What Type of Antiviral Cold Sore Medication Is Right for Me?

When it comes to treating cold sores, you have a few options when it comes to antiviral cold sore medications. You can either use an antiviral topical treatment such as Abreva, or an oral antiviral cold sore medication.¹ Depending on active ingredients and strength, antiviral cold sore medications are available either over-the-counter (OTC) or with a prescription.² Below, we’ll walk through the different types of antiviral cold sore medications to help you determine which one is right for you.

Types of Antiviral Cold Sore Medication

Docosanol

Docosanol is the active ingredient in Abreva cream.³ Docosanol is indicated to provide relief from the pain and discomfort caused by oral herpes simplex symptoms.^3,4 Although Docosanol cream cannot cure cold sores, it can decrease their healing time.^3,4 Docosanol is available as an over-the-counter cream.⁴

How to use: Docosanol cream should be applied shortly after symptoms appear.⁴ The antiviral cream should be topically applied to the cold sores and gently rubbed into the skin.⁴

Potential side effects:⁴ Headache; acne; burning sensation; dryness; itching; rash; redness; soreness; swelling.

Famciclovir

Famciclovir is an oral antiviral medication that is most commonly used to treat shingles—or herpes zoster—but can also be prescribed to treat cold sores.^2,5 Famciclovir is only available with a prescription and cannot be acquired over-the-counter.⁵ Famciclovir is available in tablet form.⁵

How to use: Famciclovir should be taken within 48 hours of the first appearance of cold sore symptoms.⁵ Famciclovir can be taken with food or without food.⁵ Always follow your physician’s instructions and the dosage information listed on the product label.

Potential side effects:⁵  Cramps; diarrhea; headache; heavy bleeding; nausea; stomach pain; bloated or feeling full; burning, crawling, itching, numbness, prickling, "pins and needles," or tingling sensation; mental confusion; excess gas; hives or welts; mood changes; flatulence; rash; skin redness; feeling, seeing, or hearing things that are not there; abnormal feelings of excitement, nervousness, or restlessness; abnormal tiredness or weakness; vomiting.

Valacyclovir

Valacyclovir is another oral antiviral medication that is only available with a prescription.⁶ In addition to treating cold sores, valacyclovir can be prescribed for the treatment of herpes zoster (shingles) and herpes simplex (genital herpes) in adults and chickenpox in children.⁶ Valacyclovir is available in tablet form.⁶

How to use: Take valacyclovir within 48 hours of the first appearance of symptoms.⁶ Valacyclovir can be taken with food or without food.⁶ While taking valacyclovir, make an effort to consume extra fluids and stay hydrated. This ensures that you’re eliminating more urine and keeping your kidneys running smoothly.⁶ Always follow your physician’s instructions and the dosage information listed on the product label.

Potential side effects:⁶ Feelings of discouragement; feeling sad or empty; irritability; loss of appetite; loss of interest or pleasure; tiredness; difficulty concentrating; difficulty sleeping; black, tarry stools; chest pain; chills; cough; decreased frequency or output of urine; fever; flu-like symptoms; headache; lower back or side pain; reduced mental alertness; shortness of breath; yellow eyes or skin.

Penciclovir

Topical penciclovir is a cream that is indicated for the treatment of cold sores.⁷ Topical penciclovir cannot cure the virus itself but it can help relieve symptoms and help speed up healing time.⁷ Unlike OTC docosanol, penciclovir cream is only available with a prescription.⁷

How to use: Apply penciclovir to your cold sores as soon as the symptoms begin to appear.⁷ Penciclovir should only be used on the face or lips, never inside the mouth or nose.⁷ Always follow your physician’s instructions and the dosage information listed on the product label.

Potential side effects: Mild pain, stinging, or burning sensation; headache; change in sense of taste; decreased skin sensitivity; skin redness; skin rash.

Acyclovir (Topical)

Topical acyclovir for cold sores is an antiviral cream that can be applied to the face or lips.⁸ Although acyclovir does not cure cold sores, it stops the virus from spreading in the body.⁸ Topical acyclovir is available by prescription.

How to use: A layer of acyclovir cream should be applied and gently rubbed into the area of skin with a cold sore.⁸ Do not apply a bandage over the area unless instructed to do so by a doctor.⁸ The best time to apply acyclovir cream is at the beginning of a cold sore outbreak when symptoms of tingling, redness, or itching have started but the cold sores itself is fully formed.⁸

Potential side effects: Cracked or dry lips; dry, flaky, or peeling skin; burning or stinging skin; redness, swelling, or irritation; hives; rash; itching; difficulty breathing or swallowing; swelling of the face, throat, lips, eyes, hands, feet, ankles, or lower legs; hoarseness.

Acyclovir (Oral)

Acyclovir is also available orally as a tablet, suspension, capsule, powder, and solution.⁹ Oral acyclovir in all forms is only available by prescription.

How to use: Dosage and usage instructions will vary depending on the form of oral acyclovir you’re taking.⁹ Always follow your physician’s instructions and the dosage information listed on the product label.

Potential side effects:⁹ Pain, swelling, or redness attheinjection site (if taking intravenously); abdominal or stomach pain; decreased amount of urine or frequency of urination; increased thirst; loss of appetite; nausea or vomiting; abnormal tiredness or weakness

How Long Do Antivirals Take to Work?

Cold sores will heal on their own in seven to 10 days, but using an antiviral cold sore medication can speed up the healing process.¹⁰ Taking famciclovir or valacyclovir can shorten the period that you experience cold sore symptoms by one to two days.¹⁰ Using a topical cream generally requires daily application for five days to relieve symptoms.¹⁰ Ultimately, the choice of antiviral cold sore medication is up to you! Always consult your doctor before trying a new medication.