Can I Get Acyclovir Over the Counter? Understanding OTC vs. Prescription Antivirals

October 9, 2025 •

4 min read

Over 67% of the global population under 50 is estimated to be infected with herpes simplex virus type 1 (HSV-1), which causes cold sores, while many others are affected by genital herpes. For these viral infections, many people wonder, “can I get acyclovir over the counter?” The answer is complex, with the vast majority of acyclovir formulations requiring a prescription, and only certain topical options available without one in some regions.

Quick Summary

Oral acyclovir and most topical formulations are not available over the counter, requiring a prescription from a healthcare provider due to the need for medical supervision. Available over-the-counter alternatives like docosanol (Abreva) treat cold sores topically but are less potent than prescription antivirals. A doctor's consultation ensures appropriate dosage and treatment for herpes infections.

Key Points

Acyclovir Requires a Prescription: Oral acyclovir (tablets, capsules) and most topical creams (like Zovirax) are not available over the counter in the U.S. and require a doctor's prescription.
Reasons for Prescription Status: Acyclovir is prescription-only to ensure correct diagnosis, prevent misuse, mitigate side effects, and combat the development of antiviral resistance.
Docosanol (Abreva) is the Main OTC Alternative: Docosanol is the only FDA-approved, nonprescription cream for cold sores (herpes labialis) and works by preventing the virus from entering healthy cells.
Early Treatment is Key: Whether using a prescription or OTC treatment, applying or taking the medication at the first sign of symptoms is critical for best results.
Oral Acyclovir is More Potent: Prescription oral acyclovir is typically more effective and works systemically compared to milder, topically applied OTC treatments like docosanol.
Telehealth Can Provide a Prescription: If you need acyclovir, telehealth services offer a convenient way to consult with a healthcare provider and receive a prescription if medically appropriate.
Different Mechanisms of Action: Acyclovir stops viral replication inside the cells, while docosanol blocks the virus from entering them.

The Short Answer: Acyclovir is Not Over the Counter

For most people in the United States, the resounding answer to "Can I get acyclovir over the counter?" is no. Oral forms of acyclovir, including tablets, capsules, and suspensions, are available only by prescription from a licensed healthcare provider. Even topical formulations, such as the branded Zovirax cream, require a prescription in the U.S.. The primary reason for this strict control is the need for accurate diagnosis and medical supervision to prevent misuse, potential adverse effects, and the development of antiviral resistance.

Why Acyclovir Requires a Prescription

Antiviral medications like acyclovir are potent drugs that target specific viruses, but their use requires careful management. Healthcare providers must confirm the diagnosis of a herpes infection—whether it's an initial or recurrent outbreak of genital herpes, cold sores, shingles, or chickenpox—to ensure the medication is used correctly. The prescription process allows a doctor to determine the appropriate dosage, duration of treatment, and form of acyclovir based on the patient's specific health needs and the severity of their condition. Without this oversight, issues could arise:

Misdiagnosis: Patients might confuse herpes outbreaks with other skin conditions, leading to improper or ineffective treatment.
Misuse: Taking an incorrect dose or using the medication for the wrong duration can reduce its effectiveness and fail to properly manage the infection.
Adverse Effects: Acyclovir can have side effects, particularly for individuals with kidney problems, and its use should be monitored.
Antiviral Resistance: Improper use of antiviral drugs can speed up the development of resistant viral strains, rendering the medication ineffective over time.

Over-the-Counter Alternatives for Cold Sores

While prescription-strength acyclovir is not available over the counter, several alternatives exist for treating cold sores (herpes labialis). These OTC products do not contain acyclovir and typically work via different mechanisms.

Docosanol (Abreva)

Docosanol is the only FDA-approved, nonprescription medication specifically for treating cold sores. It is available as a 10% cream under the brand name Abreva and can be found at most pharmacies. Unlike acyclovir, which stops the virus from replicating once inside the cells, docosanol prevents the virus from entering healthy cells in the first place. For the best results, it should be applied at the first sign of a tingle or redness. Studies have shown that when started early, docosanol can reduce the healing time of a cold sore by about half a day to a day.

Other OTC Options

Topical Anesthetics: Products containing benzocaine (like Orajel) can help numb the area and provide temporary pain relief from cold sores.
Healing Ointments: Lip balms and petroleum jelly-based products can keep sores soft and prevent cracking, helping to manage discomfort.
Topical Zinc: Some creams containing zinc oxide and glycine are available over the counter and can also aid in the healing process.

Acyclovir vs. OTC Cold Sore Treatments: A Comparison

To highlight the key differences, here is a comparison table of prescription acyclovir and the main OTC alternative, docosanol.


Feature	Prescription Acyclovir (Oral/Topical)	OTC Docosanol (Abreva)
Availability	Prescription only in the U.S.	Over the counter
Conditions Treated	Various herpes infections (genital herpes, shingles, chickenpox, cold sores)	Specifically cold sores (herpes labialis)
Mechanism of Action	Inhibits viral replication inside infected cells.	Prevents the virus from entering healthy cells.
Potency	More potent and systemic for severe or widespread outbreaks.	Milder, localized effect on the outer layers of the skin.
Effectiveness	Highly effective, especially when started early in an outbreak.	Can shorten healing time by about a day when used as directed.
Side Effects	Potential for more systemic side effects like nausea, diarrhea.	Generally localized side effects like stinging or dry skin.

How to Get Acyclovir

If you believe you need acyclovir for a herpes outbreak, your options require a consultation with a healthcare professional.

In-Person Doctor's Visit: Schedule an appointment with your primary care provider. They can perform an assessment, confirm the diagnosis, and issue an e-prescription to your pharmacy.
Telehealth/Online Consultation: For many patients, online consultation services have become a convenient way to get a prescription. Telehealth platforms allow you to consult with a licensed provider virtually, who can determine if acyclovir is medically appropriate and send a prescription to your local pharmacy.
Emergency Care: For severe or first-time outbreaks, especially if accompanied by other symptoms, seeking urgent care or emergency room treatment may be necessary.

What to Do During an Outbreak

Early intervention is crucial for any herpes outbreak, whether you are using a prescription or OTC treatment. If you have a known history of cold sores, having an OTC product like Abreva on hand and starting treatment at the first sign of symptoms (a tingling sensation, for example) can help speed up the healing process. If you are prescribed acyclovir, it is equally important to begin taking it as soon as symptoms begin. In addition to medication, practicing good hygiene and avoiding touching the sores can prevent the virus from spreading to other parts of the body or to other people.

Conclusion: Prioritize Medical Advice for Antiviral Needs

Ultimately, while the desire for quick, over-the-counter access to a powerful antiviral like acyclovir is understandable, its prescription status is a critical safeguard for patient health. It ensures proper diagnosis, prevents the risks of misuse, and helps manage the threat of viral resistance. For cold sores, effective and safe OTC options like docosanol are available, but for more serious or systemic infections, a conversation with a healthcare provider is non-negotiable. Consulting a professional, either in-person or via telehealth, is the safest and most effective path to managing a herpes infection and ensuring you receive the correct treatment. For more information on cold sore treatments, visit the Walgreens Health Answer section on Cold Sores.

Frequently Asked Questions

Oral acyclovir is a powerful antiviral medication that requires a prescription to ensure proper diagnosis and use. A healthcare provider must determine the correct dosage for your specific infection and health status to prevent misuse, serious side effects, and the development of drug-resistant viruses.

In the United States, Zovirax cream (topical acyclovir) requires a prescription from a healthcare professional. However, in other regions like the UK, a cold sore cream containing acyclovir might be available over the counter.

The most widely recognized over-the-counter alternative for cold sores is docosanol 10% cream, sold under the brand name Abreva. It is the only FDA-approved nonprescription medication specifically for treating cold sores and can shorten healing time when used early.

No, docosanol (Abreva) is specifically for cold sores on the face and lips. It is not indicated for the treatment of genital herpes, which requires a prescription medication like oral acyclovir or valacyclovir.

You can get a prescription for acyclovir by consulting with a healthcare provider, either through an in-person visit to a doctor or via a telehealth service. During the consultation, the provider will assess your condition and determine if the medication is appropriate.

Using acyclovir incorrectly, such as taking the wrong dosage or for the wrong duration, can reduce its effectiveness. This can also contribute to the development of antiviral resistance and may not properly treat your infection.

Yes, many telehealth services offer legitimate online consultations with licensed providers who can prescribe acyclovir if medically appropriate. Always use a reputable platform to ensure you are consulting with a qualified healthcare professional.

Yes, over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Motrin) can help manage the discomfort associated with herpes outbreaks, particularly cold sores.