Cold Sore Tablets: Causes, Treatment and Prevention

Cold sore tablets are antiviral medicines that can shorten an outbreak when they are started at the first tingle. They do not cure the virus, and most cold sores clear on their own in about two weeks. In Australia, a pharmacist can supply a single dose of cold sore tablets without a prescription, and a doctor can prescribe other courses for frequent or severe outbreaks. This guide covers how cold sores behave, your options and when to get help.

Key takeaways

• Antiviral tablets taken at the first tingle can shorten an outbreak by about one to two days.
• A single dose is available from a pharmacist without a prescription.
• Cold sores can spread even before blisters appear, so avoid kissing and sharing cups.
• A cold sore near the eye, or with a weakened immune system, needs a doctor in person.

What a Cold Sore Is

A cold sore is a small cluster of fluid filled blisters on or near the lips, caused by the herpes simplex virus. About 8 in 10 adults carry the virus, though many never get a sore. Cold sore tablets, creams and patches all treat the symptoms, but none removes the virus.

Paracetamol and an ice pack can ease pain. Gently dab creams on rather than rubbing them in, and wash your hands after touching the sore.

The Stages of a Cold Sore

A cold sore usually passes through five stages over one to two weeks. It starts with tingling, itching or burning for a day or so before anything shows, which is when cold sore tablets help most. Small blisters then appear, and within a day or two they break and weep, leaving a shallow, painful sore. This weeping stage is the most contagious and usually the most uncomfortable.

The sore then dries and forms a crust or scab, which can crack and bleed when you talk or eat. Finally the scab falls off and the skin heals, usually without a scar. Leave the scab alone, because picking it can spread the virus or let bacteria in.

How the Herpes Simplex Virus Flares Up

The herpes simplex virus, usually type 1, is transmitted by close contact with skin or saliva: kissing, touching a sore, or sharing cups, cutlery, towels, lip balm or a toothbrush. Most people catch it in childhood, and oral sex can pass it to the genitals. It can spread even when no blister is showing, though the risk is highest while a sore is weeping.

After the first infection, the virus stays asleep in a nerve near the lips for life. Triggers can wake it: tiredness, an illness such as a cold or flu, stress, periods, strong sunlight, cold or wind, and injury to the lips, including dental work. When it wakes, it travels back along the nerve to the skin and causes a new sore, often in much the same place. Cold sore tablets cannot clear the sleeping virus, which is why outbreaks can return.

Tablet Options for Cold Sores in Australia

Cold sore treatment in Australia starts with a pharmacist for most people. A pharmacist can supply a single dose of antiviral tablets without a prescription, after a few questions to check it suits you, such as your age, your health and whether you are pregnant. The tablets are taken all at once, as soon as the tingle starts.

A doctor can prescribe other antiviral tablets, which are only available on prescription in Australia: a short course for a severe sore, a supply to keep at home and start at the first sign, or a daily tablet to prevent frequent outbreaks. A cold sore antiviral works by stopping the virus copying itself, so it shortens an outbreak rather than curing the infection.

The evidence is modest. Started early, tablets cut an outbreak by about one to two days and can ease pain; started once blisters have formed, they do much less. For a sore that is already healing, creams, patches and pain relief may be all you need.

Timing a Dose From the First Tingle

Timing matters more than anything else with antiviral tablets. The virus copies itself fastest in the first hours, so a dose taken at the first tingle, itch or burning has the most effect, and some outbreaks may then go no further than a red patch. Taken a day or more after blisters appear, a cold sore antiviral makes little difference.

If you get cold sores often, talk to a pharmacist or doctor ahead of time, so you have a plan, or tablets on hand, before the next one starts. Take the dose exactly as the pack or your doctor directs.

Preventing Repeat Cold Sore Outbreaks

Knowing your triggers is the first step to fewer outbreaks. Use a lip balm with SPF 30 or higher outdoors all year, because sunlight is a common trigger, and look after sleep and stress where you can. Do not share lip balm, cups or towels, and replace your toothbrush after an outbreak.

For frequent or severe outbreaks, a doctor may suggest daily cold sore medication, an antiviral tablet taken every day for some months, which is only available on prescription in Australia. Lysine supplements are often promoted to prevent cold sores, but there is no evidence that they work.

When a Cold Sore Needs a Doctor

Most cold sores heal on their own, but some need a doctor, and some need one in person. A cold sore near or in the eye, or eye pain, redness, blurred vision or sensitivity to light with a cold sore, needs a doctor in person the same day, because the virus can damage the eye. People with a weakened immune system, from cancer treatment, an organ transplant, HIV or high dose steroids, should also see a doctor in person, as their sores can be severe and spread.

Some situations are urgent: sores spreading quickly over skin with eczema, a high fever with feeling very unwell, or a newborn baby who develops sores, a fever or unusual sleepiness after contact with a cold sore. Go to an emergency department, or call 000 if someone is very unwell.

See a doctor too if a sore has not healed in about two weeks, if sores are very large or keep coming back, or if over the counter cold sore medication has not helped. A doctor can confirm it is a cold sore, as impetigo and mouth ulcers can look similar.

Getting Treatment From a Pharmacist or Doctor

A pharmacist is a good first stop for a typical cold sore. They can check it, supply a single dose of antiviral tablets without a prescription where it suits you, and suggest creams or patches. If you get cold sores often, if they are severe, or if the pharmacist suggests it, a doctor can help.

A Medio doctor can assess you by phone, ask for a photo of the sore sent securely and, where the doctor thinks it right, prescribe antiviral tablets as an eScript. A doctor prescribes only when it suits you, and a sore near the eye or a weakened immune system means seeing a doctor in person.

Side Effects and Safety of Treatment

Antiviral tablets are usually well tolerated. The most common side effects are headache, nausea, diarrhoea and dizziness, and they usually pass. Tell the pharmacist or doctor if you have kidney disease, as the dose may need changing, and if you are pregnant or breastfeeding, so they can check the right option. Do not take more than directed, or repeat a single dose pack in the same outbreak.

Creams can sting a little. Avoid steroid creams on a cold sore, as they can make it worse, and wash your hands after touching the sore, especially before touching your eyes or a baby.

Summary

Cold sore tablets can shorten an outbreak when taken at the first tingle, but they do not cure the virus. This guide covered what a cold sore is, its stages, how the virus spreads and wakes, tablet options and timing, prevention, when to see a doctor, getting treatment and safety. If you get cold sores often, a Medio doctor can talk through your options by phone, look at a photo sent securely and, where the doctor thinks it right, send an eScript.

Frequently asked questions

What tablets are best for cold sores?

There is no single right choice; it depends on how often you get cold sores and how severe they are. For an occasional sore, a single dose of antiviral tablets from a pharmacist, taken at the first tingle, is the usual option. For frequent or severe outbreaks, a doctor may prescribe a course or a daily tablet. To treat an active cold sore that has already blistered, creams, patches and pain relief are mainly for comfort, as tablets do less by then.

What clears cold sores quickly?

Nothing clears a cold sore overnight, and most heal in one to two weeks. Are tablets better than cream? In studies, tablets started at the first tingle shorten an outbreak by about one to two days, a little more than creams do, but either can help, and a pharmacist can advise. Keep the sore clean, avoid picking it, and use an ice pack and paracetamol for pain while it heals.

Can a doctor help with cold sore tablets?

Yes. In a telehealth consult by phone, a Medio doctor can ask about your outbreaks, look at a photo of the sore sent securely and, where the doctor thinks it right, prescribe antiviral tablets for a severe outbreak, to keep on hand, or to take daily if outbreaks are frequent. A sore near the eye, or any cold sore when your immune system is weakened, needs a doctor in person.

Do cold sore tablets actually work?

Yes, but modestly. In studies, antiviral tablets started at the first tingle shorten an outbreak by about one to two days and can ease pain, and taken daily they make outbreaks less frequent. They do much less once blisters are established, and they never remove the virus. Famciclovir is an antiviral used for cold sores, shingles and genital herpes; a single dose pack for cold sores is sold by pharmacists, and other courses are only available on prescription in Australia. Store it in its pack, somewhere cool and dry.

What's the worst day for a cold sore?

For most people the worst day is the second or third, when the blisters break and weep. The sore is usually most painful then, and it is also the most contagious stage, so avoid kissing, oral sex and sharing cups or towels. Cold sores are common, and they often look worse than they are; once a crust forms, the pain usually eases.

How do Amish treat cold sores?

There is no particular Amish treatment with evidence behind it. Remedies described as Amish are usually herbal salves or home care, such as ice and keeping the sore clean and dry. Ice and gentle care can ease discomfort, but no home remedy has been shown to shorten a cold sore, and some herbal products can irritate broken skin. Antiviral creams or tablets started early are the treatments with evidence, and a pharmacist can advise.