Valaciclovir (ENT — Ramsay Hunt / Bell's Palsy)

Source: UK SPC (eMC) for Valaciclovir 1000 mg tablets, §4.2 (https://www.medicines.org.uk/emc/product/15072/smpc). INDICATION CAVEAT — READ BEFORE USE: the fetched SPC does NOT name Ramsay Hunt syndrome (herpes zoster oticus) or Bell's palsy anywhere. The dose above is the SPC's regimen for HERPES ZOSTER (SHINGLES) exactly as written; the clinician must confirm that it is the intended regimen for Ramsay Hunt syndrome on this page. BELL'S PALSY IS NOT AN INDICATION IN THIS SPC — no dose for Bell's palsy can be taken from this source, and any Bell's palsy regimen shown on this page must be sourced separately from an ENT/neurology guideline. TIMING: patients should be advised to start treatment as soon as possible after a diagnosis of herpes zoster; there are no data on treatment started more than 72 hours after onset of the zoster rash. IMMUNOCOMPROMISED ADULTS (zoster): 1000 mg three times daily for at least seven days and for 2 days following crusting of lesions; antiviral treatment is suggested for patients presenting within one week of vesicle formation or at any time before full crusting. All doses must be reduced according to creatinine clearance (see renalAdjustment). OTHER INDICATIONS IN THE SAME §4.2 (for completeness, not for this page): HSV treatment in immunocompetent adults and adolescents >= 12 years — 500 mg twice daily (3-5 days for recurrent episodes, up to 10 days for initial episodes); herpes labialis (cold sores) in adults and adolescents — 2000 mg twice in one day, the second dose about 12 hours (no sooner than 6 hours) after the first, treatment not to exceed one day; HSV treatment in immunocompromised adults — 1000 mg twice daily for at least 5 days (up to 10 days for initial episodes), ideally started within 48 hours; HSV suppression in immunocompetent adults and adolescents — 500 mg once daily (some with >= 10 recurrences/year may benefit from 250 mg twice daily), re-evaluate after 6-12 months; HSV suppression in immunocompromised adults — 500 mg twice daily, re-evaluate after 6-12 months; CMV prophylaxis in adults and adolescents >= 12 years — 2000 mg four times a day started as early as possible post-transplant, usually for 90 days. §4.4 ZOSTER MONITORING: clinical response should be closely monitored, particularly in immunocompromised patients; consider intravenous antiviral therapy when the response to oral therapy is insufficient; patients with complicated herpes zoster (visceral involvement, disseminated zoster, motor neuropathies, encephalitis, cerebrovascular complications) should be treated with intravenous antiviral therapy, as should immunocompromised patients with ophthalmic zoster or a high risk of dissemination and visceral organ involvement. ELDERLY: consider the possibility of renal impairment and adjust the dose accordingly; maintain adequate hydration; elderly patients and those with renal impairment are at increased risk of neurological side-effects and should be closely monitored. HEPATIC IMPAIRMENT: dose modification is not required in mild or moderate cirrhosis with maintained hepatic synthetic function, and PK data in advanced cirrhosis do not indicate a need for adjustment although clinical experience is limited. PAEDIATRIC: the efficacy of valaciclovir in children below the age of 12 years has not been evaluated; adolescents >= 12 years receive the fixed adult HSV/CMV doses listed above (no per-kg dose is given). Verify any under-18 use against a children's formulary. Note: §4.5 was not retrieved in this bundle, and §4.4 and §4.8 were truncated at the source-fetch limit.