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.

23 comments

{ 23 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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Charlene February 25, 2015 at 1:26 pm

So I have read of a few things to help cure EBV. I am starting on Valtrex 1000 mg 4 times a day. I am scared to death of it but am determined to stick it out. I have had recurrent EBV for almost 3 years now. Also coconut oil has something in it that kills EBV but it may take a while, plus you have to stay on it and there is a company that sells blood purifiers named Sota’s in Vancouver which is supposed to help kill it as well. They have 3 devices you can use. Then of course there is olive extract and other herbs and a diet of water, fresh organic vegies and protein, no sugar. Go on line and you tube also has interesting videos. Check out Dr. Lerner in Beverly Hills, Michigan for his treatments. That’s basically all I know. Good Luck. Charlene

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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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Laura July 4, 2014 at 8:09 pm

EBV is a common co-infection of Lyme Disease and could be why many of your are suffering so badly. IGeneX test for Lyme Disease (aka Borrelia).

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Julia September 15, 2014 at 12:36 pm

The previous post says EBV is a common co-infection of lyme. I have never heard this. Is this true?

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JBB February 15, 2015 at 4:14 am

Yes it is true. It is in LLMD Horowitz’s book. Perhaps because the body is under so much pressure already with Lyme and co infections that EBV can get a hold too.

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Vivian February 5, 2015 at 11:45 am

I just got bloodwork back showing active EBV replication (early antibody IGG). I had mono when I was 12 and have never been the same. Mild dysautonomia, IBS that later became microscopic colitis with gluten/dairy/soy intolerance, then Dermatomyositis. No Lyme. Strangely, I’ve never felt debilitating fatigue through all of it. My doctor suggested we’d try traditional and natural antivirals. She said they are having success with monolaurin for EBV.

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JR stockert February 11, 2015 at 9:02 pm

am 55 year old male with cfs after 2 surgeries tried many doctors not much help am on nexavir and Valtrex now any help anyone please would like some help thanks JR

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Charlene February 16, 2015 at 3:20 pm

I live in Windsor, Ontario, Canada. I had EBV about 30 years ago, recovered after a few months, didn’t todo anything special to combat it except took Xanax. It came back in April of 2012 after I was experiencing a stressfull time in my life. After 3 years some symptoms are better but I just came back from Dr. Lerner’s today to get my lab results and I have to take a potassium pill and a new prescription thyroid pill for 2 weeks then I start om 1 mg of Valtrex 4x’s a day. He said I would be sick for a month or so ( everyone is different adjusting to it) but he also said it would take 9 to 10 months before it goes away God willing but I am just grateful that I have a chance to get well. Charlene

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charlie1 March 17, 2015 at 10:45 am

Charlene, I’m not far from Windsor and have considered going to Dr. Lerner for help with my CFS symptoms (ill 3 yrs now). My most problematic symptoms are intense PEM and daily lack of energy with headaches.
I don’t know if I have EBV but I used to get cold sores in my teen years into early adulthood. I had headaches, nausea and lower than average energy levels at that time which never really went away. Could that mean I may have an ongoing virus occurring? I know almost zero about immunology and don’t want to go to Detroit if not necessary. How can I first find out about my titers for various viruses using OHIP billing? Or is that even possible.

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Charlene March 22, 2015 at 1:52 pm

If you live in Canada and are from Windsor, Ontario like myself you can be diagnosed for epstein barr by an Infectious Disease doctor named Dr. Ole Hammerberg located in London, a Ontario. He is very nice but it stops there, he doesn’t treat it. Perhaps if you could send copies of your titers etc. to Dr. Lerner with all your symptoms, how long you have had it, body weight, family health history, etc. you could work with the two doctors to come up with a treatment plan for you. It takes an hour to drive to Dr. Lerner’s from Windsor and it is very expensive. It is interesting to note Dr. Lerner is coming to London in April 2015 to speak on the subject to bring more awareness to the medical community. Both doctors can be located on line. Good Luck. I have been on Valtrex going into my 4th week. I have read that it takes 6 weeks before you even begin to see improvement. You have to go through a process called die off first which takes time. My allergies are a bit better but it is still too soon to see major benefits. I have EBV and no other viruses. I will be on Valtrex 1000 mg 4 x’s a day for a year. You have to stick with it and try to maintain a healthy life style. I am believing in God and Dr. Lerner to get me through this. Pray often and don’t give up. Jesus loves you and so do I. Charlene

Charlene April 6, 2015 at 3:29 pm

Must correct a mistake I made about Dr. Lerner coming to London, apparently I misunderstood him, he has already been to London to speak. That is all I know. I am in my 5th week of Valtrex and still going through die off. For a while there I didn’t feel too bad on it but I seem to be going through another round of worsening headache and pain in neck/shoulders. I guess that’s why you have to be patient with taking it as I have read stories of people feeling better after a month, or 4 months, or even 6 or 8 months. I had it for about 3 years before starting Valtrex so it may take a little time. Dr. Lerner said I would be on it for a year. I’m losing weight, all those fruits, vegies and water. I think too the transition from spring to summer, barometric pressure and all affects my headaches. Anyway, all one can do is hang in there. Take care all. When I get better i’ll let you know. God Bless. Charlene
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JR stockert April 8, 2015 at 9:25 pm

stopped the nexavir and Valtrex doctor that worked with dr lerner said he doesn’t think I will recover not sure what is still wrong with me not sure if it is Epstein bar virus no help almost 3 years now hoping for some help open for help from anyone hard to make it through the day. don’t know where to go cant travel very far anymore I am praying for any help . JR

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Charlene April 12, 2015 at 2:48 pm

Jr , sorry to hear you are having such a difficult time. I would suggest finding an infectious disease doctor who could do lab tests to find out if you have EBV or if it is Reactive. Also if you go on line there is a company called Sota located in Vancouver who sell devices that fight EBV and other things. Sounds to me like they are reputable and have a toll free number. It is called the Bob Be k a Protocal. Perhaps also you could get a full body MRI to eliminate any guesswork. Eat nothing out of the box and look into herbal remedies like olive leaf extract and echanachia and coconut oil and colldial silver. Get lots of rests and don’t believing because even if it takes time All things are possible with God. Look up all the scriptures that deal with health, healing and faith in the bible and saturate your mind with it and imagine yourself well. Give yourself totally over to Jesus, you may be surprised ehat He does for you but it takes patience. Good Luck snd God a Bless. Ask Him for help. He’s there! Charlene

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JR stockert April 18, 2015 at 8:48 pm

thanks Charlene called dr montoyo in California and they said stay on Valtrex for ebv and chronic fatigue with the high ebv titters started 2 days ago some better feel there may be some hope I am praying for the right things to take I feel Valtrex is the one to try I have 4 other people that got better with Valtrex like me need peace and trust this is right for me thank you for your help will keep you posted on the Valtrex thanks again for the support JR

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Charlene April 24, 2015 at 3:57 pm

JR, Glad you found something to try. They say you have to stick with the Valtrex for quite a while. I have been on it since the beginning of March and have had a recurrence of it for about 3 years before going on it so even though kind Dr. Lerner says it will take 9 months I am wondering if it will be longer, who knows, maybe it will even be a shoter period of time before I feel better. Dr. Lerner is now trying me on Hydrocortisone 20 mg 4 times a day for anti inflammation because I suffer from persistent daily headaches. It seems to have relieved the fibro pain in my shoulders and sneezing but my head is still pulsing and I get a dry sore mouth and lips in the evening. My headache is my worst symptom but I feel better on sunny days in the summer. I also have a bit of leg weakness that comes and goes. Anyway Dr. Lerner is a sweet guy and very optimistic for me. I believe he is a God send. Take care JR. Hope and pray you feel better soon. charlene

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JR stockert April 25, 2015 at 9:15 pm

Charlene just got my test back on ebstein bar virus and they went down by 20 per cent it was from taking nexavir my doctor says its worth a try to stay on nexavir longer my test were 750 and now 590 high is 20 but I went back on nexavir today and my ears stopped ringing so loud all day long just thought I would let you now am taking 500 Valtrex with nexavir now to see if I can speep up the results. I am praying for all who suffer from health problems thanks for keeping up with me and all the other people. I pray you get better to am going on 3 years now want my life back to somewhat normal can not work sure miss work. Anyway good to now other people care. God Bless you JR

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Charlene April 27, 2015 at 3:10 pm

JR — That’s great news! I go to see Dr. Lerner tomorrow. The Hydrocortisone didn’t well for me, made the pulsing in my head worse so I have gone off of it slowly. Didn’t really want to be on steroids anyway, I have never heard of Nexavir. I think I will mention it, perhaps it will help my headaches too. Hang in there JR. God Bless you too, Charlene

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Charlene May 12, 2015 at 3:54 pm

Still just doing the Valtrex 1000 mg 4x’s a day. Have noticed some small changes for the better but I am only into my third month on it and Dr. Lerner says I’ve just started as I will be on it at least 9 months but my sore mouth and dry lips are gone! the red spots I sometimes get are gone, the trembling is not as intense, the pulsing in the upper part or roof of my mouth is gone and my pulsing headache is not as intense but still bothersome .I still have some pain and pressure in my head and these weird squiggley waves that go over my head but all of these symptoms are calming down in the long run. I have had it sine 2012 when it started with severe pain on the right side of my neck then travelled up into my head after about 5 months. Now that pain is gone but I have pain on the left side of my neck. I use a heating pad for that a lot. But at any rate I still feel confident in time that I will recover. I am 63 yrs. now and had ebv about 30 years ago and I was able to go back to work after about 3 months but had to be careful for about a year and a half not to overdo. Some of my symptoms were different then and I did have pulsing in my head then too but it went away. That’s my story will let you know when I’m all better to share the hope. Charlene. P.S. — I do take thyroid medication and lorazepam for sleeping and drink ginger tea for my upset stomachs as I had my gallbladder out 2 years ago.

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