Valacyclovir dosage and administration

# Dosage And Administration
- VALTREX may be given without regard to meals.
- Valacyclovir oral suspension (25 mg/mL or 50 mg/mL) may be prepared extemporaneously from 500-mg VALTREX Caplets for use in pediatric patients for whom a solid dosage form is not appropriate .

## Adult Dosing Recommendations
Cold Sores (Herpes Labialis): The recommended dosage of VALTREX for treatment of Cold Sores is 2 grams twice daily for 1 day taken 12 hours apart. Therapy should be initiated at the earliest symptom of a cold sore (e.g., tingling, itching, or burning).
Genital Herpes: Initial Episode: The recommended dosage of VALTREX for treatment of initial Genital Herpes is 1 gram twice daily for 10 days. Therapy was most effective when administered within 48 hours of the onset of signs and symptoms.
Recurrent Episodes: The recommended dosage of VALTREX for treatment of recurrent Genital Herpes is 500 mg twice daily for 3 days. Initiate treatment at the first sign or symptom of an episode.
Suppressive Therapy: The recommended dosage of VALTREX for chronic suppressive therapy of recurrent Genital Herpes is 1 gram once daily in patients with normal immune function. In patients with a history of 9 or fewer recurrences per year, an alternative dose is 500 mg once daily.
In HIV1infected patients with a CD4+ cell count greater than or equal to 100 cells/mm3, the recommended dosage of VALTREX for chronic suppressive therapy of recurrent Genital Herpes is 500 mg twice daily.
Reduction of Transmission: The recommended dosage of VALTREX for reduction of transmission of Genital Herpes in patients with a history of 9 or fewer recurrences per year is 500 mg once daily for the source partner.
herpes zoster: The recommended dosage of VALTREX for treatment of herpes zoster is 1 gram 3 times daily for 7 days. Therapy should be initiated at the earliest sign or symptom of herpes zoster and is most effective when started within 48 hours of the onset of rash.

## Pediatric Dosing Recommendations
Cold Sores (Herpes Labialis): The recommended dosage of VALTREX for the treatment of Cold Sores in pediatric patients aged greater than or equal to 12 years is 2 grams twice daily for 1 day taken 12 hours apart. Therapy should be initiated at the earliest symptom of a cold sore (e.g., tingling, itching, or burning).
Chickenpox: The recommended dosage of VALTREX for treatment of Chickenpox in immunocompetent pediatric patients aged 2 to less than 18 years is 20 mg/kg administered 3 times daily for 5 days. The total dose should not exceed 1 gram 3 times daily. Therapy should be initiated at the earliest sign or symptom .

## Extemporaneous Preparation of Oral Suspension
Ingredients and Preparation per USPNF: VALTREX Caplets 500 mg, cherry flavor, and Suspension Structured Vehicle USPNF (SSV). Valacyclovir oral suspension (25 mg/mL or 50 mg/mL) should be prepared in lots of 100 mL.
Prepare Suspension at Time of Dispensing as Follows:
- Prepare SSV according to the USP-NF.
- Using a pestle and mortar, grind the required number of VALTREX 500 mg Caplets until a fine powder is produced (5 VALTREX Caplets for 25 mg/mL suspension; 10 VALTREX Caplets for 50 mg/mL suspension).
- Gradually add approximately 5-mL aliquots of SSV to the mortar and triturate the powder until a paste has been produced. Ensure that the powder has been adequately wetted.
- Continue to add approximately 5-mL aliquots of SSV to the mortar, mixing thoroughly between additions, until a concentrated suspension is produced, to a minimum total quantity of 20 mL SSV and a maximum total quantity of 40 mL SSV for both the 25-mg/mL and 50mg/mL suspensions.
- Transfer the mixture to a suitable 100-mL measuring flask.
- Transfer the cherry flavor- to the mortar and dissolve in approximately 5 mL of SSV. Once dissolved, add to the measuring flask.
- Rinse the mortar at least 3 times with approximately 5-mL aliquots of SSV, transferring the rinsing to the measuring flask between additions.
- Make the suspension to volume (100 mL) with SSV and shake thoroughly to mix.
- Transfer the suspension to an amber glass medicine bottle with a childresistant closure.
- The prepared suspension should be labeled with the following information Shake well before using. Store suspension between 2 to 8C (36 to 46F) in a refrigerator. Discard after 28 days.
- The amount of cherry flavor added is as instructed by the suppliers of the cherry flavor.

## Patients With Renal Impairment
Dosage recommendations for adult patients with reduced renal function are provided in Table 1 . Data are not available for the use of VALTREX in pediatric patients with a creatinine clearance less than 50 mL/min/1.73 m2.
Hemodialysis: Patients requiring Hemodialysis should receive the recommended dose of VALTREX after Hemodialysis. During Hemodialysis, the halflife of acyclovir after administration of VALTREX is approximately 4 hours. About one-third of acyclovir in the body is removed by dialysis during a 4hour Hemodialysis session.
Peritoneal dialysis: There is no information specific to administration of VALTREX in patients receiving peritoneal dialysis. The effect of chronic ambulatory peritoneal dialysis (CAPD) and continuous arteriovenous hemofiltration/dialysis (CAVHD) on acyclovir pharmacokinetics has been studied. The removal of acyclovir after CAPD and CAVHD is less pronounced than with Hemodialysis, and the pharmacokinetic parameters closely resemble those observed in patients with endstage renal disease (ESRD) not receiving Hemodialysis. Therefore, supplemental doses of VALTREX should not be required following CAPD or CAVHD.