Antiviral treatments for cold sores
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Antiviral Medications for Cold Sores: Acyclovir, Valacyclovir, and Newer Agents
Antiviral drugs are the mainstay of cold sore (herpes labialis) treatment. The most commonly prescribed medications are acyclovir and valacyclovir, with valacyclovir use increasing over time as treatment strategies evolve to include newer, potentially more effective options . These antivirals work by blocking viral replication, which shortens the duration of symptoms and speeds up healing . Oral nucleoside analogues like acyclovir can reduce healing time by about a day or more, while topical agents typically reduce healing time by about half a day .
Topical Antiviral Treatments: Nanoemulsions, Combination Creams, and Liposomal Gels
Recent research has focused on improving topical treatments for cold sores. A novel topical nanoemulsion (NB-001) demonstrated a significant reduction in healing time—over a day faster than placebo—without notable side effects, and its effectiveness was similar to oral antivirals but without systemic exposure . Another topical option, ME-609 (a combination of acyclovir and hydrocortisone), prevented the progression of cold sores to ulcerative lesions and reduced lesion area more effectively than acyclovir alone or placebo .
Liposomal shallomin gel, a new herbal-based formulation, showed even faster results than acyclovir ointment, with most users experiencing relief within 12 hours, compared to 24–48 hours for acyclovir . Controlled-release systems, such as acyclovir-loaded PLA/PEG nanofibers, are also being developed to provide sustained drug delivery and effective reduction of viral activity, offering promise for future practical treatments .
Alternative and Complementary Treatments: Medical-Grade Honey
Medical-grade honey (MGH) has emerged as a promising alternative for cold sore treatment. Studies show that MGH can heal cold sores significantly faster than conventional treatments, with most patients experiencing less pain and itching and expressing a preference for honey-based therapy . The antiviral and wound-healing properties of honey, likely due to its nitric oxide content, make it a viable option, with healing times slightly shorter than those seen with acyclovir 910.
Preventing Cold Sore Recurrence: Long-Term Antiviral Use
While short-term oral antivirals do not significantly reduce the recurrence of cold sores, there is some evidence that long-term use may offer a small reduction in recurrence rates, though the clinical significance is limited. Topical antivirals have not shown strong evidence for preventing recurrences .
Expanding Access to Antiviral Therapy
Allowing pharmacists to assess and prescribe antivirals for cold sores can improve access to timely treatment, potentially leading to faster symptom resolution and higher patient satisfaction. This approach has been shown to be safe in several countries .
Conclusion
Antiviral treatments, especially acyclovir and valacyclovir, remain the standard for managing cold sores, with newer topical formulations and delivery systems showing promise for faster healing and improved patient experience. Medical-grade honey offers an effective alternative, combining antiviral and wound-healing benefits. While prevention of recurrence with antivirals is limited, expanding access to these therapies can help more people manage cold sore outbreaks quickly and effectively.
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