Valacyclovir dosage

[jop]

@M Paine, I'm also in Auckland, just beginning trying to get some treatment for what is aptly described in someone's avatar as Cluster F--- Syndrome. I'm now on 400mg aciclovir twice daily as of Tuesday, prescribed by my GP, cos I asked her for it. I had shingles almost directly after surgery for acromegaly last year, which responded to aciclovir and I've also had EBV in the past, hence the reason I decided to wing it and try some aciclovir. Do you have an opinion as to whether that dose rate is likely to be effective in a slightly built person?

When you say positive for EBV and CMV, did you mean non-zero antibodies or meeting the treatment criteria thresholds described in hip's roadmap (and references within)? I'm keen to figure out how to get at least some of the testing done in NZ. Did your GP access it for you? Sorry for the dumb questions but I'm brain dead and struggling to figure this out fast enough to halt a rapid decline.

I've had a staph problem following last year, which seems to have been a triggering factor in my now getting CFS, which has started after only a year of being well following my last protracted medical fiasco. I talked to an infectious disease specialist earlier this week about the CFS and asked about antivirals. He was treating my staph with some success which helped me feel better, however, since I told him the other stuff which has developed he is now refusing to treat the staph anymore, cos that's not "the" problem. Reductionist twit. Perhaps we could swap notes on specialists who help and specialists to avoid.....

 

[M Paine]

@jop, thanks for your comments. I'm keen to talk with you more about this, sounds like we have a lot in common. I'll just talk about the aciclovir and valaciclovir here though to remain on topic, I'll PM you when I can, (I'm swamped with work, but quite keen to chat).

I had shingles almost directly after surgery for acromegaly last year, which responded to aciclovir and I've also had EBV in the past, hence the reason I decided to wing it and try some aciclovir. Do you have an opinion as to whether that dose rate is likely to be effective in a slightly built person?

I think it's been mentioned here previously, but valaciclovir is slightly different to aciclovir for dosage. Valacyclovir enhances acyclovir bioavailability compared to acyclovir. According to this study, valaciclovir 500 mg twice daily is equivalent in efficacy to aciclovir 200 mg five times daily.

In answer to the question of dosage requirements for larger people, it's not black and white due to renal concerns and other considerations. But if it were me, I wouldn't be too worried from an effectiveness perspective. Even if your dose is less effective due to a larger BMI, it would translate into a longer time period to lower your viral load, it would not render the treatment ineffective.

If you look at the Yo Hoshino et all paper which I linked earlier, in which they did a controlled study on Valacyclovir at 500mg daily over a long period (one year). This study was done using patients located in Texas. Unfortunately they didn't supply the patient weights, but I think we can assume that they included larger patients in their cohort.

It's a great paper, if you look at Figure 2, it demonstrates that most patients who were in the treatment arm saw a reduction in the number of EBV-infected B cells over time. The two patients in the graph who saw an increase likely have a drug resistant strain of EBV. This seems in line with other Herpes viruses such as HSV which has been resistant to acyclovir in around %5 of cases. (See: Herpes simplex virus resistance to antiviral drugs)

When you say positive for EBV and CMV, did you mean non-zero antibodies or meeting the treatment criteria thresholds described in hip's roadmap (and references within)?

I tested IgG positive to EBV and CMV which indicates past infection, but unfortunately a GP here can only access fairly rudimentary screening tests for EBV. In order to measure viral load, you would need to pursue specialist treatment, which I'm yet to do.

 

[jop]

@M Paine, thanks for the info. That means I would be better to split my doses in half to 200mg 4x daily. By slightly built I actually meant I'm small not large, so the dose seems ok. At this point for me it's about getting on with treating the obvious culprits while trying to figure out the more complex stuff. Will pm you my contact details.

 

[Katyw]

Hi everyone- just wanted to update you guys and see what your thoughts are on things.

I've been on 4g of valacicolvir daily for nearly 8 weeks now and still feel worse I'm not sure if this is a good thing. My doctor said that it's hard to decipher whether it's a normal reaction to the drug or if it's an allergy but to keep on them as improvement isn't usually seen until 6 months. Do you think I should still being feeling worse after 8 weeks?

The other thing is that my doctor has brought up Lyme!! Maybe I should get that tested! My doctkr says that by treating the EBV if there is bacterial infection then the anti virals can make you worse. i just don't know what to do as I've gone by ME diagnosis the whole time as my mum has the same illness. I have always had unexplained abnormal blood tests constantly (High ESR, CRP, lymphocytes, white blood count, liver enzymes)

K

 

[Katyw]

Hi, I just wanted to get some advice please.

I was on valacyclovir (generic version) for three months and have had to come off it. I just had too much kidney pain and generally felt worse apart from being able to stand longer than a minute compared to before I started.

I'm now off the meds and feel awful! I have swollen glands, malaise, extreme fatigue and bad face pain. I expected this as I have been treating the virus and now my body is adjusting to no meds but now I'm at a loss with what to do next. I was considering herbal/supplements like l-lysine, cats claw etc. Do I have any other options?

Anyone? Thanks xx

 

[heapsreal]

Hi, I just wanted to get some advice please.

I was on valacyclovir (generic version) for three months and have had to come off it. I just had too much kidney pain and generally felt worse apart from being able to stand longer than a minute compared to before I started.

I'm now off the meds and feel awful! I have swollen glands, malaise, extreme fatigue and bad face pain. I expected this as I have been treating the virus and now my body is adjusting to no meds but now I'm at a loss with what to do next. I was considering herbal/supplements like l-lysine, cats claw etc. Do I have any other options?

Anyone? Thanks xx

With valacyclovir theres increased risk of kidney stones. Dr lerner if he had a pt prone to kidney stones he would put them on famvir which doesn't have increased risk of kidney stones .

 

[Katyw]

Hi @heapsreal

Thank your for your advice.

I'm having a problem finding Famvir that's affordable and that will post to the U.K. The ones I've found are coming in at £12 per pill!! I was spending around £120 a month on valaciclovir so can't afford more than that.

K

 

[heapsreal]

Hi @heapsreal

Thank your for your advice.

I'm having a problem finding Famvir that's affordable and that will post to the U.K. The ones I've found are coming in at £12 per pill!! I was spending around £120 a month on valaciclovir so can't afford more than that.

K

Check out alldaychemist as they have cheap avs compared to prices you're getting now .

http://www.alldaychemist.com/catalogsearch/result/?q=Famvir

 

[Katyw]

Thanks @heapsreal. That's very helpful.

Could I ask you your doseage?

I was on 4g of valaciclovir for two months and then 2g for one month.

K

 

[heapsreal]

Thanks @heapsreal. That's very helpful.

Could I ask you your doseage?

I was on 4g of valaciclovir for two months and then 2g for one month.

K

Famvir i was taking 250mg twice a day for a long time. Recently increased it to 500mg twice a day. What i use seems to be on the low side of what others use.

 

[minkeygirl]

I take 500 mgs x2 Famvir. I upped it to 1500 to experiment but I didn't feel great. I did however, just up it without going up gradually so that could be part of it.

 

[Thinktank]

My doc prescribed me Valaciclovir 500 mg 3 x daily for 1 month to test, he believes the lab testing might have missed something.

I once took tamiflu (oseltamivir) for a week or so because this ENT-doc believed i had to protect myself from H5N1.... The tamiflu made me extremely sick.

Can i expect such a reaction from Valaciclovir?

 

[M Paine]

You can find generalised side effect lists for each of the medications, but really it's something a physician should advise you about. Your signature mentions IBD, and both drugs have nausea, diarrhea, and vomiting listed as potential side effects. I don't know if IBD increases the risk of those complaints with these sorts of drugs. Even if not, there's still a chance that it might cause those side effects.

Your ENT prescribed oseltamivir as a prophylactic? Presumably you are on an immunosuppressant for IBD in that case?