Valtrex again

I've been having success killing borrelia with valacyclovir, but I'm getting a bunch of side effects, even at a fairly low dose, 500 mg two or three times a week.

I had been taking sodium valproate too, but it was causing me too much herxing and weight gain, so I stopped that about a month ago, but continued taking valacyclovir.

I've been getting headaches, dark red spots on skin, hemolysis, and what feels like poor blood circulation like I slept on my arm. I suspect this is thrombotic thrombocytopenic purpura, a known side effect of valacyclovir.

I'm frustrated with this because valproate and valacyclovir are the only drugs I've found that really kill borrelia and not put it into a dormant state where it just comes back later. The spots where I feel pain when I herx have become fewer over time, although this has been a frustratingly slow process that has taken over a year.

I know some people have succeeded with disulfiram or dapsone, but that has even more risk of severe side effects, so I'm not doing that.

One thing I have noticed is that borrelia does not immediately die from valacyclovir, but dies some days later, and the die off is accelerated if borrelia is later stressed with something else like desloratadine or common antibiotics like minocycline and azithromycin.

The way valacyclovir normally works when treating herpes is that it is first metabolized to acyclovir. Acyclovir is relatively non-toxic to normal cells, but in infected cells the viral thymidine kinase enzyme phosphorylates acyclovir, and this metabolite blocks the DNA polymerase.

The problem seems to be that borrelia phosphorylates acyclovir much more readily than a small number of herpesvirus-infected cells, forming large amounts of this metabolite which becomes toxic to human cells, causing severe side effects even at low doses.

Since the phosphorylated acyclovir gets released during die off and herx, it seems to help to not let too much of this build up, and wait for the herx to finish before taking more valtrex.

It sometimes can be hard to tell how long the herx will go on, but I notice that the smelly opaque urine comes out toward the end.

How dangerous are the side effects of valacyclovir and is this going to cause me long term problems?

I originally took valtrex to try to treat a suspected herpes virus, but found that it instead caused a classic herxheimer reaction from borrelia die off. I get sore muscles in the areas where the bacteria are, and I detox and pee a lot.

I am not getting any mouth sores or symptoms of herpesvirus now, and have not for some time, so whatever viral infection I had seems to be inactive.

I had a big herx last week, and got some worrying side effects from the valacyclovir, including extreme fatigue, headaches, shortness of breath, and signs of microclotting. This would normally be quite unusual for such a low dose (less than 500 mg per day) which implies that the acyclovir and its active metabolite are accumulating within the bacteria and being released during the herx.

A similar problem exists with valproate or disulfiram where it's easy to overdose because of large amounts accumulating and then being released due to die off (herx). I don't know if this happens with dapsone, but I suspect it might. Pretty much everything that is really effective at killing borrelia seems to accumulate within the bacteria over a period of time before the bacteria finally die.

As for loratadine/desloratadine and manganese channels, yes I do herx from Claritin. This drug seems to be a bit safer than some other things because it does not accumulate, so there isn't a risk of too much at once.

What I notice with Claritin is that after a few hours I start to feel nervous and detox a bit (increased urination). However desloratadine interferes with the immune response, so I don't get the usual herx symptoms and feeling sick until a day or two later. I generally only take the claritin only once every three days or so, to give my immune system time to recover and clear out the dead bacteria. I've also had a big problem with getting mold or fungal infections when my immune system is weak, so I am cautious of that too.

Minocycline and azithromycin I mostly used against bartonella. I found that taking atovaquone would make bartonella much more susceptible to the antibiotics, so I didn't have to take such a high dose. Toward the end I only took 500 mg azithromycin and 100 mg minocycline and I was able to eliminate the bartonella infection. I didn't have any major side effects at this dose, although I did get diarrhea, and minocycline does suppress the immune response similar to desloratadine, so I would not take it every day.

I don't know how I could improve my sleep. I am sleeping a lot, often 12+ hours a night. When I don't feel well, I sleep a lot.

I took another dose, and I'm not herxing quite so bad, and not getting the side effects of headaches or bleeding under the skin. So it seems that some of the bacteria have been eliminated, and these side effects are lessened when there are fewer active bacteria.

It was mentioned in another thread that research in vitro found that borrelia burgdorferi is vulnerable to other nucleoside analogues including ganciclovir. Although chemically similar, ganciclovir is more toxic than aciclovir and has more side effects, so is usually not recommended if aciclovir can be used instead.

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4790293/

A similar study of bartonella henselae did not identify such an effect, so this appears to be a relatively unique vulnerability of borrelia.

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6628006/