you apply directly to the area, for example an eye ointment or a skin cream.

If you’re using the eye ointment, you would apply about 1cm of the ointment five times a day, for at least 3 days and up to 10 days.

If you’re applying aciclovir cream to lesions on the skin (cold sore or genital herpes), you apply it five times per day, every four hours, for 5 to 10 days.

Suppression of herpes

Your doctor may prescribe you with an aciclovir suppression dose. This means you’ll take the medication daily for a longer period of time, and it’s been shown to protect against repeat outbreaks.

You’ll typically be given an aciclovir 400mg dose to take twice a day, though this might need to be increased if there are repeat outbreaks. You might also be told to stop using your aciclovir prevention dose every 6 to 12 months so that your doctor can reassess how often outbreaks are repeating.

Aciclovir dose for genital herpes

If this is your first outbreak of genital herpes, you’ll usually be given 400mg taken three times a day, and this will be used for 5 to 10 days. Longer doses might be needed for people who are HIV-positive or immunocompromised – speak to your doctor if this is the case.

For repeat outbreaks, the dosage that is prescribed can either be an aciclovir 800mg dosage (usually 2 x 400mg tablets) taken three times a day for two days, or an aciclovir 400mg dosage taken three times a day for five days. You should begin taking aciclovir as soon as you notice signs of a herpes outbreak.

Aciclovir dosage for shingles and chickenpox

When you’re taking tablets, you’ll usually be given an aciclovir 800mg dosage for shingles,this will typically be taken 5 times a day for 7 days. Similarly, you’ll be given an aciclovir 800mg dosage for chickenpox, which you take five times a day for seven days.

If you are immunocomprised, your doctor will prescribe a specific dosage that is suitable for you.

If you need to have intravenous infusion for shingles or chickenpox, it usually lasts five days, and 5 mg/kg is given. If you’re immunocompromised, it’s 10 mg/kg.

What’s the usual aciclovir dose for cold sores?

If you are an adult and are not immunocompromised, you will usually be given aciclovir 200mg for cold sores if it is given as a tablet. You will usually take it five times per day, for five days.

Aciclovir is available in several different doses. When your doctor prescribes you with aciclovir, they will decide on the right dose for your personal situation.

Aciclovir doses can vary because:

• aciclovir is used to treat different types of virus – you may need a higher aciclovir dosage for some conditions, and a lower dosage for others
• your dosage might need to change as part of your treatment – for instance, you might start on a high dose, then shift to a lower dose
• there are lots of different types of formulations (eye ointments, creams, tablets and intravenously) and these come in different ‘strengths’
• the number of times you need to use aciclovir per day or how many days you take it for might vary and also influence the size of the dose

When your doctor is prescribing aciclovir, they will take a few factors into account when deciding on the right dose for you.

“If you’re unsure what aciclovir dosage to take, if you forgot, or if you’ve lost your instructions, I’d always advise contacting your GP, online prescriber, or pharmacist. They can tell you exactly how much to take, so you’ll receive the right treatment. I’d also recommend talking to your doctor about any existing health conditions you may have, any other medications you take, or any general concerns you have about aciclovir treatment, or which treatment type is right for you.” – Dr Brenda Ikeji, Medical Editor.

If you miss a dose of aciclovir, take the missed dose as soon as you remember. However, if it’s nearly time for your next dose, simply skip the missed dose, then carry on with your usual treatment plan. You should never ‘double dose’ to make up for a missed dose. If you’re struggling to remember, try setting an alarm or use diary reminders on your phone.

The same applies whether you missed your aciclovir tablets dosage, your aciclovir cream application, or the eye ointment.

What if you took more than your maximum dose of aciclovir?

If you accidentally took more than your maximum dose of aciclovir as a one off, this is generally not a cause for concern, according to the NHS. However, it could be an issue if you take too much for a longer period of time. Taking too much aciclovir could also be an issue if you have certain other health conditions, including kidney or liver issues.

➤ Talk to your doctor if you think you’ve taken too much aciclovir. Our guide to aciclovir side effects also provides more general information.

Depending on your situation it’s possible that you may need to switch your aciclovir dosage. Your doctor is likely to make this decision based on factors such as:

1. Your response to the current dosage – if your symptoms are not properly controlled by your current dosage you could get assessed by a doctor in order to change to a stronger dosage.
2. You start a new course of other medications – if your health status changes and you need to start taking new medications, then you need to let your doctor know. This could impact how much of each medication you can take and it can be a balancing act and monitoring of your side effects might be necessary.
3. What side effects you experience – for example, normally you’re prescribed a relatively high dosage of aciclovir for shingles, and this might mean that you have more severe side effects. These should be watched quite carefully, and if the side effects are too difficult to manage, then changes in the dosage might be recommended.

There are a few things you can do to support your treatment. To get the best experience with your treatment:

1. Start your medication as soon as you can after your symptoms start and take your medication as directed by your doctor.
2. Time your doses – it’s best to take aciclovir as soon as possible after the first sign of any symptoms (typically, tingling or burning that you get before a cold sore or genital herpes blister).
3. Take tablets with a drink – you can use your tablets, capsules, or oral suspension with your meals or on an empty stomach, but one thing that could interfere is dehydration. If you’re taking any of these aciclovir formulas, then you should drink plenty of water. This is particularly important if you’re elderly or taking doses of 400mg a day or higher.
4. Be accurate when measuring doses – if you need to measure out your dosages, you need to try and be accurate. For example, if you’re using an aciclovir oral suspension, using a specially marked measuring spoon can help you measure your dosages.
5. Complete your course – to help clear up your infection, you should always finish your full treatment, even if you’re not feeling your symptoms anymore. At the same time, don’t take the medication for longer than you’ve been told to.

If you’re taking aciclovir, then it’s important to take the correct amount, several times per day, for the right number of days. Your doctor or pharmacist will give you instructions for how to do this. But if you can’t remember, you should contact your doctor. There’s no need to feel embarrassed if you forget – it happens all the time, and your doctor will want to be sure you’re getting the correct treatment.

At ZAVA, we can prescribe cold sore and genital herpes aciclovir doses. Our doctors can approve prescription treatment and you can check your online account if you need a reminder of the correct strength and timings for taking your tablets.