Which medications in the drug class Antivirals are used in the treatment of Bell Palsy?

Updated: Jun 14, 2019
  • Author: Danette C Taylor, DO, MS, FACN; Chief Editor: Selim R Benbadis, MD  more...
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Acyclovir and valacyclovir have been administered in the treatment of Bell palsy in combination with prednisone or have been used alone in patients who cannot take prednisone. The use of antivirals has proved most beneficial in patients with severe to complete facial palsy. [57]

Acyclovir (Zovirax)

Acyclovir is a prodrug activated by phosphorylation, by way of virus-specific thymidine kinase (TK), that inhibits viral replication. Herpes virus TK, but not host cell TK, uses acyclovir as a purine nucleoside, converting it into acyclovir monophosphate, a nucleotide analogue. Guanylate kinase converts the monophosphate form into diphosphate and triphosphate analogues that inhibit viral DNA replication.

Acyclovir has an affinity for viral TK and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase.

The drug inhibits the activity of HSV-1 and HSV-2. Patients experience less pain and faster resolution of cutaneous lesions when acyclovir is used within 48 hours after rash onset. Acyclovir may also prevent recurrent outbreaks. Early initiation of therapy is imperative.

Valacyclovir (Valtrex)

Valacyclovir is a prodrug that is rapidly converted to acyclovir. It is more expensive than acyclovir, but it has a more convenient dosing regimen.

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