Buy aciclovir: episodic or suppressive, and the 72-hour window

Aciclovir does not cure herpes. It cannot: the virus persists in nerve ganglia between episodes and no antiviral reaches it there. What it does is shorten an outbreak and, taken continuously, make outbreaks substantially less frequent. People buy aciclovir expecting the first and are disappointed by it; understanding the second is what makes the drug worth having.

Two completely different ways of taking it

Episodic. Started at the first symptom — the tingling, itching or burning that precedes a lesion by hours — and continued for five days. Started at that point it can abort an outbreak or cut it short. Started once blisters have formed it does much less, because viral replication has already peaked. The usual adult dose for recurrent genital herpes is 400 mg three times daily or 800 mg twice daily for five days.

Suppressive. 400 mg twice daily continuously. This reduces recurrence frequency by seventy to eighty per cent in people with frequent outbreaks, and reduces asymptomatic viral shedding, which is relevant to transmission. It is reviewed annually, because recurrence rates often fall over time and some people no longer need it.

First episodes are treated more aggressively than recurrences — typically 400 mg three times daily for seven to ten days — because they are more severe and longer.

Shingles: the seventy-two-hour rule

For herpes zoster the dose is much higher — 800 mg five times daily for seven days — and the timing is the thing that determines whether it helps at all. Starting within seventy-two hours of the rash appearing reduces the duration and may reduce the risk of post-herpetic neuralgia, the persistent nerve pain that is the real reason shingles matters. Starting after that window, the evidence of benefit largely disappears.

Five doses a day is demanding, and it is the reason valaciclovir and famciclovir, which are dosed three times daily, have largely replaced aciclovir for this indication where cost permits. If you are taking aciclovir for shingles, the five doses are not negotiable — three a day of an 800 mg tablet is simply underdosing.

Prices by strength

Suppressive therapy at 400 mg twice daily consumes sixty tablets a month, which makes the ninety and 120-tablet packs the practical units. An episodic course is fifteen tablets.

Hydration, and the one real safety point

Aciclovir is cleared by the kidneys and can crystallise in the renal tubules if someone is dehydrated, particularly at the high shingles doses. Drinking adequately during treatment is not generic advice here — it is the specific precaution that prevents the drug's main serious adverse effect. Dose reduction is required in renal impairment, and in the elderly, where renal function is often lower than it looks.

Neurological effects — confusion, agitation, hallucinations — occur almost exclusively in people with reduced renal clearance who have not had the dose adjusted. Nausea, headache and diarrhoea are the common mild effects.

What it does not do, and what to tell a partner

Suppressive therapy reduces but does not eliminate transmission risk. Condoms reduce it further and also do not eliminate it, because shedding can occur from skin outside the covered area. The honest position with a partner is that risk is reduced substantially, not removed — and that a large proportion of people with HSV-2 are unaware they have it, which is how most transmission happens.

A herpes diagnosis lands harder than its medical seriousness warrants. The distress, the sense of being contaminated, the difficulty raising it with a new partner and the sexual avoidance that follows are frequently more disabling than the outbreaks, and they are treatable in their own right. That is squarely the territory of clinical sexology, and the first consultation at this studio is free and carries no obligation.

Related products here

The 5% cream is available without a prescription and is useful for cold sores if applied at the tingling stage; it does nothing for genital herpes, where oral treatment is required. Other antivirals are listed under antivirals.

Starting a standby supply at the right moment

People on episodic treatment are frequently given a supply to keep at home, and the reason is timing. The prodrome — the tingling, itching or burning that precedes a visible lesion by hours — is the window in which treatment changes the outcome. Waiting for an appointment means waiting past it.

Practically: keep the course where you will find it, start at the first unmistakable prodromal symptom rather than at the first blister, and complete the five days even if the outbreak aborts. An episode caught at the prodrome frequently does not develop at all, which is the best result this drug produces and the one most people never experience because they start too late.

Suppressive therapy: who it is for and what it achieves

Continuous dosing reduces recurrence frequency by seventy to eighty per cent in people with frequent outbreaks, and it reduces asymptomatic viral shedding, which matters for transmission to a partner. It is usually offered to people having six or more recurrences a year, to those whose outbreaks are severe, and to couples where one partner is uninfected.

It is reviewed annually because recurrence rates decline naturally over time — many people find that after a year or two of suppression, a trial off treatment reveals they no longer need it. That review is part of the treatment rather than an administrative step.

Hydration and renal function

Aciclovir is cleared by the kidneys and can crystallise in the renal tubules when concentrated, which is the mechanism behind its main serious adverse effect. Adequate fluid intake during treatment is the specific precaution, and it matters most at the high doses used for shingles.

Dose reduction is required where renal function is reduced, including in the elderly where it is frequently lower than it appears. The neurological effects sometimes reported with aciclovir — confusion, agitation, hallucinations — occur almost entirely in people whose dose was not adjusted for clearance.

Storage

Store Aciclovir as it arrives, in the pack, below twenty-five degrees and out of reach of children. Loose tablet transferred into a pill organiser lose both their expiry date and their protection from moisture.

A standby course kept at home for months is normal practice and is the point of having one — but check the expiry date periodically rather than discovering it has passed at the moment you need it. Replace it when it expires rather than letting the supply lapse.

Talking to a partner

The practical content is short. Suppressive therapy reduces transmission substantially but not completely. Condoms reduce it further and also not completely, since shedding can occur from skin outside the covered area. Avoiding contact during an outbreak and during the prodrome matters most.

And the epidemiological fact that changes how the conversation feels: a large proportion of people with genital herpes do not know they have it, which is how most transmission happens and why a diagnosis says nothing about anyone’s behaviour.

Questions

Will it stop me passing it on?

It reduces shedding and transmission substantially. It does not eliminate either.

How long can I stay on suppressive therapy?

Years, with periodic review. Safety data over long periods are reassuring, and recurrence frequency often declines enough that a trial off treatment becomes reasonable.

What if I start it late in an outbreak?

It will do less. The benefit is concentrated in the first forty-eight hours of symptoms, which is why people on suppressive therapy are often given a standby supply to start themselves.

Is it safe in pregnancy?

It has been widely used in pregnancy with reassuring data, and suppressive therapy late in pregnancy is standard practice for women with genital herpes to reduce the risk of neonatal infection. That is a prescriber decision.

The label these figures come from

Dosing by indication, the shingles timing window and renal precautions follow the FDA prescribing information for aciclovir and the genital herpes treatment guidance published by the US Centers for Disease Control and Prevention.