Klarinet Archive - Posting 000935.txt from 1999/02

From: Martin Pergler <pergler@-----.edu>
Subj: RE: [kl] Cold Sores (acyclovir)
Date: Thu, 25 Feb 1999 02:10:59 -0500

Question to the doctor types:

The standard prescription I get for acyclovir tablets seems to be
"take for 3 (or 5) days", but without the stern warning given with
antibiotics to not stop early. Is it harmful to not finish
the prescription?

What I'd like to do is have a bottle of tablets (they're quite
expensive) at home or in my locker, and if I feel a cold sore
"coming on" to take the 200mg 5x daily for a day, since
it's usually gone in 1/2 day for me, or 2 days if I don't take
the acyclovir. But I don't want to develop (or worse yet, spread)
a resistant strain. Need I worry?

What follows is my guesswork, that of someone with no medical
training, but who read a bit before starting to take something
repeatedly. Is it valid?

I understand acyclovir is supposed to work by damaging/inhibiting
the ability of herpes-family viruses to replicate, hopefully
lessening the length or severity of an outbreak, whether it is a
cold sore, chicken pox, or genital herpes (different viruses of the
same "family"). Sometimes it can even prevent an outbreak from
starting or becoming bothersome. However, I also gather that
controlled clinical trials were less effective than the theory would
suggest, and that effectiveness varies from person to person. In any
case, the virus remains dormant in the nerve endings between/after
outbreak, so resistant mutants are presumably a non-issue. Thus the
only risk in stopping taking acyclovir too early is that the current
outbreak is not actually contained and will take longer, not that
the risk of future outbreaks *not* reacting to acyclovir is
increased. Is this right?

(This part pure speculation:) I would suspect that the placebo
effect may apply quite strongly here: If I am stressed, I am more
likely to "get" a cold sore or have a more severe one. If I have a
cold sore and need to play, I will be stressed. If I take pills,
whether acyclovir, lysine, or anything else that "usually works" for
me, I will be less stressed since I will have faith my cold sore
will go away, and it truly will since I am less stressed! My faith
in my pills is thus increased and so they work even better next
time. Great, though if it's all placebo effect I would prefer not to
pay over $1 a pill.

Martin

--
Martin Pergler pergler@-----.edu
Grad student, Mathematics http://www.math.uchicago.edu/~pergler
Univ. of Chicago

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