Cold Sores Treatments

There are several medications available to treat cold sores. Some are used topically and others are taken orally. Cold sores are best treated as early as possible. Starting a medication when prodromal symptoms such as burning, tingling, or redness start gives the best chance of keeping the cold sores from developing or shortening their course.

Cold Sore Treatment and FDA Approval:

There are several antiviral medications that are used to treat herpes infections. The FDA approves these medications for the specific type of infections they treat. The FDA has approved the use of certain drugs for cold sores, but some antiviral drugs that are not specifically FDA approved for cold sores have been shown in clinical studies to be effective. Receiving a prescription for an off-label use of one of these drugs may still be effective. The decision to use a medication that is prescribed off-label should be made based on current data and discussed thoroughly with a health-care provider.


Cold Sore Treatment Effects:

Antiviral drugs can have several effects on oral herpes simplex virus infections. Examples of the effects of antiviral medications on cold sores include: Decrease the time it takes for cold sores to heal
Reduce symptoms - especially pain
Prevent lesions from occurring if taken soon enough
Reduce the number of lesions developed if taken soon enough
Reduce the size of lesions developed if taken soon enough
Reduce the amount of viral shedding
Decrease the time it takes for cold sores to heal
Reduce symptoms - especially pain
Prevent lesions from occurring if taken soon enough
Reduce the number of lesions developed if taken soon enough
Reduce the size of lesions developed if taken soon enough
Reduce the amount of viral shedding


Cold Sore Treatment - First Outbreak:

The first outbreak of any herpes simplex infection is worse than recurrent infections. A first outbreak of oral herpes should be treated with oral medications, while recurrences can be treated with topical medications.


Cold Sore Treatment - Topical Denavir:

Penciclovir 1% cream (Denavir) is FDA-approved for recurrent cold sores. It is applied every two hours to the site for four days. Starting treatment within one hour of an outbreak reduced the time to healing by two days and reduced the symptoms. Penciclovir also decreases the duration viral shedding. The earlier penciclovir is started the better the benefits, but improvement was still found when penciclovir was started even after vesicles developed.


Cold Sore Treatment - Acyclovir:

Acyclovir 5% cream (Zovirax) is also FDA approved for the treatment of recurrent cold sores. In studies, frequent application of the cream reduced the time to healing by about half a day. Oral acyclovir given five times a day for primary gingivostomatitis in children shortened the course from 10 days to four days and reduced the duration of fever, eating and drinking difficulties, and viral shedding. Using low dose oral acyclovir for cold sores shortened the duration by about one day but did not affect pain. Using a higher dose and starting during the prodrome phase did have an effect on pain and duration.


Cold Sore Treatment - Famciclovir:

Famciclovir (Famvir) is approved by the FDA for treatment of cold sores. If started at the first sign of symptoms, taking Famvir 1500 mg once shortened the herpes infection by two days.


Cold Sore Treatment - Valacyclovir:

Valacyclovir (Valtrex) is approved by the FDA to treat cold sores. If started at the first sign of symptoms, taking Valtrex 2 gm twice a day for one day shortened the herpes infection by a little over one day.


Cold Sore Treatment - Suppression Therapy:

Suppression therapy, taking medication every day to prevent outbreaks, is not yet FDA-approved. Studies have shown that people who have more than six recurrences or more per year can benefit from taking acyclovir 400 mg twice daily by reducing the number of recurrences and decreasing viral shedding. Other possibilities are famciclovir 250 mg twice a day or valacyclovir 500 mg once a day.