An antiviral for herpes viruses. For shingles the timing matters more than almost anything else about it.
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Aciclovir is an antiviral that blocks herpes viruses from replicating. It is activated only inside infected cells, which is why it targets the virus without doing much to healthy tissue.
It does not eliminate the virus — herpes viruses remain dormant in nerve tissue for life. What it does is shorten the episode, reduce its severity, and in shingles reduce the chance of lasting nerve pain afterwards.
Cream for cold sores is available over the counter; tablets are prescription-only.
Timing is the single most important thing about this drug.
For shingles, the evidence-based window is 72 hours from the rash appearing. Started within it, aciclovir meaningfully reduces the duration and the risk of post-herpetic neuralgia. Started later, the benefit falls away sharply — though it may still be given if the rash is still spreading, or in anyone over 50 or immunosuppressed.
For cold sores, start at the first tingle rather than once the blister appears.
Aciclovir tablets are taken five times daily, which people genuinely struggle to keep up. Valaciclovir is better absorbed and taken two or three times daily — usually the more practical choice.
Drink plenty of fluids. Aciclovir is cleared by the kidneys and can crystallise if you are dehydrated.
Generally well tolerated. Nausea, vomiting, diarrhoea, headache and dizziness are the common ones, and most people notice nothing.
Rash and photosensitivity occur occasionally.
The important one relates to the kidneys. At full dose in someone with reduced kidney function, aciclovir accumulates and can cause confusion, agitation, hallucinations and drowsiness. This happens more often in older people, and — critically — it is frequently mistaken for delirium caused by the illness itself rather than recognised as drug toxicity. Doses must be reduced according to kidney function.
Kidney injury itself can occur, particularly with dehydration or intravenous use.
Dose reduction is required in kidney impairment — this is the main practical limitation rather than an outright contraindication.
It is considered acceptable in pregnancy where treatment is needed, and this is worth discussing rather than avoiding.
Some situations need more than a tablet:
Interactions are few. Probenecid raises aciclovir levels. Care is needed with other drugs affecting the kidneys.
Kidney function should be known before prescribing higher shingles doses, particularly in anyone older or with existing impairment.
No routine monitoring is needed for a short course in someone with normal kidneys.
For long-term suppressive treatment, periodic review of whether it is still needed — usually annually — is the sensible approach.
Yes, and this is one of the clearest cases where a remote service genuinely changes the outcome rather than merely being convenient.
The 72-hour shingles window is the whole point. A same-day video consultation and a prescription sent to your own pharmacy can land comfortably inside it, where waiting for a routine appointment often does not.
What that involves: assessing the rash by video and photograph, checking where it is and whether the eye is involved, considering kidney function for dosing, and — importantly — planning the pain relief. Shingles pain is neuropathic and is routinely undertreated with paracetamol alone.
For recurrent cold sores or genital herpes, we would also raise suppressive treatment — a daily low dose to prevent outbreaks rather than treating each one. For anyone with frequent recurrences it can be genuinely life-changing, and it is markedly under-offered.
Where we will send you elsewhere: shingles involving the eye or nose tip, anyone immunosuppressed with widespread disease, or anyone systemically unwell.
This page is information, not an offer to supply.
Aciclovir cold sore cream is available over the counter and costs a few pounds. The tablets used for shingles and genital herpes are prescription-only.
On a private prescription the tablets are inexpensive — drug cost plus dispensing fee, usually comparable to the England NHS prescription charge of around £10. NHS prescriptions are free in Wales.
Antiviral treatment for shingles works considerably better started within 72 hours of the rash appearing, and the benefit falls away sharply after that.
If waiting for an NHS appointment would push you past that window, a same-day private consultation is buying you the window rather than the tablets. That is a genuine and time-limited reason to pay, and one of the clearest we offer.
For shingles or a first episode of genital herpes, complete the course as prescribed — usually five to seven days, taken five times a day, which is demanding but matters.
Stopping early because the rash has stopped spreading is a common mistake. The course is calculated on viral replication, not on appearance.
Suppressive treatment is usually reviewed after around a year, stopping to see what the natural pattern has become — recurrences often become less frequent over time regardless.
Aciclovir does not treat post-herpetic neuralgia, the nerve pain that can persist after the rash clears. That needs a different class of medicine altogether.
Continuing antivirals for ongoing pain achieves nothing, and it is a common misunderstanding.
Drink plenty while taking it, particularly at the high shingles doses. Dehydration is what makes aciclovir hard on the kidneys, and the dose is reduced where kidney function is impaired.
Within 72 hours of the rash appearing. The benefit is substantially greater started early and falls away after that window.
Do not wait to see whether it settles — that is the single most useful sentence on this page.
No. It suppresses the virus during an outbreak and reduces how often outbreaks happen, but the virus stays dormant in nerve tissue permanently.
No treatment currently eradicates it, and anything sold on that claim is not honest.
Daily suppressive treatment substantially reduces transmission but does not eliminate it.
Condoms reduce it further, and avoiding contact during an outbreak matters most — though transmission can occur without visible symptoms.
Because aciclovir is cleared quickly and needs frequent dosing to stay effective.
Valaciclovir is taken less often and is a reasonable alternative if the schedule is the obstacle — worth asking about rather than taking it erratically.
You cannot give someone shingles, but you can give chickenpox to someone who has never had it or been vaccinated.
Keep the rash covered, and avoid pregnant women who have not had chickenpox, newborns, and anyone immunosuppressed until it has crusted over.
Starting early reduces the chance of persistent nerve pain, but does not remove it.
Post-herpetic neuralgia needs different treatment — continuing the antiviral does not help.
It is widely used in pregnancy where needed, with reassuring data.
Herpes in late pregnancy needs specific management because of risk to the baby at delivery, so always mention pregnancy.
Yes, particularly at the higher shingles doses. Aciclovir is cleared by the kidneys and dehydration is what causes problems.
If you are eligible, yes. It reduces both shingles and the nerve pain that follows.
It is offered free on the NHS to specific age groups and to some immunosuppressed people — worth checking whether you qualify.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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