Valtrex (Valacyclovir)

From: <a href="http://phoenixrising.me/treating-cfs-chronic-fatigue-syndrome-me/immune/antivirals-and-immunemodulators/valtrex">http://phoenixrising.me/treating-cfs-chronic-fatigue-syndrome-me/immune/antivirals-and-immunemodulators/valtrex</a>

Valtrex (valycyclovir) is…

an antiviral drug approved to treat genital herpes infection, herpes zoster (shingles) and herpes labialis (cold sores) infections. Dr. Martin Lerner of Royal Beaumont Hospital in Royal Oak, Michigan, is currently investigating its efficacy in chronic fatigue syndrome (ME/CFS) patients with Epstein-Barr virus infections. Valtrex is converted in the body to acyclovir which inhibits viral DNA replication. It is produced by GlaxoSmithKline.

Valtrex May Work in Chronic Fatigue Syndrome (ME/CFS) Because..

it may inhibit the replication of a virus (Epstein-Barr virus (EBV) shown to be activated in some chronic fatigue syndrome (ME/CFS) patients.

Chronic Fatigue Syndrome (ME/CFS) Studies

Dr. Lerner’s 2002 Valtrex trial resulted in much decreased symptoms and increased energy and improved ventricular functioning for about 2/3rds of ME/ CFS patients at 18 months suggests an EBV associated cardiomyopathy may be important in some patients.

A blinded, placebo-controlled 2007 study of chronic fatigue syndrome (ME/CFS) patients with documented Epstein-Barr virus (EBV) reactivation by Dr. Lerner found Valtrex resulted in increased physical functioning and improved heart functioning (reduced sinus tachycardias, decreased abnormal cardiac wall movements) and reduced EBV antibody levels. He reported that many patients were able to resume normal activities by the end of the 36 month trial.

Patients with both EBV and cytomegalovirus infections did not improve. This suggested a different kind of drug treatment was needed for patients with multiple infections.

A recent study may explain why long time antiviral therapy may be necessary to successfully fight an EBV infectious (Hoshino 2009). It found that Valacyclovir reduces cell to cell reinfection but does not effect EBV infected cells. Since cell to cell reinfection is the chief means EBV has of maintaining itself in the body very long term antiviral therapy could reduce EBV infection rates simply by allowing infected B cells to die off over time without being replaced. This could account for the long treatment times needed some CFS physicians call for.

<ul >

<li >Dig Deeper! <a href="http://aboutmecfs.org/Rsrch/EBVPtI.aspx" >EBV and Chronic Fatigue Syndrome (ME/CFS)</a></li>

<li >Dig Deeper!<a href="http://www.treatmentcenterforcfs.com/CFS_Foundation/index.html" > Dr. Lerner’s Website</a></li>

</ul>

Dosing

In his <a href="http://www.treatmentcenterforcfs.com/documents/MECFSTreatmentResourceGuideforPractitioners.pdf" >ME/CFS Treatment Guide </a>Dr Lerner states “If the patient weighs 70 kg, the dosage is 1 gram four times daily, ideally every six hours; however safe to take four hours after the last dosage (it is not necessary to awake in the middle of the night for a dose). It is important that the patient take four doses for treatment.

A higher dose of Valtrex may be necessary with patients who weigh more than 175 pounds and this must be done carefully. A patient who weighs more than 175 pounds may require 1.5 grams of Valtrex, valacyclovir four times daily.

Please note valacyclovir is now available in generic form. While I have not had experience with all distributors of generic forms yet, I have had patients move to the generic form of valacyclovir by Teva and Mylan with no issue. Famvir at the same dosage can be substituted and although there is not the strong evidence that we have

for valacyclovir, it likely is equally effective.”

Benefits usually do not begin until after 6 weeks and the drug is usually taken for a minimum of a year.

Side Effects

Dr. Lerner call’s Valtrex “remarkably safe and effective” but notes that “one concern is that valacyclovir is excreted….can cause acyclovir stones and obstructive uropathy. This will not occur if the patient drinks at least six 8-ounce glasses of water daily. Side effects can include nausea, headache, fatigue, diarrhea and others.

Herxheimer effects early in the treatment protocol are common and suggest a good prognosis.

From user on <a href="http://forums.phoenixrising.me/index.php?threads/best-antiviral-for-ebv-and-hsv-1-titer.43533/">http://forums.phoenixrising.me/index.php?threads/best-antiviral-for-ebv-and-hsv-1-titer.43533/</a>

i tried the Valtrex and it made me depressed

From: PhoenixRising user herpesbaby on 'valtrex withdrawal symptoms' <a href="http://forums.phoenixrising.me/index.php?threads/valtrex-withdrawal-symptoms.53347/">http://forums.phoenixrising.me/index.php?threads/valtrex-withdrawal-symptoms.53347/</a>

My Doctor suggested that therapy should be at least 6 weeks.

(I stopped because of my concern that) it is possible for patients with herpes who take long courses of valtrex to stop making antibodies to the virus because valtrex is preventing the virus from reproducing. That's why they test negative - even though they still have the virus - but the body stopped making antibodies.

From: PhoenixRising user Wonkmonk on 'valtrex withdrawal symptoms' <a href="http://forums.phoenixrising.me/index.php?threads/valtrex-withdrawal-symptoms.53347/">http://forums.phoenixrising.me/index.php?threads/valtrex-withdrawal-symptoms.53347/</a>

It has to be taken for at least 4-6 months to see any improvement (which I can confirm in my case), so maybe the 6 weeks were not enough to have a good effect.

If you have a primary infection or reactivation with active herpes virus replication, your immune system produces IgM antibodies. If you take Valtrex, active replication stops, and the body stops producing IgM antibodies, but that's a good thing because they are no longer needed.

Also, if you ever had a herpes virus infection, you never test negative. The virus stays in a dormant state in the body without replicating and another type of antibody, IgG antibodies, will be present for the rest of your life. Every once in a while, there is a reactivation of the virus and it starts to replicate. If the patient is immunocompetent, the body quickly produces IgM antibodies and attacks the virus and fights it back into the dormant state.

As long as there is active herpes virus replication, your immune system will produce IgM antibodies and attack the virus - with or without Valtrex. Only once active replication has been suppressed, it stops producing IgM antibodies. That's going to happen faster if you take Valtrex, but it isn't any sort of immune system dysfunction because of the Valtrex. It is how things ought to be.

This study hypothesizes that several years of high-dose Valtrex could eradicate EBV:<a href="http://jvi.asm.org/content/83/22/11857.full" target="_blank" rel="nofollow" >http://jvi.asm.org/content/83/22/11857.full</a>

(I think I also read about some patients who received Rituximab cleared EBV entirely from the body.)

From: PhoenixRising user Learner1 on 'valtrex withdrawal symptoms' <a href="http://forums.phoenixrising.me/index.php?threads/valtrex-withdrawal-symptoms.53347/">http://forums.phoenixrising.me/index.php?threads/valtrex-withdrawal-symptoms.53347/</a>

It is important to be monitored on Valtrex, Valcyte, etc. for kidney, liver, and bone marrow function.

Its also helpful to be on a nutrient support program to promote liver, kidney, and bone marrow health.

And, as my expert CFS doc says, "Beating these infections back is the most important thing. They're damaging your body and promoting autoimmune antibodies which are making you sicker. You'll be on these drugs for many months, but we'll monitor you the entire time and back off if we need to."

And though IgG antibodies will be there if you've had a past infection, there are most definitely situations where high values indicate a recurrent infection. I spent a year wondering if I actually had some of the infections I do, and had a few doctors dismiss them as I had no IgM readings. But, when I got to my expert CFS doc, he said "I know what we were taught in medical school, but these values indicate that you absolutely have an active infection."

Its important to use different methods to test for infections. He found a huge hidden EBV infection that hadnt shown up on other tests as my immune system was too compromised to register. Its important to know what infections you have so you know how to fight them best.

Having immunoglobulins checked (with subclasses) is also a good idea. Apparently, some of us need IVIG for out immune systems to work well enough to fight off the infections with the drugs.

From: PhoenixRising user Wonkmonk on 'Renal injury after high-dose Valacyclovir - do I have to stop completely?' <a href="http://forums.phoenixrising.me/index.php?threads/renal-injury-after-high-dose-valacyclovir-do-i-have-to-stop-completely.52193/">http://forums.phoenixrising.me/index.php?threads/renal-injury-after-high-dose-valacyclovir-do-i-have-to-stop-completely.52193/</a>

after tests in January returned elevated EBV Early-antibodies, I started Valacyclovir treatment according to the protokoll suggested by Dr. Lerner. I'm 95 kg so I used the higher recommended dose of 1,500mg four times a day.

In the beginning, I had the Herxheimer reaction Dr Lerner warns about, but after 3 months, several of my symptoms improved markedly (e.g., joint pain).

I was monitored by a physician during the whole period, and we performed all tests recommended by Dr Lerner (blood counts, liver and kidney tests, urinalysis). All were normal in the first 3 months. I always drank more than six 8-ounce glasses of water per day as recommended.

While some symptoms stayed improved, my overall state deteriorated sharply in the 4th months of treatment. In particular, I developed neurological symptoms (dizziness, extreme sleepiness) and fatigue worsened dramatically and I felt very sick.

The following blood test showed borderline ALT/AST and an impaired kidney function with elevated creatinine of 1.4 (norm: 0.8-1.2) and a GFR of 65 (normal: >90). Urinalysis was normal (no protein or Hb in the sample).

I was then diagnosed with Valacyclovir-induced kidney injury with concomitant neurotoxic symptoms and was advised to stop Valacyclovir completely until the kidneys improve, which I did.

Two weeks later, another blood test showed that all values had recovered. Creatinine, GFR, AST and ALT all returned to normal. Urinalysis was also normal.

I then thought I could restart Valacyclovir starting at a lower dose of 500mg four times a day. But when I tried yesterday, even with the much lower dose, within a few hours, I had pain in the kidney region, nausea, general malaise, back pain and the neurological symptoms also returned (a bit weaker though). I immediately stopped taking the drug.

My question is:

Does that mean that I shouldn't restart Valacyclovir again and have to switch to Famciclovir (which is much more expensive)?

Or were the two weeks not enough for the kidneys to recover completely (despite good blood tests)?

Is there a chance I can restart Valacyclovir in 1 month perhaps, or 3 months or is it generally too dangerous?

I absolutely agree with you that strong caution is required. The only other good option I know of is Famciclovir, but it is very expensive in my country (_€250 per day of treatment).

So my hope is that at some point I might be able to restart Valacyclovir. I know that in one of his studies, Dr Lerner recommends in the case of Valcyte (ValGANciclovir) that if liver values deteriorate, patients can wait for a while until they come down and then he restarts with the drug at a lower dose.

The problem in my case is that even the lowest dose that would likely be effective for my weight (500mg 4x a day) had really bad side effects the first day after restarting it.

So I'm wondering if there is anyone out there who successfully restarted Valacyclovir after having stopped it because of renal injury.

Valtrex (Valacyclovir)

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