Five questions to ask your doctor about suppressive therapy

Charlotte Grayson, M.D. Health Pro February 20, 2009
  • I see a lot of patients who take suppressive therapy with no clear understanding of why they are taking it, what the goals are of suppressive therapy and most concerning ... taking the WRONG dose!

     

    I also see patients who suffer through multiple terrible outbreaks of herpes who have NEVER HEARD of suppressive therapy!

     

    Here's a list of questions to ask your doctor about suppressive therapy to see if it is right for you.

     

    1. Am I a candidate for suppressive therapy?

    If you have more than six outbreaks a year, you should definitely consider suppressive therapy to reduce the number, duration and severity of herpes attacks. Studies show that appropriately dosed suppressive therapy can reduce herpes attacks by 70-80%!

    Many people who take daily antiviral therapy have NO outbreaks at all. Thus many people with genital herpes who have fewer than 6 outbreaks a year may also want to consider daily therapy... particularly if those outbreaks interfere with the quality of your life.

    Given that daily suppressive therapy can reduce (see next question) the transmission of the virus, I offer it to most of my patients who have outbreaks more than once a year.

     

    2. Can I still transmit herpes while on suppressive therapy?

    In a word, yes. There aren't a lot of studies looking at asymptomatic shedding of herpes while on suppressive therapy. But what has been done so far show that while daily antiviral therapy for a year significantly decreases asymptomatic shedding of virus, it doesn't eliminate it. Thus barrier protection (think condoms or dental dams) should be used when having sex if you have genital herpes.

     

    So far, Valtrex is the only antiviral that carries the labeling that suppressive therapy with that drug reduces risk of transmission.

     

    3. What are the risks of daily antiviral therapy?

    So far, the studies show that the side effects and risks of daily antiviral therapy are no more common than in people who take intermittent antivirals for herpes outbreaks. Those side effects are pretty mild and include: headache, nausea, sore throat and abdominal pain.

     

    These drugs are very well tolerated. I hardly ever see anyone with side effects.

    Always let your doctor know if you develop side effects that concern you.

     

    4. How much should I take?

    It's important to get this right. I've seen all sorts of oddball regimens that patients are taking. And in these tough economic times, patients often are taking shortcuts with their meds!

     

    This is what is proven to suppress herpes:

    Acyclovir. 400 mg twice a day. (Some doctors prescribe a higher dose, if you don't have side effects, and it works, that's fine.)

    Famciclovir (Famvir). 250 mg twice a day

    Valcyclovir (Valtrex). For people with fewer than 10 recurrences a year, 500 mg a day. For those with more than 10 outbreaks a year, take 1000 mg a day or 500 mg twice a day.


    5. How long should I take suppressive therapy?

    I recommend starting with one year of therapy. Then we reassess the situation. Some patients don't mind daily meds and get such dramatic improvement in their symptoms; they want to stay on the drugs. I usually recommend stopping the meds, for a few months to see if daily therapy is truly needed. There is published medical research following patients on acyclovir for over a decade with no adverse events.