Do you need a prescription for topical acyclovir?

October 9, 2025 •

4 min read

An estimated 3.8 billion people under the age of 50 (64%) have herpes simplex virus type 1 (HSV-1), the primary cause of cold sores. When facing an outbreak, a common question is: do you need a prescription for topical acyclovir? The answer is yes, in the United States, this antiviral medication requires authorization from a healthcare provider.

Quick Summary

Topical acyclovir, an antiviral medication for herpes simplex virus infections, is available by prescription only in the U.S. It helps manage symptoms of cold sores and genital herpes, though over-the-counter options exist for cold sores.

Key Points

Prescription Required: In the U.S., all forms of acyclovir, including topical cream and ointment, require a prescription from a healthcare provider.
Approved Uses: Acyclovir cream is for recurrent cold sores on the lips, while the ointment is for initial genital herpes and other skin infections.
Mechanism of Action: Acyclovir is an antiviral that works by stopping the herpes virus from replicating its DNA.
OTC Alternatives Exist: For cold sores, docosanol (Abreva) is an FDA-approved over-the-counter alternative that prevents the virus from entering cells.
Proper Application is Key: Treatment should begin at the first sign of an outbreak (e.g., tingling) for maximum effectiveness.
Formulation Matters: Acyclovir cream should not be used on genital sores due to potential irritation; the ointment is intended for that use.
Consult a Doctor: For proper diagnosis, management of frequent outbreaks, or treatment of genital herpes, consulting a healthcare professional is crucial.

Understanding Acyclovir and Its Prescription Status

Acyclovir is a potent antiviral medication that belongs to a class of drugs called nucleoside analogues. It works by interfering with the DNA polymerase of the herpes virus, an essential enzyme the virus needs to replicate. By halting this process, acyclovir helps to reduce the severity and duration of outbreaks, although it is not a cure for the virus itself.

In the United States, all forms of acyclovir, including the topical cream and ointment (often known by the brand name Zovirax), are available only by prescription. This means you must consult with a licensed healthcare provider to determine if the medication is appropriate for your condition. While some countries, like the UK, may offer specific formulations of acyclovir cream for cold sores over the counter, this is not the case in the U.S..

Conditions Treated with Topical Acyclovir

Healthcare providers prescribe topical acyclovir to treat infections caused by the herpes simplex virus (HSV). Its primary uses include:

Recurrent Herpes Labialis (Cold Sores): The 5% cream is FDA-approved for treating recurrent cold sores on the lips and around the mouth in adults and adolescents aged 12 and older.
Initial Genital Herpes: The 5% ointment is used for the management of initial genital herpes outbreaks. It helps relieve pain and discomfort and can help sores heal faster.
Limited Mucocutaneous HSV Infections: The ointment may also be used for non-life-threatening HSV infections on the skin in individuals with a weakened immune system.

It's crucial to use the correct formulation for the specified area. Acyclovir cream should not be used on the genitals, as it can cause irritation. Oral antiviral medications like acyclovir, valacyclovir, or famciclovir are generally recommended by the CDC for treating genital herpes over topical options.

How to Properly Apply Topical Acyclovir

For the medication to be effective, it should be applied as soon as the first signs of an outbreak appear, such as tingling, burning, or itching.

Wash Hands: Always wash your hands with soap and water before and after applying the cream or ointment.
Clean and Dry: Ensure the affected area is clean and dry before application.
Apply a Thin Layer: Use enough cream or ointment to completely cover the lesion and its outer margin. For the cream, rub it in gently until it disappears. For the ointment, use a finger cot or rubber glove to prevent spreading the virus.
Follow Directions: Adhere to the frequency and duration of application as prescribed by your doctor or indicated on the product labeling.
Avoid Certain Areas: Do not apply the medication inside your eyes, mouth, nose, or on the genitals (for the cream version).

Prescription Acyclovir vs. Over-the-Counter (OTC) Alternatives

While acyclovir requires a prescription, there are effective FDA-approved over-the-counter treatments for cold sores, with docosanol (Abreva) being the most prominent.


Feature	Prescription Topical Acyclovir (Zovirax)	OTC Docosanol (Abreva)
Availability	Prescription only	Over-the-counter (OTC)
Active Ingredient	Acyclovir	Docosanol 10%
Mechanism of Action	Stops the virus from replicating its DNA.	Prevents the virus from entering healthy cells.
Primary Use	Recurrent cold sores, initial genital herpes (ointment).	Cold sores (fever blisters) on the face or lips only.
Application	Apply as directed by a healthcare professional.	Apply as directed on the packaging.
Effectiveness	Can reduce healing time and pain duration.	Can shorten healing time and duration of symptoms.

Potential Side Effects

Topical acyclovir is generally well-tolerated. The most common side effects are mild and occur at the application site. These can include:

Burning or stinging sensation
Itching
Dry or cracked lips
Flaky or dry skin
Redness or swelling

Serious allergic reactions are rare but possible. Seek immediate medical help if you experience signs of a severe allergic reaction, such as a rash, hives, difficulty breathing, or swelling of the face, lips, or tongue.

Conclusion: Consult a Healthcare Professional

To answer the question directly: yes, in the United States, you need a prescription to obtain topical acyclovir. It is a proven antiviral medication for managing herpes simplex virus outbreaks, including cold sores and initial genital herpes. However, it is not an over-the-counter product.

For individuals seeking immediate, non-prescription relief for cold sores, OTC options like Abreva (docosanol) are available and work by a different mechanism to shorten healing time. If you have frequent or severe outbreaks, or if you believe you have genital herpes, consulting a healthcare provider is essential. A doctor can provide an accurate diagnosis, write a prescription for the most effective treatment—whether topical or oral—and offer guidance on managing the condition safely.

For more information from an authoritative source, consider visiting the NHS page on aciclovir.

Frequently Asked Questions

No, in the United States, acyclovir cream is a prescription-only medication. You cannot buy it over the counter.

There is no direct OTC equivalent. However, docosanol 10% cream (brand name Abreva) is an FDA-approved over-the-counter antiviral treatment specifically for cold sores.

No, Zovirax is a brand name for acyclovir, and both the brand and generic versions of the topical cream and ointment require a prescription in the U.S..

Acyclovir 5% ointment is indicated for initial genital herpes outbreaks. However, the 5% cream should not be used on the genitals. Oral antiviral medications are generally the recommended treatment for genital herpes.

Abreva (docosanol) is an OTC cream that works by blocking the herpes virus from entering healthy cells. Prescription acyclovir is an antiviral that stops the virus from replicating after it has already entered cells.

You should start applying topical acyclovir at the earliest sign or symptom of a cold sore, such as tingling, itching, redness, or burning, to achieve the best results.

If you miss a dose, you should apply it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not apply extra cream to make up for a missed dose.