There are several medications available to treat fever blisters. Some are used topically and others are taken orally. Fever blisters are best treated as early as possible. Starting a medication when prodromal symptoms such as burning, tingling, or redness start gives the best chance of keeping the fever blisters from developing or shortening their course. There are several antiviral medications that are used to treat herpes infections. The FDA approves these medications for the specific type of infections they treat. The FDA has approved the use of certain drugs for fever blisters, but some antiviral drugs that are not specifically FDA approved for fever blisters have been shown in clinical studies to be effective. Receiving a prescription for an off-label use of one of these drugs may still be effective. The decision to use a medication that is prescribed off-label should be made based on current data and discussed thoroughly with a health-care provider.

Fever Blister Treatment - Penciclovir

Penciclovir 1% cream is FDA-approved for recurrent fever blisters. It is applied every 2 hours to the site for 4 days. Starting treatment within 1 hour of an outbreak reduced the time to healing by 2 days and reduced the symptoms. Penciclovir also decreases the duration viral shedding. The earlier Penciclovir is started the better the benefits, but improvement was still found when Penciclovir was started even after vesicles developed.

Fever Blister Treatment - Acyclovir

Acyclovir 5% cream is also FDA approved for the treatment of recurrent fever blisters. In studies, frequent application of the cream reduced the time to healing by about half a day. Oral acyclovir given 5 times a day for primary gingivostomatitis in children shortened the course from 10 days to 4 days and reduced the duration of fever, eating and drinking difficulties, and viral shedding. Using low dose oral acyclovir for fever blisters shortened the duration by about 1 day but did not affect pain. Using a higher dose and starting during the prodrome phase did have an effect on pain and duration.

Fever Blister Treatment - Suppression Therapy

Suppression therapy, taking medication every day to prevent outbreaks, is not yet FDA-approved. Studies have shown that people who have more than 6 recurrences or more per year can benefit from taking acyclovir 400 mg twice daily by reducing the number of recurrences and decreasing viral shedding. Other possibilities are famciclovir 250 mg twice a day or valacyclovir 500 mg once a day.

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