8 best cold sore remedies

Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.

All people, sooner or later, are faced with one of the manifestations of herpes infection, which manifests itself as the usual 'cold sores', or signs of labial herpes. But herpes infection is a much more serious and complex problem. There are several families of herpes viruses, and a person can affect not only the skin, but also the mucous membranes of the oral cavity and genitals, ophthalmic herpes or eye damage can occur, which leads to blindness without treatment.

Herpetic encephalitis and meningoencephalitis, that is, viral inflammation of the brain and its membranes, are extremely difficult. In immunodeficient patients, herpetic lesions of internal organs such as hepatitis or pneumonia develop. Intrauterine herpes infection is very difficult, which often leads to severe lesions of the skin and central nervous system in infants. If left untreated, more than 60% of newborn babies die.

Nowadays, herpes infection in HIV-infected persons has acquired particular importance, which is rapidly becoming generalized. There are also long-term consequences of herpes infection. So, with shingles, or intercostal neuralgia, which caused herpes, after many years persistent and burning neuropathic pains along the intercostal nerves can continue, they are very difficult to treat, lead to insomnia, neuroses, and in some cases even cause suicide.

There are practically no people who do not have herpes viruses in their bodies. We all become infected with viruses in early childhood, and more than 90% of all healthy people have specific antibodies to these viruses. So, the herpes simplex virus is detected already from the age of 18 months in almost all babies, and with the onset of sexual activity, antibodies to the genital herpes virus appear. Only in healthy people herpes viruses 'dormant' in a latent form in the cells of the central nervous system, and the immune system does not allow them to be activated. And in people with an immunodeficient condition, they begin to multiply, and symptoms of an acute or chronic infection appear.

That is why it is necessary to be able to navigate in the means that can quickly inactivate herpes, and this rating will consider drugs that have antiviral efficacy, as well as those that can increase the immunity of patients, and activate the internal mechanisms of the body's struggle. In conclusion, ointments and creams for the treatment of herpetic eruptions on the skin and mucous membranes will be considered.

Rating of the best herpes remedies

Nomination	a place	Name of product	price
The best antiviral drugs for herpes	1	Acyclovir (Zovirax)	RUB 250
	2	Valacyclovir (Valtrex, Vairova, Valvir, Valtsikon, Vacirex)	1 264 rub.
	3	Famciclovir (Famvir, Minaker, Familar)	RUB 1,535
Herpes immune remedies: truth and fiction
Best herpes remedies for topical treatment	1	Erazaban	423 r
	2	Virgan	–
	3	Oftaquix	237 r
	4	Fenistil Pentsivir	355 RUB
	5	Oxolinic ointment	RUB 53

The best antiviral drugs for herpes

The first of the antiviral drugs, which is still very widely used in practice, was created in the early eighties. This is acyclovir. But, despite more than forty years of use of this remedy, it is still the most commonly prescribed medicine for herpes. More than 50 million patients around the world have already evaluated its ability to eliminate herpes rash.

In addition to acyclovir, drugs such as Famvir (famciclovir) and Valtrex (valacyclovir) have been introduced into clinical practice. The activity of antiviral agents for herpes is gradually increasing, from acyclovir to famciclovir. Valacyclovir occupies an intermediate position.

Antiviral medicine for herpes can be prescribed in two different ways:

1. one-time, or episodic appointment when symptoms of herpes appear in a healthy person;
2. prolonged therapy.

If in the first case the medicine is prescribed in short courses lasting about a week, then in the second case the patient is treated daily, and the course of treatment is months or even years. In the second case, the task is to prevent recurrence of chronic infection in patients with severe immunodeficiency, with HIV infection, and in other clinical complex cases.

Acyclovir (Zovirax)

Rating: 4.9

Zovirax is the original acyclovir drug manufactured by the pharmaceutical company Glaxo Smith Kline, UK. Zovirax is available in the form of tablets of 200 and 400 mg of acyclovir in each, as well as in the form of an eye ointment, a cream for topical use and as a powder for intravenous injections for severe forms of herpes.

The mechanism of action of the tool is to deceive the virus, and the use of defective building material for its DNA. The result is a break in the DNA helix, which stops the virus from multiplying. This mechanism is reliable and proven.

Zovirax is prescribed for adults with herpes simplex, or herpes on the lips, for the prevention of herpes infection, for the treatment of chickenpox and shingles. There are also other indications for certain patient groups. Zovirax tablets should be taken with food and water.

It is necessary to take Zovirax frequently, every 4 hours, which is 5 doses a day. The average course of treatment lasts at least 5 days, but can be extended according to indications and on the recommendation of specialists. To prevent the recurrence of herpes infection, it is necessary to take the remedy every 6 hours, that is, 4 times a day, or according to another scheme recommended by the doctor. There are dosages for the treatment of chickenpox and in immunocompromised patients. The cost of 25 Zovirax tablets is about 460 rubles.

Advantages and disadvantages

Zovirax, and other products containing acyclovir, have, perhaps, only two drawbacks. The first is the too rapid metabolism and breakdown of this drug in the human body, so frequent use of the drug cannot be avoided. The second drawback is that over the 40 years that have passed since the introduction of acyclovir into clinical practice, more powerful drugs have already appeared, although acyclovir continues to be the main, reliable and popular drug. A very important positive point is the possibility of using the drug in pregnant women and during lactation, this is important in the prevention of herpes infection in newborns.

Acyclovir has side effects such as nausea, rash, increased activity of liver enzymes. It is important that the use of acyclovir can be carried out together with the treatment of HIV infection, it does not cause any drug interaction effects.

Valacyclovir (Valtrex, Vairova, Valvir, Valtsikon, Vacirex)

Rating: 4.8

Valacyclovir, the next generation antiviral drug, is also widely available in pharmacy counters. The original drug that first entered the market is the drug Valtrex, it is produced by the English company Glaxo Smith Klein, which before the merger of the companies was called Glaxo Wellcome.

Valacyclovir is a much more active agent for the treatment of herpes than acyclovir, but a curious fact is that once in the body, valacyclovir, under the influence of a liver enzyme, turns into acyclovir, an antiviral drug of the 'older generation'? described above. But at the same time, a package of 10 Valtrex tablets of 500 mg for some reason costs from 960 rubles. and higher. What is the reason?

The fact is that Valtrex has such features of pharmacokinetics and pharmacodynamics that they allow acyclovir, as an active metabolite, to remain in the body in a higher concentration. As a result, Valtrex can be taken in a much more convenient way – just one tablet in the morning and one tablet in the evening, and not at all 5 times, like Zovirax. The usual total daily dose is 1 or 2 g. In addition, the resulting constant concentration of acyclovir, as an active metabolite, allows the drug to act on the herpes virus in more complex cases.

If Zovirax is quite suitable for the treatment of the common cold sore on the lips, then Valtrex is used for the treatment of shingles, for genital herpes, for immunodeficiency states, for the prevention of cytomegalovirus infection, as well as for the treatment of herpes zoster, affecting the eye area with lesions of the facial and trigeminal nerves (dangerous localization with possible development of ophthalmic herpes). In the event that patients have a recurrent type of herpetic lesion, then it is necessary to immediately start treatment with this drug, within 3 or 5 days, but according to the doctor's prescription, the period can be increased to 10 days, and the dose is also increased.

Valtrex is a fairly expensive treatment for herpes. So, 10 tablets of 0.5 g, designed for 5 days of admission with the usual, non-recurrent form of herpes, can be purchased for 960 rubles.

Advantages and disadvantages

As a first approximation, Valtrex can be considered a form of acyclovir, which acts in the body powerfully and constantly, and is devoid of its disadvantages. But Valtrex has its own characteristics. It cannot be used in children and adolescents, it is intended for adults over 18 years of age. It should be used with caution in the presence of renal failure, and there is not enough data on the use of Valtrex in pregnant women and nursing mothers. And, although there is no unequivocal prohibition on the use of the drug, it can be used only if the benefits of taking it outweigh the possible risk to the fetus.

Side effects often included headache and nausea, less often allergic rash and itching. Valacyclovir can be considered a drug that can cope with herpetic lesions of the eyes, as well as prevent the transmission of genital herpes to a healthy sexual partner, which is not always possible for simple acyclovir.

Famciclovir (Famvir, Minaker, Familar)

Rating: 4.7

Famvir is a new and most modern antiviral drug for herpes, which, after ingestion, turns into an active metabolite – pencivir. Penzivir is active not only against herpes viruses, but is also able to suppress the multiplication of the varicella-zoster virus, Epstein-Barr virus and CMV (cytomegalovirus infection). The agent acts on the hereditary material of viruses, suppressing the doubling of the DNA strand and inhibiting the multiplication of viral particles – replication. Thus, famciclovir, like valacyclovir described above, are not active drugs, but prodrugs that are activated in the human body under the influence of hepatic enzymes.

Famvir is indicated for the treatment of various forms of herpes and shingles caused by the varicella-zoster virus. It is prescribed for the prevention and treatment of exacerbations in recurrent herpes infection, including in patients with reduced immunity. Famciclovir is more likely to eradicate herpes zoster, and treating herpes with this remedy contributes to the least residual postherpetic neuralgia.

It is recommended to use Famvir, on average, 500 mg 3 times a day for 7 days. This dosage is recommended for herpetic eye lesions, for shingles, as well as for some other forms of herpes infection. There are different dosage regimens, which are indicated by the attending physician.

Famvir is produced by the pharmaceutical company Novartis, and for the price this medicine for herpes is the absolute leader in the Russian market. Three tablets with a dosage of 500 mg can be purchased at a price of 1350 rubles. Thus, a comma course reception of this remedy, for example, for the treatment of ophthalmic herpes, will be about 9500 rubles. during the week. Of course, taken by itself, this price seems high, but if it allows you to avoid blindness, then it can not be taken into account at all.

Advantages and disadvantages

The advantages of famciclovir include its highest bioavailability of all the listed drugs, and, consequently, its activity. This agent is well tolerated, and low immunity in patients with HIV infection is not an obstacle to its use. Of the side effects, mild headache and nausea were most often noted. Overdose data are practically unknown. In general, we can say that the original famciclovir from Novartis is the 'gold standard' for the treatment of severe forms of herpes infection. The only drawback is the rather high price, as well as the produced form only for internal use, in the form of tablets. There is no doubt that in the future, famciclovir will be able to be produced in forms for parenteral, intravenous administration, which is why its effectiveness in severe forms of herpes infection will significantly increase.

Herpes immune remedies: truth and fiction

In various domestic recommendations for the treatment of herpes infection, one can often find the appointment to patients of such drugs that are inducers of interferons, or agents that stimulate the production of this substance with antiviral activity in the human body.

Patients are shown to receive such drugs as Amiksin, Ridostin, Cycloferon, and even Kagocel. Often, domestic experts advise the use of interferons themselves, such as Viferon, Reaferon and other drugs in order to raise their own non-specific immunity with antiviral activity. Are these drugs really as good at fighting the herpes virus as the antiviral drugs with the known mechanism of action described above? Let's try to understand this situation.

We give data on the first named drug – Amiksin. If you go through pharmacies and see which companies produce Amiksin and similar drugs, the active ingredient of which is tilorone, you can see that it is: the domestic company Pharmstandard, which produces Amiksin, Nizhpharm, which produces Lavomax, Dalkhimpharm, which produces an analogue of Tilaxin, the company Ozone, with the analogue of Tiloram, and so on.

It is immediately striking that among the manufacturers there are no leading world leaders in the pharmaceutical industry who produce drugs of the first group with proven antiviral activity. What's the matter?

Amiksin is widely used in Russia for many viral infections, for the prevention of influenza, for hepatitis, for acute respiratory viral infections and for herpes. In the instructions for it, you can read that it is characterized only by such side reactions as allergies, dyspepsia and chills. The instructions say that it is contraindicated for use in pregnant women, but why is unclear.

Despite the fact that this drug is actually in the laboratory, that is, in vitro, showed a fairly high activity for the synthesis of interferon, it is not used abroad. Serious side effects have been reported with this drug, such as adverse effects on fetal development or embryotoxicity. Clinical trials were stopped due to side effects. There are no international evidence-based studies conducted with a high level of reliability on Amiksin, the World Health Organization (WHO) has no information about it, it is not used in the developed countries of Europe and in the USA. Links confirming this information:

1. http://journals.sagepub.com/doi/abs/10.3109/10915819409140990 embryotoxicity;
2. https://www.ncbi.nlm.nih.gov/pubmed/1720315 Amiksin's ability to induce mucopolysaccharidosis.

As for other interferon inducers, such a drug as Cycloferon and Ridostin are also not registered outside the CIS countries, and in the countries of North America and Western Europe such a drug as Cycloferon is unknown. There are many works on cycloferon, but there is not a single randomized clinical trial (RCT) conducted with a high level of evidence for this drug, and its clinical efficacy has not been proven.

But maybe, if interferon inducers have no proven effectiveness, maybe the interferon itself, introduced into the human body, can help protect against herpes? Maybe Viferon, which is produced in different dosage forms, really helps? Viferon, for example, is available in the form of an ointment, in the form of rectal suppositories of four dosages, in the form of a gel for topical use.

Alas, it has long been proven in experiments that the direct and continuous effect of exogenous or exogenous interferon on a cell should last at least 4 hours, and in high doses. Therefore, instilling interferon into the nose, injecting it into suppositories and spreading it on the surface of the skin cannot provide any real benefits that will help in overcoming herpes infection.

It is a completely different matter when ointments, creams and gels are used for topical application, which contain really effective antiviral drugs: the same acyclovir, penciclovir, ganciclovir, and other antiviral agents. So it's time to move from drugs with questionable effectiveness, which are not used in developed countries, to local treatment of herpes infection.

Best herpes remedies for topical treatment

The best way to achieve the speedy elimination of herpetic rashes on the skin and mucous membranes is a combination of effective intake of antiviral drugs by mouth, with the creation of an effective concentration of the herpes medicine in the blood, and application to the skin and mucous membranes that stop the replication of the virus in the skin and the appearance of new foci of blistering rash. All antiviral ointments and creams must be used in the same way as pills – immediately at the initial diagnosis, or even earlier, at the stage of prodromal phenomena, when there is still no blistering rash.

In this case, the patient in the classic case may experience a slight irritation on the skin in the area of ​​the nasolabial triangle against the background of general cold symptoms, and from these unpleasant sensations, a person who already has sufficient experience understands that the next day he will have herpetic eruptions. In this case, it is necessary to immediately start using special local preparations that will help inactivating the manifestation of infection from the outside.

It should be remembered that you should not touch the herpetic vesicles with your hands, as well as the vesicles formed during the chickenpox disease. The fact is that if these hands then accidentally grab the eyes, then you can bring in a herpetic infection there, with severe damage to the cornea, then to all environments of the eye, and with an unfavorable immune status, ophthalmic herpes can transform into herpes encephalitis, with a high mortality rate. Let's consider the most famous effective topical remedies for the treatment of herpes infection.

Erazaban

Rating: 4.9

The active ingredient in Erazaban cream is docosanol. It possesses a unique mechanism of antiviral activity. It does not affect, like the drugs of the first group, a fatal change in the hereditary material of the herpes virus, but acts on the mechanism of penetration of the virus into the cell. One of the key points in this mechanism is the initial fusion of the virus with the cell membrane. It is on this stage of pathogenesis that provedanol affects.

Erazaban is applied to the area of ​​vesicular viral rashes on the skin, as well as to adjacent healthy areas, and is used in adult patients and in children over 12 years of age, for 4-6 days. In the event that the patient applied this cream before the appearance of the rash, with prodromal signs, then the use of Erazaban generally prevents the development of blistering rashes. On average, 1 or 2 days after the start of treatment, a significant improvement or even complete elimination of the rash occurs, but still, in order for the effect to be best, the cream should be applied for 5 days, or even longer. Erazaban is produced by Health Care brands International, and you can buy a cream packaged in small tubes of 2 g for 400 rubles.

Advantages and disadvantages

The only drawback of Erazaban is the rather frequent need to apply it to the skin. Every 3 hours it is necessary to renew the applied cream, and this must be done five times a day. Side effects include dry skin, and slight itching, tingling, or burning on the areas of the skin where the cream is applied. But most patients tolerate it well, but it is not recommended to apply it to the skin near the eyes. The only limitations are patients with severe immunodeficiency and pregnant women, but not because of the development of special side effects, but due to the lack of full-scale clinical studies. In patients with liver and kidney pathology, the cream can be used as usual.

Virgan

Rating: 4.8

Virgan is a special gel that is intended exclusively for use in ocular forms of herpes. Virgan contains ganciclovir, which is similar in its mechanism of action to acyclovir, and by means of competitive inhibition it disrupts the formation of viral hereditary material. This gel is active not only against herpes and varicella viruses, but also against the causative agent of cytomegalovirus infection and the Epstein-Barr virus.

This cream is used as part of complex therapy in the treatment of herpetic superficial keratitis, for the treatment of cytomegalovirus infection and for the prevention of the formation of eye complications in AIDS. This gel is recommended for prophylaxis in transplant immunodeficiencies, when the patient receives massive doses of immunosuppressive drugs, or chemotherapy in connection with the upcoming or ongoing organ transplantation.

The gel has an opalescent appearance and has a low viscosity, so it is not smeared, but is buried in the eyes, in the area of ​​the lower conjunctiva, from 3 to 5 times a day. The average duration of the course of treatment is 2 weeks, but not less than 7 and not more than 21 days. Since the conjunctiva has an increased ability to absorb, Virgan can cause minor pain, blurred vision, symptoms of eye irritation and the development of conjunctival hyperemia. Produced by Virgan Laboratoires THÉA, (France), and its average cost is about 900 rubles.

Advantages and disadvantages

The advantages of Virgan include high antiviral activity, good absorption and distribution in the intraocular media, and a relatively low resorptive capacity for absorption into the systemic circulation. Ganciclovir is the next generation antiviral agent and is more active than the usual acyclovir-containing eye ointment. The disadvantages include a ban on its use in children under 12 years old, the need to store it in a cool place. Patients with contact lenses should remember that if the ophthalmologist suspects the risk of developing ophthalmic herpes, the lenses must be removed and not worn until this risk disappears, or until the manifestations of the infection are completely cured.

Oftaquix

Rating: 4.7

Surprisingly, for the treatment of ophthalmic herpes, those drugs are also used that have no proven effect on herpesvirus. For example, we are talking about a drug such as Oftaquix, which is available in the form of eye drops and contains levofloxacin. This substance belongs to the class of fluoroquinolones, and is able to suppress the multiplication of a large number of pathogens, various bacteria, but still related to cellular life forms, unlike viruses.

But such means must be used to prevent the addition of a secondary infection, especially if ophthalmic herpes has already reached the stage of ulceration, and the patient has a high risk of developing such complications as acute purulent keratitis, iridocyclitis, or creeping corneal ulcer. None of the most effective antiviral drugs affects the reproduction of common pyogenic staphylococci, and the doctor must take this fact into account. In the event that a patient lives far enough and he can get to a doctor in only a few days, but there is a pharmacy nearby, then he needs not only to instill antiviral agents in his eyes, but also to reinforce their action with the use of local antimicrobial drugs. For the treatment of skin rashes, as a rule, such a 'reinsurance' is not required.

It is necessary to drip Oftaquix for prophylaxis every 2 hours, one or two drops into the affected eye. Starting from the 3rd day of treatment, the agent is instilled twice less often, and the course is usually no more than 5 days. It is necessary to bury not on the conjunctiva, but directly on the cornea, that is, on the 'eye itself'.

The Finnish company Santen produces Oftaquix, and one bottle containing 5 ml of drops can be purchased for 185 rubles.

Advantages and disadvantages

The advantage of Oftaquix is ​​a reliable cover, under which the treatment of eye herpes can be safer. It is active against many gram-negative and gram-positive microorganisms, is well preserved in the tear film, and is widely used for prophylaxis. Side effects include a slight burning sensation in the eye, which can occur in 10% of cases and, most often, goes away on its own. Oftaquix is ​​contraindicated for use in pregnant and lactating women, as well as in case of hypersensitivity. In childhood, it can be prescribed, but with caution.

Fenistil Pentsivir

Rating: 4.7

This cream, produced by the well-known pharmaceutical concern Novartis, contains an antiviral drug – pencivir. It is also an active metabolite, and acts on the hereditary material of the herpes virus. For comparison, in laboratory studies, it turned out that pencivir is able to stay inside cells and cope with the virus several times longer than acyclovir. But, despite laboratory tests, the application of the cream must be repeated every 2-3 hours, with the exception of the night break. But with such an inconvenient regime, in 3-4 days the cream produces the necessary therapeutic effect, and there is no need to use it for a week or even longer. The cost of a tube weighing 2 g starts at 280 rubles.

Advantages and disadvantages

As with any drug, individual intolerance to the components of the cream is a contraindication to its use. There have been no large-scale clinical studies on the use of the cream in children under 12 years of age, so it is also contraindicated for early childhood. But during pregnancy and lactation, this remedy can be applied to the skin, but very carefully, after consulting your doctor, and only if the benefits of this drug exceed the possible risk. As for the advantages of this remedy, it can help in the case when acyclovir for topical application works slowly, or a short course is needed.

Oxolinic ointment

Rating: 4.6

With oxolinic ointment, which is recommended by some domestic guidelines as an antiviral local agent, the situation is exactly the same as with interferons and its inductors. It is produced, including in the form of an intranasal form, only by domestic enterprises, and it has no proven effectiveness, both antiherpetic and antiviral in general. Chemists know oxolinic acid, which indeed has, at least in laboratory conditions, antimicrobial activity, but there is no information about scientific research abroad, and even more so, about the registration of drugs, and the introduction of drugs containing oxolin into wide clinical practice. or (dioxotetrahydroxytetrahydronaphthalene) we will not find. In North America and Western Europe, this tool is not used, and the World Health Organization (WHO) does not have any recommendations for its use for the treatment and prevention of herpes. Therefore, the decision to use oxolin in Russia is just a 'tribute to tradition'.

Conclusion

Unfortunately, many tend to underestimate the danger of herpes sores, and often they are not treated at all, especially if the patient is accustomed to the fact that in cold and rainy times he develops signs of labial herpes, or 'colds' on the lips every year. This impression is misleading. For example, an acute illness such as Bell's palsy, or paresis of the facial nerve, in which one half of the facial muscles of the facial muscle is paralyzed, most often occurs due to herpes infection. The facial nerve swells at its narrowest point, where it passes in the temporal bone canal. The speed of regression of neurological symptoms depends on the speed of prescribing antiviral therapy in the first hours of the onset of signs of paralysis. In such cases, treatment should immediately begin with taking drugs with antiviral activity inside, and support them by applying ointment and cream to the skin of the face.

In the case of the appearance of vesicular rashes along the intercostal nerves, the same strict and rigorous approach to the combined administration of drugs is required. Untreated intercostal neuralgia can result in excruciating, persistent, long-term neuropathic pain that is extremely difficult to treat.

Therefore, medical literacy of the general population, and the timely start of antiviral therapy, can serve as a guarantee, if an incomplete recovery, then a significant inactivation of the virus and its return to a dormant and inactive state.

And if, instead of immediately contacting a doctor and starting to urgently use antiviral drugs with proven efficacy, the patient relies on homeopathic remedies, compresses and traditional medicine, then most likely he will remain with partial paralysis of the facial muscles for for the rest of my life.

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Attention! This rating is subjective and does not constitute an advertisement and does not serve as a purchase guide. Before buying, you need to consult with a specialist.