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Australian Journal of Pharmacy : October 2006
Patients who present with recurrent genital symptoms unresponsive to OTC or prescribed treatment may need to be directed to their GP, who can provide accurate diagnosis and a Facts Pack on genital herpes. An example of an at-risk patient is a female who regularly buys an anti-fungal to treat the symptoms of self-diagnosed thrush, which shares similar symptoms to genital herpes.7 As patients can be in shock when told they have genital herpes, they may not take in advice from the prescribing doctor. Discreet advice when dispensing the prescription may be more readily absorbed once the emotional response to the diagnosis has passed.7 Pharmacists should consider discussing the option of suppressive therapy with patients when they first present with a prescription, or when you observe patients returning sporadically for antiviral scripts.7 Ensure that customers are aware that condoms reduce the risk of transmitting genital herpes, but do not entirely remove the risk.2,3 Condoms are partially effective in reducing HSV-2 transmission and, along with abstinence during outbreaks, should continue to be recommended. The lowest observed rates of transmission were among couples who reported they almost always used condoms and in whom the source partner was taking valacyclovir.6 W hat role does Valtrex (valacyclovir) have in genital herpes treatment? There is no cure for genital herpes, however, valacyclovir, used as a suppressive therapy, can reduce the number of genital herpes recurrences by 85 to 90 per cent. Valtrex REFERENCES 1. Cunningham A L, Taylor J et al. Prevalence of infection with herpes simplex virus types 1 and 2 in Australia: a nationwide population based survey. Sex. Trans. Infect. 2006;82;164–168. 2. www.thefacts.com.au 3. Australian Herpes Management Forum www.ahmf.com.au 4. Alexander L, Naisbett B. Patient and Physician Partnerships in Managing Genital Herpes. The Journal of Infectious Diseases 2002: 186 (Suppl 1): S57–65. 5. Romanowski B et al. Patients’ Preference of Valacyclovir Once-Daily Suppressive Treatment Therapy Versus Twice-Daily Episodic Therapy for Recurrent Genital Herpes. STD vol 30 2003:226–31 6. Corey L et al. Once daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004. 350;1. www.nejm.org 7. Cunningham T. Call for pharmacy watch on genital herpes. Aust J of Pharm. Aug. 2006. Vol 87. p30. PBS Information: Authority required. Refer to PBS Schedule for full information PLEASE REVIEW PRODUCT INFORMATION BEFORE PRESCRIBING For full Product Information please contact GlaxoSmithKline Australia Pty Ltd. 1061 Mountain Hwy, Boronia, Victoria, 3155. ABN 47 100 162 481. ®Valtrex is a registered trade name of GlaxoSmithKline Group of Companies. VALTREX MINIMUM PRODUCT INFORMATION INDICATIONS: Genital herpes (GH) treatment and prevention; GH transmission reduction in patients with recurrent genital herpes (safer sex practices also rec- ommended). Herpes zoster (shingles; duration of rash ( 72 hours); ophthalmic zoster. Cytomegalovirus (CMV) prophylaxis following solid organ transplantation. CONTRAINDICATIONS: Hypersensitivity. PRECAUTIONS: Dehydration; renal impairment; high doses in hepatic impairment, liver transplantation; pregnancy (CAT.B3); lactation; children; elderly; GH transmission risk is reduced but not eliminated. ADVERSE EVENTS: Headache; GI disturbances; Uncommon/rare neu- rological reactions; for more details/other ADEs, see full PI. INTERACTIONS: No clinically significant interactions have been identified. Caution: coadministra- tion of high dose valaciclovir and other drugs excreted via tubular secretion (eg cimetidine, probenecid; mycophenolate mofetil) or drugs affecting other aspects of renal physiology (eg cyclosporin, tacrolimus). DOSE: Genital Herpes - initial: 500mg BD for 5-10 days. Recurrent: 500mg BD for 5 days. Prevention of recur- rent genital herpes: 500mg OD (immunocompetent <10 recurrences/year), 1000mg OD (immunocompetent =10 recurrences/year), 500mg BD (immunocompro- mised). Reduction of transmission: 500mg OD (taken by infected, immunocompetent, heterosexual adult < 10 recurrences/year; susceptible partner discordant for HSV-2). Herpes Zoster/Ophthalmic Zoster: 1000mg TDS for 7 days. CMV prophylaxis: 2g QID for 90 days adjusted for renal function. ? halves the risk of infecting others,3 a chief concern of people with genital herpes and their sexual partners.4 this concern is data showing that HSV-2 seropositive people have an increased risk of infection with the human immunodeficiency virus (HIV). HSV-2 infection during late pregnancy also poses a high risk of transmission to the neonate.6 Valacyclovir has been shown effective for both episodic or suppressive treatment of genital herpes recurrence. The risk of recurrence was nearly 78 per cent lower than for those on suppressive therapy compared to those on episodic treatment.5 Valacyclovir also cut transmission rates between couples by half.6 Double-blind, placebo-controlled studies have demonstrated the efficacy of valacyclovir (500mg once daily) in suppressing recurrent genital herpes outbreaks in immunocompetent subjects. Subjects with frequent recurrences of more than 10 per year may derive additional benefit from 1000mg daily or 250mg twice daily. Randomised controlled clinical trials have demonstrated the efficacy of valacyclovir given as episodic therapy (500mg twice daily for five days) for genital herpes outbreaks.5 Adding to