Herpes labialis (cold sores)
Clinical basis & sources
- Primary source
- OCP Minor Ailments Prescribing
Sources used
- Ontario Regulation 256/24: GeneralGovernment of Ontario · 2026
- Minor Ailments: Drug Classes and Specified DrugsOntario College of Pharmacists · 2026
- Executive Officer Notice: Update to Funding for Minor Ailment Services in Ontario Pharmacies (Effective July 1, 2026)Government of Ontario · 2026-05-19
- Nongenital Herpes Simplex VirusAmerican Family Physician · 2010
- Herpes SimplexDermNet · 2026
- Herpes Simplex Virus (HSV) InfectionsMerck Manual Professional Edition · 2026
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Allowable drugs under Schedule 4 (5)
Drugs an Ontario pharmacist may prescribe for Herpes labialis (cold sores) under O. Reg. 256/24, Schedule 4. Choice still depends on the assessment, contraindications, allergies, and product availability — this is the eligible list, not a recommendation.
- Acyclovir
- Docosanol
- Famciclovir
- Hydrocortisone
- Valacyclovir
Symptoms this assessment screens
- Tingling, burning, itching, or pain before a cold sore appears
- Grouped blisters, vesicles, ulcers, or crusting on the lip or perioral skin
- Recurrent lesions in the same or similar location
- Symptoms started within the early treatment window
- Trigger pattern such as sun exposure, stress, fever, cold, trauma, or procedures
- Localized lip/perioral episode without eye, systemic, genital, or widespread features
Red flags — any positive means refer
- Eye pain, light sensitivity, vision change, eyelid/periocular lesion, or lesion close to the eye
- Immunocompromised patient, widespread lesions, eczema herpeticum concern, or disseminated infection concern
- Infant/neonate, severe primary mouth infection, fever, dehydration, or inability to eat or drink
- Genital/anogenital lesion, finger lesion, shingles pattern, intraoral lesions beyond uncomplicated cold sores, or diagnostic uncertainty
- Pus, spreading redness, honey crusting, severe pain, lesion not healing, or poor antiviral response
- Frequent severe recurrences, pregnancy complexity, or request for suppressive therapy
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