Docosanol (topical)

Marketed as Abreva, docosanol is saturated fatty alcohol originally used in beauty products as an emulsifier, but now also used alone as a treatment for cold sores and fever blisters that are symptomatic of herpes simplex type 1 virus. While it does not cure the patient of the virus, it does show some effectiveness in reducing the amount of time the patient suffers from the outbreak and the manifest symptoms.


Docosanol is a saturated fatty alcohol. It is also known as behenyl alcohol and has been used for decades in cosmetics and beauty products because of its emulsifying and emollient properties. Since 2000, it has also been marketed individually under the brand name Abreva (in the United States) and Erazaban (in Europe) as a topical treatment for cold sores and fever blisters caused by herpes simplex virus type 1.

It is believed that docosanol functions to fight the virus by interrupting its ability to fuse with the skin cells necessary for the virus to replicate and the cold sore to continue to grow. Effectively, the medication forms a barrier between the active cells of the virus and the skin it is attempting to invade. Abreva does not cure the virus. The patient will continue to carry the herpes simplex virus and be at risk of future lesions. This medication helps alleviate the symptoms, slows the spread of the virus and speeds up the healing process for the patient. Docosanol earned FDA approval for this application in 2000.

Clinical trials of docosanol in the treatment of herpes simplex type 1 showed a significant reduction in healing time if the initial treatment begins within 12 hours of the onset of symptoms of the outbreak.

The typical course of treatment is anywhere from three to 10 days. Abreva should not be used for more than 10 days at a time. Caution should be used when applying Abreva to the cold sore lesion(s), using only clean hands. Patients should not share their medication with others or use anyone else's medication as the infection can be spread from person to person.

Docosanol is generally very well tolerated, although it is a mild irritant. Allergic reaction is possible, but very rare. It has not been tested in pediatric patients or in pregnant women so there is not a recommended dosage or usage protocol for these groups.

Conditions Treated

  • Herpes simplex virus type 1

Type Of Medicine

  • Antiviral, topical ointment

Side Effects

As with any medication, docosanol carries the risk of some side effects. The most frequently reported side effect is a headache. Less frequently, patients may also suffer from the following:

  • Burning sensation
  • Dry skin
  • Increased outbreak of acne
  • Itching skin, particularly at application site
  • Swelling
  • Irritation of skin, rash
  • Red skin

Very rarely, a patient may suffer an allergic reaction to docosanol that can result in anaphylaxis (swelling of the face, mouth, throat, or lips, difficulty breathing, hives, dizziness or wheezing). Patients who experience these symptoms should seek immediate medical treatment.


Abreva (docosanol)is delivered in the form of a topical cream. It is usually a 10% strength solution and is available over the counter. No prescription is necessary. The recommended dosing level is to apply cream to the lesion(s) five times daily. Length of treatment is between three and ten days. If the medication is used in the early onset of the cold sore, the length of treatment may be as short as two and a half to three days. Abreva should not be taken for more than ten days consecutively. The patient should be sure to wash hands thoroughly before applying the ointment and then wash hands again after application to avoid spreading infection. The cream should cover the lesion completely and be applied gently, but thoroughly.

This medication has not been studied in children under the age of twelve. Pediatric patients over the age of 12 should follow the same instructions as adult dosing levels.

This medication should not be applied near the eyes or ingested. If Abreva is accidentally ingested and overdose is suspected, contact poison control for guidance. It also should not be used to treat other forms of the herpes virus, including chicken pox or shingles. It should not be applied on the body or genitals. Patients should avoid using cosmetics while using Abreva to treat the cold sore. It could interfere with the absorption of the medication and runs the risk of spreading the infections to other parts of the face or mouth.

In the event that the patient misses a dose, he or she should apply medication as soon as possible. If it is near to the time of the next dose, skip the missed dose and proceed with the regular application.


There are no known drug interactions with docosanol. It is not recommended that patients who are pregnant or nursing use this product unless absolutely necessary. It is also not recommended for children under the age of twelve. There is no need to adjust dosage for patients with compromised renal, hepatic or cardiovascular systems. There is no contraindication for use of this medication in conjunction with other medicines. The only contraindication involves patients who may be allergic to docosanol.


Docosanol (Abreva) is only indicated for the treatment of symptomatic herpes simplex virus type 1. It should not be used prophylactically. It should not be used to treat other lesions or sores related to other viruses, such as herpes zoster (the virus that causes chicken pox and shingles), canker sores (lesions that occur inside the mouth) or other blisters.

It should also not be ingested or used on genitalia. In the event that docosanol is accidentally ingested, the patient should call poison control. It is also important that patients keep this medication stored safely and securely out of the reach of children or animals as it can be dangerous if swallowed.

If the cold sore or fever blister has not healed after ten days of regular use, the patient should discontinue treatment with abreva and seek medical attention. A different sort of treatment protocol is indicated at that point. It may also be indicative of another sort of infection, perhaps bacterial.

There has been limited testing of the use of docosanol in patients with autoimmune disorders or compromised immune systems.

Docosanol is most effective when it is taken as soon as the patient notices the earliest signs of a lesion forming, including tingling sensation in the lip, a bump forming or other symptoms.

Patients should only take Abreva from a container that belongs to him or her. This medication should not be shared among patients as it serves to spread the infection. Use of a cotton swab for the application of the cream is recommended as it prevents the introduction of germs from the hands to the lesion and the virus present in the lesion from getting on the hands and then being spread.


Docosanol should be stored at room temperature, between 20 and 25 degrees Celsius (68 to 77 degrees Fahrenheit). It should not be refrigerated or allowed to freeze. It is possible to overdose on this medication and it should not be ingested, it is very important that this medication be stored in a safe and secure environment, away from heat and moisture. When finished with this product, any expired or residual medication should be safely disposed of. It should not be flushed down the toilet or disposed of in such a way that it may end up in a landfill. A pharmacist or healthcare provider can provide information on appropriate disposal.


Docosanol has been approved for the treatment of herpes simplex type 1 virus since 2000. Originally, the product was used as an emulsifier in beauty products and creams. After its FDA approval, docosanol has been marketed in the United States as the topical solution Abreva. It is available over the counter, without prescription. The normal course of treatment involves the patient applying the cream to the lesion(s) five times a day. The cream should be applied with a cotton swab as to keep the tip of the medication container free of germs and keep the lesion free of germs from the hand. The cream should not be used beyond ten days. If the lesion has not healed in that time, the patient should seek advice of a health care provider as it would indicate a secondary infection or other complicating factor.

This medication is generally very well-tolerated with few side effects or drug interactions. Allergic reaction is possible, but otherwise, there is little danger to this medication unless it is ingested. Because accidental overdose is possible if Abreva is swallowed, safe and secure storage of the medication is very important.

Abreva is only effective in the treatment of herpes simplex type 1 virus, and should not be used to treat other forms of the herpes virus. It should not be applied near the eyes or genitals, nor should it be used for the treatment of canker sores or other kinds of skin and mouth lesions.