People’s Pharmacy: Take a gun to a knife fight with cold sores

Q. I used Zovirax ointment for two decades while I had employer-funded insurance. Once I went on Medicare, I learned the real price of this cold sore ointment – outrageous!

I asked my dermatologist about this, and he prescribed oral valacyclovir. He winked and said: “Compared to the ointment, these pills are like taking a gun to a knife fight. Do you remember the scene from ‘Indiana Jones?’ ”

He was absolutely right. The pills are way more effective than the ointment at a fraction of the cost, plus no greasy mess on my lip.

A. The first antiviral drug developed for herpes simplex infections was Zovirax (acyclovir). It was first approved in 1982 as a topical cream to treat cold sores. Oral tablets also became available; the Food and Drug Administration approved them for shingles, chickenpox and genital herpes.

A similar antiviral medicine, valacyclovir (Valtrex), was approved in 1995 for treating shingles, cold sores, genital herpes infections and chickenpox. There is evidence that the oral formulation is quite effective, especially when taken preventively (JMIR Dermatology, June 14, 2022).

A 5-gram tube of Zovirax cream runs more than $200. A month’s supply of valacyclovir (500 milligrams) tablets costs between $23 and $30. We agree with your dermatologist that valacyclovir seems like a better choice.

Q. My adult daughter has a prescription for ivermectin to treat suspected scabies. The FDA has not approved this medication for the treatment of scabies, so her insurance company thus far has refused to cover the prescription. Is ivermectin safe for this use? Two health care providers (her PCP and dermatologist) have prescribed it.

A. Scabies is an incredibly itchy skin condition caused by the mite Sarcoptes scabiei. Dermatologists rely on permethrin cream to eliminate the infestation. If that doesn’t work, they may resort to oral ivermectin. The FDA approved this anti-parasitic medication to treat river blindness (onchocerciasis) and intestinal worms (Strongyloides stercoralis). Veterinarians prescribe ivermectin to prevent heartworm in dogs.

Although oral ivermectin is not approved for scabies, there is good evidence that it is effective (JAMA, Sept. 9, 2024). A review in a Spanish dermatology journal noted that “Oral ivermectin has been recommended as a systemic alternative to topical scabicides due to its ease of administration, convenience, safety and favourable side effect profile.” The generic oral medication is reasonably affordable even without insurance.

Q. My doctor prescribed doxycycline for scalp inflammation. After taking this antibiotic for a few weeks, I realized how much less pain I was feeling in my hip. That has hurt for more than 30 years, and the pain spreads to my back.

After taking doxy for 18 months, my dermatologist said there was no further benefit for my scalp, and that I should stop taking it. Within a few days, all the pain in my hip returned.

My PCP will not write a script for doxycycline. My orthopedist gave me meloxicam, which did nothing for the hip but did give me tinnitus. How can I get someone to give me a drug I know works?

A. You might want to consult a rheumatologist. There is evidence that doxycycline might be helpful for osteoarthritis (Journal of Rheumatology, October 1991). A more recent review suggests that this antibiotic may be a “disease-modifying osteoarthritis drug” (Journal of Clinical Medicine, April 18, 2023).

To learn more about this and other nonstandard approaches to easing joint pain, you may wish to read our “eGuide to Alternatives for Arthritis.” This online resource is located under the Health eGuides tab at PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla. 32803, or email them via their website: PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”