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About Aciclovir cream

Aciclovir is an antiviral which stops herpes viruses multiplying and spreading. Aciclovir cream is used to treat cold sores around the lips, caused by herpes virus. See cold sore information page for details about cold sores, their treatment, and how to order.

Aciclovir 5% cream is available under different brand names, e.g. Zovirax (which was the original brand), Boots Antiviral Cold Sore Cream, Virasorb Cold Sore Cream, Pinewood Cold Sore Cream, and Teva aciclovir cream. All contain the same active ingredient. Dr Fox supplies 2 gram and 10 gram tubes. The 2 gram tube is for a single course of treatment and is also available over the counter at pharmacies, supermarkets, and other shops. The 10 gram tube is sufficient for repeated courses. Once opened, tubes should be stored in a cool place (below 25°C), but not in a fridge. Tubes should not be shared between people and should be discarded when out-of-date.

How to use

Apply cream at the first sign of a cold sore, preferably at the tingling/itching stage before the sore is visible, although it can still be used once the sore has appeared. Apply by gently dabbing cream with a clean finger or cotton bud over the sore five times daily. Treatment should be continued for at least 4 days, but can be continued for up to a total of 10 days if the sore has not healed. If an application is missed, apply when you remember and then continue without extra doses.

Wash hands after use, to prevent spreading cold sores and getting cream into the eyes or mouth. Do NOT apply around the eyes. Wash away any contamination from the eyes with lots of cool water. Aciclovir cream should not be used inside the mouth or swallowed, however swallowing a small amount is unlikely to be harmful.

When to see a doctor

Use aciclovir only if you have a recurrence of your typical cold sore. Consult a doctor if the sore is different from normal, has not healed after 10 days, or there are other symptoms such as fever and headache.

Yellow, sticky, crusty spreading lesions are more likely to be impetigo (see photos of perioral impetigo infection) which is very contagious and should be treated with antibiotics or hydrogen peroxide, not antivirals. If unsure, consult your regular doctor.

Side effects of aciclovir cream

Not everybody gets side effects. The most common are mild burning, redness, itching, dry skin, and other rashes. For a full list see the manufacturer's leaflet supplied with the cream. Stop using if there is an allergic type reaction with swelling of the lips, face, and eyelids.

Pregnancy and breastfeeding

Only very small amounts of aciclovir are likely to pass into the body, but you should discuss this with a doctor before use.

Active cold sores can pass the herpes virus to newborn infants so consult your GP or midwife if you develop cold sores in late pregnancy or whilst breastfeeding.

See BUMPS - Aciclovir factsheet.

What else can I do to prevent outbreaks?

Sunlight is often a trigger for cold sores. Wearing a sun hat, using a strong sunscreen and a sunblock lip balm (SPF >15) will help to reduce outbreaks. A healthy diet, plenty of sleep, and not getting run down also helps. Do not use sun beds.

Aciclovir 400mg tablets can be taken twice daily to reduce the frequency of outbreaks, if you are getting more than 6 per year. This is called suppression treatment.

Other measures to help with cold sores

• Pain can be helped by paracetamol or ibuprofen.
• Mouthwash, and anaesthetic gels may help with pain from lesions inside the mouth.
• Lip barrier gels may be soothing.
• Cold sore patches may help with healing, disguise the sore and also provide a barrier to reduce risk of spread.
• Drink plenty of water to prevent dehydration.

If cold sores are not improving after 5-7 days or you are seriously unwell with them, consult your regular doctor.

There are devices on the market which offer heat or near-infra-red light therapy for cold sores. Both types of product have been shown in their manufacturers' trials to be effective at reducing symptoms and overall healing times.

Delay dental treatment until lesions have healed.

Other cold sore treatments

Other cold sore creams are also available. Many contain ingredients which soothe cold sores but do not contain an active antiviral. Some cold sore creams contain docosanol, which may have a small direct effect on the herpes virus, but is not as effective as aciclovir.

Cold sores can also be treated by taking aciclovir or valaciclovir by mouth as tablets. Aciclovir tablets are usually more effective than aciclovir cream. In some situations other antiviral medication may be prescribed by specialist doctors.

Further information

• NHS - Cold sores
• British Association of Dermatologists - Herpes simplex

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