Pharmacy Corner
Cold Sores: What You Need to Know What treatments are available?

Non-medication strategies to help with your cold sore:

  • Application of protectant creams like petroleum jelly, zinc oxide or cocoa butter to prevent cracking or drying of the sore
  • Keep cold sore clean by gently washing with mild soap and water
    • Cleaning can also be done by soaking the area with cool compresses of water
  • Gently dab creams on the sore rather than rubbing them in to prevent bothering the area more

Over-the-counter products:

  • 10% docosanol cream (Abreva®)
    • Applying this cream has been shown to shorten healing time by up to 1.5 days and the time you have pain by half a day
    • Works best as soon as you feel any burning, tingling or stinging (prodrome phase)
    • Side effects: sometimes causes mild burning or stinging
  • Local anesthetics - benzocaine, lidocaine, prilocaine, pramoxine (e.g. Orajel®)
    • Works by numbing the area to relieve pain and itching, however does not help the healing time or severity of the cold sore
    • Can be used anytime during the time you have a cold sore
    • Side effects: sometimes causes mild burning or stinging

Prescription medications:

Prescription

Acyclovir 5% cream (Zovirax®)

Acyclovir 5% + hydrocortisone 1% cream (Xerese)

Acyclovir, valacyclovir, famciclovir tablets

What is it?

Topical antiviral

Topical antiviral plus steroid (anti-inflammatory)

Oral antivirals

Does it work?

Lowers the length of time you have the cold sore, time to crust formation

No effect on lowering pain

Shortens healing time and reduces size of cold sore

42% of people who used this cream as soon as they felt the burning or tingling, never got a cold sore

Faster healing time and less time you have pain

When do you start treatment?

All treatments are best started as soon as you feel the first symptoms of a cold sore
(within 1 hour of first sign of tingling, itching or stinging = prodrome phase)

How do I take it?

Applied 5 times per day for 5-10 days

Taken by mouth

*Speak to your doctor or pharmacist to decide which is best for you

Side effects

Well tolerated;

Possible mild burning or stinging at site of application

Nausea, diarrhea, headache

Caution if you have kidney problems


Speak to your doctor or pharmacist to see which cold sore medication will best suit you.


NOTE:

There is no benefit to using a cold sore cream every day to try and prevent future cold sores. They cannot cure the virus and will only work when the cold sore is starting.