Valtrex

Drug overview for VALTREX (valacyclovir hcl):

Generic name: VALACYCLOVIR HCL (val-uh-SYE-klo-veer)
Drug class: Antiviral - Herpes Viruses
Therapeutic class: Anti-Infective Agents

Valacyclovir, the l-valine ester of acyclovir, is an antiviral agent that is a prodrug of acyclovir and is active against herpes viruses.

Oral valacyclovir is used for the treatment of initial and recurrent episodes of genital herpes infections in immunocompetent adults and adolescents and for the suppression of recurrent episodes of genital herpes in immunocompetent adults and adolescents and individuals infected with human immunodeficiency virus (HIV). Valacyclovir also is used for the episodic treatment of herpes labialis (perioral herpes, cold sores, fever blisters) in adults and adolescents and for the treatment of acute, localized herpes zoster (shingles, zoster) in adults and adolescents. The manufacturer states that safety and efficacy of valacyclovir in immunocompromised patients have not been established for any use other than suppression of genital herpes and safety and efficacy of the drug have not been established for any use in prepubertal pediatric patients.

DRUG IMAGES

VALTREX 1 GM CAPLET
VALTREX 500 MG CAPLET

The following indications for VALTREX (valacyclovir hcl) have been approved by the FDA:

Indications:
Chickenpox
Genital herpes simplex
Herpes labialis
Herpes zoster
Recurrent herpes genitalis
Suppression of recurrent Herpes simplex infection in HIV
Suppression of recurrent herpes simplex infection

Professional Synonyms:
Herpes genitalis
Herpes simplex type 1 infection of the lip or nares
HSV type 1 infection of the lip or nares
Latent varicella zoster virus infection
Latent VZV infection
Prophylaxis for herpes simplex
Recurrent genital herpes simplex
Varicella

The following dosing information is available for VALTREX (valacyclovir hcl):

Dosing
Administration
VALTREX
VALACYCLOVIR

Dosage of valacyclovir hydrochloride is expressed in terms of valacyclovir.

Valacyclovir dosage modification according to renal function may be necessary in geriatric patients, depending on the underlying renal status of the patient. (See Dosage and Administration: Dosage in Renal and Hepatic Impairment.)

The manufacturer states that valacyclovir should be used with caution in patients receiving potentially nephrotoxic agents because this may increase the risk of renal dysfunction and/or reversible CNS manifestations. In patients with impaired renal function, doses and/or frequency of administration of valacyclovir must be modified in response to the degree of impairment.

For the treatment of first episodes of genital herpes in immunocompetent adults with impaired renal function, the manufacturer states that patients with creatinine clearances of 30 mL/minute per 1.73 m2 or greater may receive the usual oral valacyclovir dosage of 1 g every 12 hours; however, those with creatinine clearances of 10-29 or less than 10 mL/minute per 1.73 m2 should receive 1 g or 500 mg, respectively, once every 24 hours.

For the episodic treatment of recurrent genital herpes in immunocompetent adults with impaired renal function, patients with creatinine clearances of 30 mL/minute per 1.73 m2 may receive the usual dosage of 500 mg every 12 hours, but those with clearances of 29 mL/minute per 1.73 m2 or less should receive 500 mg once every 24 hours.

For chronic suppression of recurrent episodes of genital herpes in immunocompetent adults with renal impairment, those with creatinine clearances of 30 mL/minute per 1.73 m2 or greater may receive the usually recommended dosage of oral valacyclovir. Patients with creatinine clearances less than 30 mL/minute per 1.73

m2 should receive 500 mg once every 24 hours; alternatively, those with a history of 9 or fewer recurrences per year may receive 500 mg once every 48 hours.

For chronic suppression of recurrent episodes of genital herpes in HIV-infected adults with renal impairment, those with creatinine clearances of 30 mL/minute per 1.73 m2 or greater may receive the usually recommended dosage of oral valacyclovir and those with creatinine clearances less than 30 mL/minute per 1.73 m2 should receive 500 mg once every 24 hours.

For the treatment of herpes labialis (cold sores) in patients with renal impairment, patients with creatinine clearances of 50 mL/minute or greater per 1.73 m2 may receive the usual oral valacyclovir dosage of 2 g every 12 hours for 1 day. Those with creatinine clearances of 30-49 mL/minute per 1.73

m2 should receive 1 g every 12 hours for 1 day, those with creatinine clearances of 10-29mL/minute per 1.73 m2 should receive 500 mg every 12 hours for 1 day, and those with creatinine clearances less than 10 mL/minute per 1.73 m2 should receive a single 500-mg dose.

For the treatment of acute, localized herpes zoster in adults, the manufacturer states that patients with creatinine clearances of 50 mL/minute or greater per 1.73 m2 may receive the usual oral valacyclovir dosage of 1 g every 8 hours. Those with creatinine clearances of 30-49 mL/minute per 1.73

m2 should receive 1 g every 12 hours, and those with creatinine clearances of 10-29 or less than 10 mL/minute per 1.73 m2 should receive 1 g or 500 mg, respectively, once every 24 hours.

Because acyclovir is removed by hemodialysis, the manufacturer states that patients undergoing hemodialysis may require a supplemental dose of valacyclovir after each dialysis period. However, if usual dosing coincides with a valacyclovir dose being administered soon after hemodialysis and subsequent dialysis takes place toward the end of the dosing interval, a supplemental dose would not be necessary.

Information regarding use of valacyclovir in patients undergoing peritoneal dialysis is not available. Based on experience with acyclovir, the manufacturer states that supplemental doses of valacyclovir do not appear to be necessary following peritoneal dialysis, either continuous ambulatory peritoneal dialysis (CAPD) or continuous arteriovenous hemofiltration/dialysis (CAVHD).

The rate but not the extent of conversion of valacyclovir to acyclovir may be reduced in patients with moderate (biopsy-proven cirrhosis) or severe (with and without ascites and biopsy-proven cirrhosis) hepatic impairment. Therefore, the manufacturer states that dosage modification is not necessary for patients with cirrhosis.

Valacyclovir hydrochloride is administered orally without regard to meals. Food does not affect systemic bioavailability of the drug. Patients should maintain adequate hydration during valacyclovir treatment.

Dosing information for VALTREX
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
VALTREX 1 GM CAPLET	Maintenance	Adults take 1 tablet (1,000 mg) by oral route every 12 hours
VALTREX 500 MG CAPLET	Maintenance	Adults take 1 tablet (500 mg) by oral route once daily

Generic dosing information for VALACYCLOVIR
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
VALACYCLOVIR HCL 500 MG TABLET	Maintenance	Adults take 1 tablet (500 mg) by oral route once daily
VALACYCLOVIR HCL 1 GRAM TABLET	Maintenance	Adults take 1 tablet (1,000 mg) by oral route every 12 hours

The following drug interaction information is available for VALTREX (valacyclovir hcl):

Contraindicated
Severe
Moderate

There are 1 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction	Drug Names
Varicella; Zoster Live Vaccine/Acyclovir; Famciclovir; Valacyclovir SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Acyclovir, famciclovir, and valacyclovir inhibit varicella zoster virus activity and may prevent the body from developing an immune response to the live vaccine. CLINICAL EFFECTS: Administration of antiviral agents active against varicella zoster virus may decrease the efficacy of live, attenuated varicella or zoster vaccines.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: CDC immunization guidelines recommend acyclovir, famciclovir or valacyclovir discontinuation at least 24 hours prior to administration of varicella or zoster vaccines, if possible. Delay use or resumption of antiviral therapy for 14 days after vaccination.(1) DISCUSSION: Acyclovir, famciclovir, valacyclovir inhibit varicella zoster virus activity and may prevent the body from developing an immune response to the live vaccine, decreasing the efficacy of efficacy of live, attenuated varicella or zoster vaccines.(1)	PROQUAD, VARIVAX VACCINE

Drug Interaction

Drug Names

Varicella; Zoster Live Vaccine/Acyclovir; Famciclovir; Valacyclovir

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Acyclovir, famciclovir, and valacyclovir inhibit varicella zoster virus activity and may prevent the body from developing an immune response to the live vaccine.

CLINICAL EFFECTS: Administration of antiviral agents active against varicella zoster virus may decrease the efficacy of live, attenuated varicella or zoster vaccines.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: CDC immunization guidelines recommend acyclovir, famciclovir or valacyclovir discontinuation at least 24 hours prior to administration of varicella or zoster vaccines, if possible. Delay use or resumption of antiviral therapy for 14 days after vaccination.(1)

DISCUSSION: Acyclovir, famciclovir, valacyclovir inhibit varicella zoster virus activity and may prevent the body from developing an immune response to the live vaccine, decreasing the efficacy of efficacy of live, attenuated varicella or zoster vaccines.(1)

PROQUAD, VARIVAX VACCINE

There are 4 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Tizanidine/Acyclovir SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Acyclovir may inhibit the metabolism of tizanidine by CYP1A2.(1) CLINICAL EFFECTS: Concurrent use of acyclovir may result in elevated levels of and effects from tizanidine, including hypotension, bradycardia, drowsiness, sedation, and decreased psychomotor function. PREDISPOSING FACTORS: The risk of anticholinergic toxicities including cognitive decline, delirium, falls and fractures is increased in geriatric patients using more than one medicine with anticholinergic properties.(2) PATIENT MANAGEMENT: The US manufacturer of tizanidine states that concurrent use of tizanidine with inhibitors of CYP1A2, such as acyclovir, should be avoided. If concurrent use is warranted, tizanidine should be initiated with a 2 mg dose and increased in 2-4 mg steps daily based on patient response to therapy.(1) If adverse reactions such as hypotension, bradycardia, or excessive drowsiness occur, reduce or discontinue tizanidine therapy.(1) DISCUSSION: In a study in 10 healthy subjects, concurrent fluvoxamine, another inhibitor of CYP1A2, increased tizanidine maximum concentration (Cmax), area-under-curve (AUC), and half-life (T1/2) by 12-fold, 33-fold, and 3-fold, respectively. Significant decreases in blood pressure and increases in drowsiness and psychomotor impairment occurred.(1) In a study in 10 healthy subjects, concurrent ciprofloxacin, another inhibitor of CYP1A2, increase tizanidine Cmax and AUC by 7-fold and 10-fold, respectively. Significant decreases in blood pressure and and increases in drowsiness and psychomotor impairment occurred.(1)	TIZANIDINE HCL, ZANAFLEX
Talimogene laherparepvec/Acyclovir;Valacyclovir;Famciclovir SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Talimogene laherparepvec is a live, attenuated herpes simplex virus (HSV-1) which has been modified to express human GM-CSF.(1) Acyclovir, famciclovir, and valacyclovir inhibit HSV virus activity. CLINICAL EFFECTS: Administration of antiherpetic agents may interfere with the effectiveness of talimogene laherparepvec.(1) Agents linked to this monograph are systemic formulations of acyclovir, valacyclovir and famciclovir. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid concomitant use when possible. Talimogene laherparepvec is a live, attenuated herpes simplex virus (HSV-1) which is injected into cancerous lesions where it replicates and produces GM-CSF, leading to lysis of tumors. It is sensitive to antiherpetic agents such as acyclovir, valacyclovir and famciclovir and so administration of these antivirals may impair talimogene laherparepvec effectiveness.(1) DISCUSSION: Acyclovir, famciclovir, valacyclovir inhibit herpes simplex virus activity which may impair the ability of talimogene laherparepvec to replicate and produce GM-CSF in tumors. The impact of concurrent acyclovir, famciclovir, valacyclovir and talimogene laherparepvec therapy has not been studied; patients requiring antiviral prophylaxis or treatment with acyclovir, valacyclovir and famciclovir were excluded from clinical trials.(1)	IMLYGIC
Selected Nephrotoxic Agents/Foscarnet SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Foscarnet is nephrotoxic. Concurrent administration of other nephrotoxic agents may result in additive or synergistic effects on renal function.(1) Concurrent intravenous pentamidine may also result in hypocalcemia.(1) CLINICAL EFFECTS: Concurrent use of foscarnet with nephrotoxic agents such as acyclovir, adefovir, intravenous aminoglycosides, amphotericin B, cyclosporine, methotrexate, non-steroidal anti-inflammatory agents, intravenous pentamidine, tacrolimus, tenofovir, vancomycin and voclosporin may result in renal toxicity.(1) Other nephrotoxic agents include capreomycin, cisplatin, gallium nitrate, high-dose methotrexate, and streptozocin. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of foscarnet state that concurrent administration of potentially nephrotoxic agents such as acyclovir, intravenous aminoglycosides, amphotericin B, cyclosporine, methotrexate, tacrolimus, and intravenous pentamidine should be avoided.(1) Other nephrotoxic agents include adefovir, capreomycin, cisplatin, gallium nitrate, high-dose methotrexate, non-steroidal anti-inflammatory agents, streptozocin, tenofovir, vancomycin and voclosporin. If concurrent therapy is warranted, monitor renal function closely. In patients receiving concurrent foscarnet and pentamidine, also monitor serum calcium levels and instruct patients to report severe muscle spasms, mental/mood changes, and/or seizures.(1) DISCUSSION: The safety of foscarnet has not been studied in patients receiving other known potentially nephrotoxic agents. Renal impairment is the major toxicity of foscarnet.(1)	FOSCARNET SODIUM, FOSCAVIR
Selected MATE Substrates/MATE Inhibitors SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inhibitors of the Multidrug and Toxin Extrusion (MATE) renal protein transporters in the kidneys may inhibit the transport of MATE substrates.(1) Acyclovir, cephalexin, and valacyclovir are MATE substrates. CLINICAL EFFECTS: Concurrent use of MATE renal transporter inhibitors may result in increased levels of and toxicity from MATE substrates.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid concurrent use of acyclovir, cephalexin, or valacyclovir with MATE renal transporter inhibitors. If concurrent use cannot be avoided, monitor for toxicity of the MATE substrate and consider dosage reduction of the MATE substrate.(1) DISCUSSION: Based upon in vitro data, risdiplam is expected to produce clinically significant inhibition of MATE1 and MATE2-K transporters at clinically relevant concentrations.(1) Selected MATE substrates linked include: acyclovir, cephalexin, and valacyclovir.(1,2) MATE inhibitors include: cimetidine, pyrimethamine, risdiplam, and vandetanib.(2)	CAPRELSA, CIMETIDINE, DARAPRIM, EVRYSDI, PYRIMETHAMINE

There are 1 moderate interactions. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.

Drug Interaction	Drug Names
Tenofovir/Selected Nephrotoxic Agents SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Tenofovir and other nephrotoxic agents may result in additive or synergistic effects on renal function and increase nephrotoxicity risk.(1) CLINICAL EFFECTS: Concurrent use of tenofovir and other nephrotoxic agents may result in renal toxicity and acute renal failure.(1) Reports of acute renal failure and Fanconi syndrome have been reported with tenofovir use.(2,3) However, this has been reported in 3 case reports and the renal failure may have been complicated by other pre-existing conditions.(2) PREDISPOSING FACTORS: Pre-existing renal dysfunction, long duration of use, low body weight, concomitant use of drugs that may increase tenofovir levels may increase the risk of nephrotoxicity.(1) PATIENT MANAGEMENT: The US prescribing information for tenofovir recommends avoiding concurrent or recent use of a nephrotoxic agent.(3) Evaluate renal function prior to initiation of concurrent therapy and continue renal function monitoring during therapy. Dose adjustments may be required for impaired renal function. Tenofovir should be avoided with high-dose or multiple NSAIDs. Alternatives to NSAIDs should be considered in patients at risk for renal dysfunction.(3) Patients receiving concurrent NSAIDs with tenofovir should be monitored for possible renal toxicity.(1,2) The dosing interval should be adjusted in patients with a baseline creatinine clearance of less than 50 ml/min.(1-3) DISCUSSION: From March 18, 2003 to December 1, 2005, Health Canada received 10 reports of nephrotoxic reactions with tenofovir. Three of these occurred following the addition of a NSAID to tenofovir therapy. In the first report, a patient maintained on tenofovir for 29 months developed acute renal failure and acute tubular necrosis requiring dialysis 5 days after beginning indomethacin (100 mg rectally twice daily). In the second report, a patient maintained on tenofovir for 7 months developed acute renal failure and acute tubular necrosis after taking 90 tablets of naproxen (375 mg) over 2 months. The patient died. In the third report, a patient maintained on tenofovir for over a year developed acute renal failure and nephrotic syndrome after 2 months of valdecoxib (20 mg daily) therapy. Symptoms subsided following discontinuation of valdecoxib.(1)	BIKTARVY, CIMDUO, COMPLERA, DELSTRIGO, DESCOVY, EFAVIRENZ-EMTRIC-TENOFOV DISOP, EFAVIRENZ-LAMIVU-TENOFOV DISOP, EMTRICITABINE-TENOFOVIR DISOP, GENVOYA, ODEFSEY, STRIBILD, SYMFI, SYMFI LO, SYMTUZA, TENOFOVIR DISOPROXIL FUMARATE, TRUVADA, VEMLIDY, VIREAD

Drug Interaction

Drug Names

Tenofovir/Selected Nephrotoxic Agents

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Tenofovir and other nephrotoxic agents may result in additive or synergistic effects on renal function and increase nephrotoxicity risk.(1)

CLINICAL EFFECTS: Concurrent use of tenofovir and other nephrotoxic agents may result in renal toxicity and acute renal failure.(1) Reports of acute renal failure and Fanconi syndrome have been reported with tenofovir use.(2,3) However, this has been reported in 3 case reports and the renal failure may have been complicated by other pre-existing conditions.(2)

PREDISPOSING FACTORS: Pre-existing renal dysfunction, long duration of use, low body weight, concomitant use of drugs that may increase tenofovir levels may increase the risk of nephrotoxicity.(1)

PATIENT MANAGEMENT: The US prescribing information for tenofovir recommends avoiding concurrent or recent use of a nephrotoxic agent.(3) Evaluate renal function prior to initiation of concurrent therapy and continue renal function monitoring during therapy. Dose adjustments may be required for impaired renal function.

Tenofovir should be avoided with high-dose or multiple NSAIDs. Alternatives to NSAIDs should be considered in patients at risk for renal dysfunction.(3) Patients receiving concurrent NSAIDs with tenofovir should be monitored for possible renal toxicity.(1,2) The dosing interval should be adjusted in patients with a baseline creatinine clearance of less than 50 ml/min.(1-3)

DISCUSSION: From March 18, 2003 to December 1, 2005, Health Canada received 10 reports of nephrotoxic reactions with tenofovir. Three of these occurred following the addition of a NSAID to tenofovir therapy. In the first report, a patient maintained on tenofovir for 29 months developed acute renal failure and acute tubular necrosis requiring dialysis 5 days after beginning indomethacin (100 mg rectally twice daily).

In the second report, a patient maintained on tenofovir for 7 months developed acute renal failure and acute tubular necrosis after taking 90 tablets of naproxen (375 mg) over 2 months. The patient died. In the third report, a patient maintained on tenofovir for over a year developed acute renal failure and nephrotic syndrome after 2 months of valdecoxib (20 mg daily) therapy. Symptoms subsided following discontinuation of valdecoxib.(1)

BIKTARVY, CIMDUO, COMPLERA, DELSTRIGO, DESCOVY, EFAVIRENZ-EMTRIC-TENOFOV DISOP, EFAVIRENZ-LAMIVU-TENOFOV DISOP, EMTRICITABINE-TENOFOVIR DISOP, GENVOYA, ODEFSEY, STRIBILD, SYMFI, SYMFI LO, SYMTUZA, TENOFOVIR DISOPROXIL FUMARATE, TRUVADA, VEMLIDY, VIREAD

The following contraindication information is available for VALTREX (valacyclovir hcl):

Overview
Contraindicated
Severe
Moderate

Drug contraindication overview.

Known hypersensitivity or intolerance to valacyclovir, acyclovir, or any component of the formulation.

There are 0 contraindications.

There are 5 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Chronic kidney disease stage 3A (moderate) GFR 45-59 ml/min
Chronic kidney disease stage 3B (moderate) GFR 30-44 ml/min
Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
Chronic kidney disease stage 5 (failure) GFr<15 ml/min
Dehydration

There are 1 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
Kidney disease with likely reduction in glomerular filtration rate (GFr)

The following adverse reaction information is available for VALTREX (valacyclovir hcl):

Overview
Severe
Less Severe

Adverse reaction overview.

Headache, nausea, vomiting.

There are 24 severe adverse reactions.

More Frequent	Less Frequent
None.	Dysmenorrhea Increased alanine transaminase

Rare/Very Rare
Anaphylaxis Angioedema Aplastic anemia Coma DRESS syndrome Drug-induced psychosis Dyspnea Encephalopathy Erythema multiforme Facial edema Hemolytic uremic syndrome Hepatitis Hypertension Leukopenia Neutropenic disorder Renal failure Seizure disorder Thrombocytopenic disorder Thrombotic microangiography Thrombotic thrombocytopenic purpura Urticaria Visual changes

There are 23 less severe adverse reactions.

More Frequent	Less Frequent
Acute abdominal pain Headache disorder Nausea	Anorexia Arthralgia Constipation Diarrhea Dizziness Fatigue Vomiting

Rare/Very Rare
Acute cognitive impairment Aggressive behavior Agitation Alopecia Ataxia Hallucinations Manic disorder Pruritus of skin Renal pain Skin photosensitivity Skin rash Tachycardia Tremor

The following precautions are available for VALTREX (valacyclovir hcl):

Pediatric
Pregnant
Lactation
Geriatric

Safety and efficacy not established in prepubertal children.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

Category B.

Acyclovir distributed into human milk following oral administration of valacyclovir. Use valacyclovir with caution.

Increased risk of adverse renal or CNS effects. CNS effects reported more frequently in geriatric adults than in younger adults include agitation, hallucinations, confusion, delirium, and encephalopathy. In herpes zoster, longer duration of pain after healing (post-herpetic neuralgia) than in younger adults.

Consider age-related decreases in renal function when selecting dosage and adjust dosage if necessary. (See Renal Impairment under Dosage and Administration.)

The following icd codes are available for VALTREX (valacyclovir hcl)'s list of indications:

Chickenpox
B01	Varicella [chickenpox]
B01.9	Varicella without complication
Genital herpes simplex
A60	Anogenital herpesviral [herpes simplex] infections
A60.0	Herpesviral infection of genitalia and urogenital tract
A60.00	Herpesviral infection of urogenital system, unspecified
A60.01	Herpesviral infection of penis
A60.02	Herpesviral infection of other male genital organs
A60.03	Herpesviral cervicitis
A60.04	Herpesviral vulvovaginitis
A60.09	Herpesviral infection of other urogenital tract
A60.9	Anogenital herpesviral infection, unspecified
Herpes labialis
B00.1	Herpesviral vesicular dermatitis
Herpes zoster
B02	Zoster [herpes zoster]
B02.0	Zoster encephalitis
B02.1	Zoster meningitis
B02.2	Zoster with other nervous system involvement
B02.3	Zoster ocular disease
B02.30	Zoster ocular disease, unspecified
B02.31	Zoster conjunctivitis
B02.32	Zoster iridocyclitis
B02.33	Zoster keratitis
B02.34	Zoster scleritis
B02.39	Other herpes zoster eye disease
B02.7	Disseminated zoster
B02.8	Zoster with other complications
B02.9	Zoster without complications
Recurrent herpes genitalis
A60	Anogenital herpesviral [herpes simplex] infections
A60.0	Herpesviral infection of genitalia and urogenital tract
A60.00	Herpesviral infection of urogenital system, unspecified
A60.01	Herpesviral infection of penis
A60.02	Herpesviral infection of other male genital organs
A60.03	Herpesviral cervicitis
A60.04	Herpesviral vulvovaginitis
A60.09	Herpesviral infection of other urogenital tract
A60.9	Anogenital herpesviral infection, unspecified
Suppression of recurrent herpes simplex infection
A60	Anogenital herpesviral [herpes simplex] infections
A60.0	Herpesviral infection of genitalia and urogenital tract
A60.00	Herpesviral infection of urogenital system, unspecified
A60.01	Herpesviral infection of penis
A60.02	Herpesviral infection of other male genital organs
A60.03	Herpesviral cervicitis
A60.04	Herpesviral vulvovaginitis
A60.09	Herpesviral infection of other urogenital tract
A60.1	Herpesviral infection of perianal skin and rectum
A60.9	Anogenital herpesviral infection, unspecified
B00.2	Herpesviral gingivostomatitis and pharyngotonsillitis
B00.89	Other herpesviral infection
B00.9	Herpesviral infection, unspecified
Suppression of recurrent herpes simplex infection in HIV
A60	Anogenital herpesviral [herpes simplex] infections
A60.0	Herpesviral infection of genitalia and urogenital tract
A60.00	Herpesviral infection of urogenital system, unspecified
A60.01	Herpesviral infection of penis
A60.02	Herpesviral infection of other male genital organs
A60.03	Herpesviral cervicitis
A60.04	Herpesviral vulvovaginitis
A60.09	Herpesviral infection of other urogenital tract
A60.1	Herpesviral infection of perianal skin and rectum
A60.9	Anogenital herpesviral infection, unspecified
B00.0	Eczema herpeticum
B00.1	Herpesviral vesicular dermatitis
B00.2	Herpesviral gingivostomatitis and pharyngotonsillitis
B00.5	Herpesviral ocular disease
B00.50	Herpesviral ocular disease, unspecified
B00.51	Herpesviral iridocyclitis
B00.52	Herpesviral keratitis
B00.53	Herpesviral conjunctivitis
B00.59	Other herpesviral disease of eye
B00.89	Other herpesviral infection