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    , and the resulting acyclovir serum levels are much higher than those achieved with oral acyclovir. Pharmacokinetic studies reveal that a therapeutic drug level equivalent to acyclovir 800 mg five times daily can be achieved with 1000 mg valacyclovir given every 8 hours []. Because of the improved bioavailability of valacyclovir compared with acyclovir, studies have evaluated less frequent dosing for patients with HSV infection. Valacyclovir is effective in the treatment of first-episode HSV infection at a dose of 500–1000 mg to twice daily, and in the treatment of recurrent HSV infection at a dose of 500 mg twice daily if initiated within the first 24 h of signs or symptoms. Therapy should be continued until all lesions are dry and crusted. Additionally, valacyclovir is effective as suppressive therapy at a dose of 250 mg twice daily, 500 mg once daily (for patients with fewer than 10 recurrences per year), and 1 g once daily (for patients with 10 or more recurrences per year) [). A study evaluating very high valacyclovir dosing (8 g/day) for suppression of CMV in patients with advanced HIV disease suggested a possible association between valacyclovir and the syndromes of thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome (TTP/HUS). Goodman Masson – Behind The Walls Diffuse large B-cell lymphoma - A Hematology. Adult Immunization Schedule by Vaccine and Age Group CDC
     
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