Valtrex (valycyclovir)

A herpesvirus viral package

Valtrex (valycyclovir) is…

an antiviral drug approved to treat genital herpes infection, herpes zoster (shingles) and herpes labialis (cold sores) infections. Dr. Martin Lerner of Royal Beaumont Hospital in Royal Oak, Michigan, is currently investigating its efficacy in chronic fatigue syndrome (ME/CFS) patients with Epstein-Barr virus infections. Valtrex is converted in the body to acyclovir which inhibits viral DNA replication. It is produced by GlaxoSmithKline.

Valtrex May Work in Chronic Fatigue Syndrome (ME/CFS) Because..

 it may inhibit the replication of a virus (Epstein-Barr virus (EBV) shown to be activated in some chronic fatigue syndrome (ME/CFS) patients.

Chronic Fatigue Syndrome (ME/CFS) Studies

Dr. Lerner’s 2002 Valtrex trial resulted in much decreased symptoms and increased energy and improved ventricular functioning for about 2/3rds of ME/ CFS patients at 18 months suggests an EBV associated cardiomyopathy may be important in some patients.

A blinded, placebo-controlled 2007 study of chronic fatigue syndrome (ME/CFS) patients with documented Epstein-Barr virus (EBV) reactivation by Dr. Lerner found Valtrex resulted in increased physical functioning and improved heart functioning (reduced sinus tachycardias, decreased abnormal cardiac wall movements) and reduced EBV antibody levels. He reported that many patients were able to resume normal activities by the end of the 36 month trial.

Patients with both EBV and cytomegalovirus infections did not improve. This suggested a different kind of drug treatment was needed for patients with multiple infections.

A recent study may explain why long time antiviral therapy may be necessary to successfully fight an EBV infectious (Hoshino 2009). It found that Valacyclovir reduces cell to cell reinfection but does not effect EBV infected cells. Since cell to cell reinfection is the chief means EBV has of maintaining itself in the body very long term antiviral therapy could reduce EBV infection rates simply by allowing infected B cells to die off over time without being replaced. This could account for the long treatment times needed some CFS physicians call for.

Dosing

In his ME/CFS Treatment Guide Dr Lerner states “If the patient weighs 70 kg, the dosage is 1 gram four times daily, ideally every six hours; however safe to take four hours after the last dosage (it is not necessary to awake in the middle of the night for a dose). It is important that the patient take four doses for treatment.

A higher dose of Valtrex may be necessary with patients who weigh more than 175 pounds and this must be done carefully. A patient who weighs more than 175 pounds may require 1.5 grams of Valtrex, valacyclovir four times daily.

Please note valacyclovir is now available in generic form. While I have not had experience with all distributors of generic forms yet, I have had patients move to the generic form of valacyclovir by Teva and Mylan with no issue. Famvir at the same dosage can be substituted and although there is not the strong evidence that we have
for valacyclovir, it likely is equally effective.”

Benefits usually do not begin until after 6 weeks and the drug is usually taken for a minimum of a year.

Side Effects

 Dr. Lerner call’s Valtrex “remarkably safe and effective” but notes that “one concern is that valacyclovir is excreted….can cause acyclovir stones and obstructive uropathy. This will not occur if the patient drinks at least six 8-ounce glasses of water daily. Side effects can include nausea, headache, fatigue, diarrhea and others.

Herxheimer effects early in the treatment protocol are common and suggest a good prognosis.

The Phoenix Rising website is compiled by a layman. It is not a substitute for a physician and is for informational uses only. It does not present complete information on this drug. Please discuss any treatments in these pages with your physician.

6 comments

{ 6 comments… read them below or add one }

Micah August 30, 2012 at 10:44 am

Such a refreshing change to find some good content
for once, I was getting sick of the constant drivel I find daily,
thanks.

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Jill Gentner February 1, 2013 at 6:27 pm

I have been battling epstein barr virus for 4 years and I can;t live like this anymore, can you help me. I’m trying not to kill myself

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Jackie Robinson April 13, 2013 at 3:48 pm

Hi Jill,

Your comment “spoke to me”, and I felt the need to reply to your desperate plea. I have had EBV on and off for seven years. I have been active for the last 1 1/2 years straight, and can identify with how you are feeling. Have you tried any antivirals at all? The first one I tried, Acyclovir, gave me a solid year of EBV dormancy. I thought I was cured! The drug itself is inexpensive and covered by most insurances. Please know that you are not alone. I know how much you are suffering.

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AnnMarie Deis July 15, 2013 at 8:49 am

I myself treat with Dr. Lerner at William Beaumont Hospital in Royal Oak, Michigan. He is a true gem! He always shakes my hand and wraps the other warmly around it while reassuring me that everything is going to be okay. He does joke with me that I am “inpatient,” which I am, of course. If you are at all able to travel to the area, he is THE doctor to see for EBV, CMV, Lyme, and a host of other infectious diseases. There was a guy from Uganda in his waiting room the last time. He has been traveling to see Dr. Lerner every eight weeks for two years! Brilliant doctor and the absolute Sherlock Holmes of doctors. Highly recommended!!!!!

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April October 17, 2013 at 8:09 pm

Hello AnnMarie,
Does he treat children. My son had a vaccine injury to MMR immunization. He has post illness neuropathy or Fibromyalgia. He has been seen at Duke and had all the “scary” things ruled out, but this impacts his daily life just as much. We still have to do therapy, he can’t just play like he used to, and he is becoming “wimpy” because he physically hurts as much as I do when I am having a flare up of my EBV. He is only 5 and I want him to have his whole life ahead of him, not keep looking back to how he was before this horrible vaccination illness.

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jamie owens November 30, 2013 at 1:40 pm

I am going to make an appointment asap. I was diagnosed with active ebv last year. I get vaginal ulcers which is very rare. Thought it would never happen again. Well the same symptoms are occurring now. Fatigue, diarrhea, Lower back aches, and lesions now in the same area as before. It’s scary I can almost deal with the rest but being w the same person and having these scary lesions shows up which feels like someone is putting cigarettes out in your privates for weeks is excruciating. I need help.

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