Compare Valtrex (Valacyclovir) with Alternatives: What Works Best for Cold Sores and Herpes

If you’ve been prescribed Valtrex for a cold sore, genital herpes, or shingles, you’ve probably wondered: is there something better? Or cheaper? Or just as effective without the side effects? You’re not alone. Thousands of people in New Zealand and around the world ask the same thing every year. The truth is, Valtrex isn’t the only option - and for some, it’s not even the best one.

What is Valtrex, really?

Valtrex is the brand name for valacyclovir, an antiviral drug that stops herpes viruses from multiplying in your body. It’s used for treating outbreaks of cold sores (oral herpes), genital herpes, and shingles (herpes zoster). The key advantage? It’s absorbed better than older drugs, so you take fewer pills. A typical cold sore dose is just one 2,000 mg tablet twice a day for one day.

But Valtrex doesn’t kill the virus. It just slows it down. That’s why it works best when taken within 24 hours of the first tingling or burning sensation. If you wait too long, it won’t help much. And it won’t prevent future outbreaks - only reduce their severity and duration.

How does valacyclovir compare to acyclovir?

Acyclovir is the original drug that valacyclovir was built from. It’s been around since the 1980s and is available as a generic. You might see it sold as Zovirax or just as acyclovir tablets.

The big difference? Dosing. To treat a cold sore with acyclovir, you need to take 200 mg five times a day for five days. That’s one pill every four hours, even at night. Most people forget. Or find it too inconvenient. Valtrex, by contrast, is just two pills total in one day.

But here’s the catch: acyclovir is cheaper. In New Zealand, a 5-day course of generic acyclovir costs about $15-$20 at most pharmacies. A single Valtrex pack for a cold sore can run $40-$60 without subsidy. If you’re on a budget and don’t mind the hassle, acyclovir still works - it just takes more effort.

Famciclovir: The middle ground

Famciclovir (brand name Famvir) is another antiviral option. It’s similar to Valtrex in how well it’s absorbed, but it’s often used for shingles and genital herpes outbreaks.

For shingles, famciclovir is taken three times a day for seven days. For genital herpes, it’s usually 1,000 mg twice a day for one day - just like Valtrex. The dosing is equally simple. Studies show it works just as well as Valtrex for reducing outbreak length and pain.

But famciclovir isn’t always covered by the same subsidies as Valtrex in New Zealand. If you’re paying full price, it’s often more expensive than acyclovir and sometimes even pricier than Valtrex. It’s a solid alternative, but not always the most cost-effective.

Topical creams: Do they help?

You’ve probably seen creams like Abreva (docosanol) or Zovirax cream (acyclovir) in the pharmacy aisle. They promise to shrink cold sores overnight. The reality? They offer mild relief at best.

Docosanol reduces healing time by about half a day, on average. That’s not nothing - but it’s not a game-changer. Topical antivirals like acyclovir cream need to be applied five times a day for five days. Most people stop after day two because it’s messy and doesn’t feel like it’s working.

These creams are fine if you’re avoiding pills for medical reasons, or if you just have a single, small cold sore. But if you get frequent outbreaks, or if you’re trying to stop an outbreak before it explodes, pills are far more effective.

Is there a natural alternative?

People turn to lysine supplements, lemon balm, tea tree oil, or zinc oxide to treat cold sores. Some swear by them. But science says otherwise.

A 2023 review of 12 clinical trials found no strong evidence that lysine reduces outbreak frequency or severity. Topical lemon balm showed slight improvement in healing time - but only in small, low-quality studies. Tea tree oil can irritate skin and isn’t regulated for safety.

These aren’t dangerous, but they’re not replacements for antivirals. If you’re using them alongside Valtrex or acyclovir, fine. If you’re skipping the prescription to save money or avoid chemicals, you’re risking longer outbreaks and more spreading.

Who should choose what?

Here’s a simple guide based on your situation:

• Want the fastest, easiest treatment? Go with Valtrex. One or two pills, one day. Best for people who get frequent outbreaks or hate taking pills multiple times a day.
• On a tight budget? Acyclovir is your best bet. It’s cheap, effective, and widely available. Just be prepared to take it five times a day.
• Dealing with shingles? Both Valtrex and famciclovir are recommended. Your doctor might pick one based on your kidney function or other meds you take.
• Just got one small cold sore? A topical cream might be enough. But if it’s your fifth outbreak this year, skip the cream and take a pill.
• Have kidney problems? Talk to your doctor. All these drugs are processed by the kidneys. Doses may need to be lowered.

Side effects and safety

All three oral antivirals - Valtrex, acyclovir, and famciclovir - have similar side effect profiles. Most people feel nothing. The most common complaints are:

• Headache
• Nausea
• Dizziness
• Mild stomach upset

Severe reactions are rare. But if you get confusion, tremors, or hallucinations after taking any of these, stop and call your doctor. That could be a sign of toxicity, especially if you have kidney issues.

These drugs are safe during pregnancy if prescribed. They’re also safe for older adults, as long as kidney function is checked.

What about resistance?

Herpes viruses can become resistant to antivirals - but it’s uncommon in healthy people. Resistance usually shows up in people with weakened immune systems, like those with HIV or after organ transplants.

If you’ve been taking Valtrex for years and notice outbreaks lasting longer or getting worse, it might be worth checking with your doctor. They can test for resistance and switch you to another drug if needed.

Bottom line: No single ‘best’ option

Valtrex isn’t the best for everyone - but it’s the most convenient. Acyclovir is the most affordable. Famciclovir is a close second in effectiveness. Creams help a little. Natural remedies don’t deliver what they promise.

Your choice depends on your budget, how often you get outbreaks, and how much effort you’re willing to put in. If you’re not sure, ask your pharmacist. They can compare prices, check your subsidy status, and help you pick the right one.

And remember: antivirals work best when taken early. Keep a pack on hand if you get cold sores often. Don’t wait until the blister is full of fluid - that’s already too late.

What to do next

If you’re unsure which medication to use, start by checking your pharmacy’s price list. Many pharmacies in Christchurch offer price comparisons between generic acyclovir and brand-name Valtrex. Ask if you qualify for a prescription subsidy - it can cut the cost by half.

Keep a small supply of antiviral pills at home if you get outbreaks often. Store them in a cool, dry place. Set a reminder on your phone to take them as soon as you feel the first sign - a tingle, itch, or red spot.

And if you’re sexually active, remember: antivirals reduce but don’t eliminate the risk of spreading herpes. Always use condoms and talk to your partner. Medication helps - but communication matters too.