Aciclovir Cream

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Aciclovir Cream on Prescriptsy

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Important information about this medicine

The information on this page is for general reference and does not replace advice from a healthcare professional.

Aciclovir cream is a pharmacy medicine (P) available without a prescription for adults and adolescents aged 12 and over.

If you are unsure whether this product is suitable for you, speak with your pharmacist or GP before use.

• Apply aciclovir cream only to cold sores on the lips and surrounding facial skin. Do not use it inside the mouth, on the eyes, or on genital areas.
• If you experience swelling of the face, lips or throat, difficulty breathing, or a severe skin reaction, stop using the cream and seek emergency medical help by calling 999.
• This page provides general guidance. Always read the Patient Information Leaflet or pharmacy label supplied with your product.

What is aciclovir cream and what is it used for?

Aciclovir cream 5% is an antiviral medicine applied directly to cold sores, which are caused by infection with the herpes simplex virus type 1 (HSV-1).

Cold sores, also known as herpes labialis, typically appear as clusters of small fluid-filled blisters on or around the lips.

They are extremely common in the United Kingdom, with most people contracting the virus during childhood through close contact such as kissing a family member who has an active sore.

The cream works by delivering aciclovir directly to the site of viral replication in the skin.

Once inside virus-infected cells, aciclovir is converted by the viral enzyme thymidine kinase into its active form, which blocks the virus from copying its DNA.

This slows the progression of the cold sore and can reduce the duration of symptoms such as tingling, blistering and crusting.

Aciclovir cream is most effective when applied at the very first sign of a cold sore, during the prodromal phase when you feel tingling, itching or warmth on the lip before any blister is visible.

Starting treatment early may prevent a full blister from developing or shorten the episode by approximately one day compared with no treatment.

Once blisters have already formed, the cream can still help but the benefit is more modest.

How aciclovir cream differs from aciclovir tablets

Aciclovir is available in both topical (cream) and systemic (tablet) formulations.

The cream is designed for localised treatment of cold sores on the face and produces minimal systemic drug levels.

In contrast, aciclovir tablets are prescribed for more extensive or severe herpes infections, including genital herpes, shingles and chickenpox, and are classified as prescription-only medicines.

For uncomplicated cold sores in otherwise healthy individuals, topical aciclovir cream is usually the first-line treatment and can be purchased from pharmacies without a prescription.

If you experience frequent recurrences, your GP may recommend oral antiviral therapy for suppression.

The two approaches serve different clinical needs and your healthcare provider can advise which is appropriate for you.

Who can use aciclovir cream?

Adults and adolescents aged 12 and over

Aciclovir cream is licensed for over-the-counter sale to adults and adolescents aged 12 years and older.

It is suitable for treating occasional cold sores in individuals who are otherwise healthy.

You can purchase it from community pharmacies, some supermarket pharmacies and certain registered online pharmacies throughout the United Kingdom.

People who should seek medical advice first

Although aciclovir cream is widely available, certain individuals should consult a doctor or pharmacist before using it.

This includes people with weakened immune systems (for example, those receiving chemotherapy, immunosuppressive medicines or living with HIV), those who are pregnant or breastfeeding, anyone who gets cold sores very frequently (more than six episodes per year), and anyone whose cold sore is unusually large, painful or does not respond to treatment.

Children under 12 should not use the cream without guidance from a healthcare professional.

When aciclovir cream is not appropriate

This cream is not suitable for treating genital herpes, herpes infections of the eye (ophthalmic herpes), or cold sores inside the mouth.

It should not be used if you are allergic to aciclovir, valaciclovir or any ingredient in the cream base, including cetostearyl alcohol and propylene glycol.

If you are unsure, check the ingredients listed on the packaging or ask your pharmacist for guidance.

How to apply aciclovir cream correctly

Proper application technique maximises the effectiveness of the cream and helps reduce the risk of spreading the virus to other areas of your body or to other people.

1. Wash your hands thoroughly with soap and water before touching the cold sore area.
2. Squeeze a small amount of cream onto a clean fingertip or a disposable cotton bud.
3. Apply a thin layer of cream to the cold sore and a small margin of surrounding skin.
4. Wash your hands again immediately after application to prevent viral spread.
5. Repeat five times a day at approximately four-hourly intervals during waking hours.
6. Continue for five days. If the sore has not healed, you may continue for up to ten days total.

Avoid rubbing the cream in vigorously, as this can irritate the skin. Allow it to absorb naturally.

Do not cover the treated area with plasters or occlusive dressings unless your doctor advises it.

If you are applying cosmetics or lip products, apply these after the cream has been absorbed.

What to expect during treatment

Cold sores typically progress through several stages: tingling (prodrome), redness, blistering, weeping, crusting and healing. The entire cycle usually lasts seven to ten days without treatment.

With aciclovir cream applied from the prodromal stage, the duration may be shortened by roughly one day and the severity of blistering reduced.

It is important to have realistic expectations. Aciclovir cream does not cure the underlying herpes simplex virus infection.

The virus remains dormant in nerve cells (specifically, in the trigeminal ganglion for oral herpes) and can reactivate at any time, triggered by factors such as stress, illness, fatigue, sun exposure, hormonal changes or a weakened immune system.

The cream treats the current outbreak but does not prevent future ones.

Some patients find that cold sores become less frequent over time even without suppressive treatment, as the body's immune response to the virus strengthens with repeated exposure. Others continue to experience regular episodes throughout their lives.

Side effects of aciclovir cream

Aciclovir cream is generally well tolerated.

The most common side effects are mild and localised, including a temporary burning or stinging sensation at the application site, slight itching, and dryness or flaking of the skin.

These effects usually resolve quickly and do not require medical attention.

Less commonly, redness or contact dermatitis may occur, sometimes related to excipients in the cream base such as cetostearyl alcohol or propylene glycol rather than the active ingredient itself.

If you have known sensitivity to these substances, check the ingredients before use. Allergic reactions including hives and angioedema are rare but have been reported in post-marketing surveillance.

Because systemic absorption from the cream is negligible, the side effects associated with oral aciclovir (such as headache, nausea, kidney effects) are not expected with topical use.

If you do experience any unexpected symptoms, stop using the cream and speak with your pharmacist or doctor.

Understanding cold sore triggers

Recognising your personal triggers can help you anticipate cold sore outbreaks and start treatment at the earliest possible stage. Common triggers reported by cold sore sufferers in the UK include the following.

• Colds, flu and other viral infections that temporarily suppress immune function.
• Physical and emotional stress, including work pressure, exams and major life events.
• Fatigue and lack of sleep.
• Exposure to strong sunlight or ultraviolet radiation, particularly on the lips. Using a lip balm with SPF protection can help.
• Hormonal changes, including menstruation.
• Extremes of temperature, such as cold, windy weather.
• Dental treatment or facial surgery, which can irritate the nerve pathways where the virus lies dormant.

Keeping aciclovir cream readily available means you can begin treatment at the very first tingle, when it is most effective. Many people who experience recurrent cold sores carry a tube in their bag or medicine cabinet for this purpose.

Preventing cold sore transmission

Cold sores are contagious from the moment you feel the first tingle until the sore has completely healed and the skin is intact.

The virus spreads through direct skin-to-skin contact and through contact with saliva or fluid from the blister.

To reduce the risk of transmission during an active outbreak, take the following precautions.

• Avoid kissing anyone, especially babies, young children and people with weakened immune systems, as neonatal herpes can be very serious.
• Do not share lip balm, lipstick, cutlery, cups, straws, towels or face flannels.
• Wash your hands frequently, especially after touching the cold sore or applying cream.
• Avoid oral sex during an active outbreak, as HSV-1 can be transmitted to the genital area.
• Avoid touching your eyes after touching the cold sore, as this can lead to herpes simplex keratitis, a potentially sight-threatening eye infection that requires urgent ophthalmic assessment.
• If you play contact sports, cover the cold sore if possible and avoid skin-to-skin contact with other players until it has fully healed.

Buying aciclovir cream in the UK

Aciclovir cream 5% is classified as a pharmacy medicine (P), which means it can be sold without a prescription but must be purchased from a registered pharmacy under the supervision of a pharmacist.

It is available from high street pharmacies, supermarket pharmacy counters and registered online pharmacies across the United Kingdom.

Common pack sizes are 2g tubes, which are sufficient for treating one or two cold sore episodes.

Several branded and generic versions are available, including well-known brands such as Zovirax Cold Sore Cream. Your pharmacist can help you choose a suitable product.

Prices vary but aciclovir cream is generally affordable and widely stocked, typically costing between three and six pounds for a 2g tube.

When purchasing online, verify that the pharmacy is registered with the General Pharmaceutical Council (GPhC) and displays the registered online pharmacy logo.

Avoid purchasing from unregistered websites, as products may be counterfeit, expired or improperly stored, which could reduce their effectiveness or pose health risks.

Alternative treatments for cold sores

In addition to aciclovir cream, several other options are available for managing cold sores in the UK.

Docosanol cream (sold under various brand names) is another topical treatment that works by a different mechanism, blocking the virus from entering healthy cells.

Cold sore patches, which contain a hydrocolloid dressing, create a moist healing environment, protect the sore and can be worn under cosmetics.

Some people use tea tree oil or lysine supplements, although the clinical evidence supporting these is limited.

For frequent or severe cold sores, your GP may prescribe oral antiviral tablets such as aciclovir or valaciclovir.

These are more effective than topical treatment for reducing recurrence frequency when used as suppressive therapy.

If you experience more than six cold sore episodes per year, it is worth discussing systemic treatment options with your doctor to determine whether long-term prophylaxis could improve your quality of life.

Cold sores and children

Primary herpes simplex infection in young children can cause a more widespread mouth infection called herpetic gingivostomatitis, characterised by mouth ulcers, sore gums, drooling and difficulty eating.

This is different from a typical cold sore and may require assessment by a GP. Over-the-counter aciclovir cream is not licensed for children under 12 without medical advice.

If your child develops cold sores or mouth blisters, consult your pharmacist or GP for appropriate management options.

When to see your GP or pharmacist

Most cold sores can be managed at home with over-the-counter aciclovir cream.

However, you should seek professional advice if your cold sore does not improve after ten days of treatment, if the sore is unusually large or spreading beyond the lip area, if you develop a cold sore near your eye (this requires urgent assessment to rule out ocular herpes), if you have a weakened immune system, or if you are experiencing cold sores for the first time and are unsure of the diagnosis.

Newborn babies exposed to cold sores need urgent medical assessment, as neonatal herpes simplex is a serious condition.

For non-emergency advice, call NHS 111 or visit your local pharmacy. In an emergency, call 999.

Sources and further reading

• Summary of Product Characteristics, Aciclovir Cream 5%, EMC (medicines.org.uk)
• British National Formulary, Aciclovir, bnf.nice.org.uk
• NHS, Cold sores, nhs.uk
• NICE Clinical Knowledge Summaries, Herpes simplex oral, cks.nice.org.uk
• Herpes Viruses Association, Cold sores information, herpes.org.uk
• MHRA Yellow Card Scheme, yellowcard.mhra.gov.uk