Disulfiram is an FDA-approved drug (Antabuse) that has been in use for over 50 years. Its approved indication is as an alcohol antagonist to help alcoholic patients stay sober. When alcohol is used in conjunction with disulfiram, a strong reaction occurs that involves highly unpleasant symptoms. These symptoms are unpleasant enough to help prevent further alcohol consumption. Recent research has found new uses for this drug, including in the treatment of persistent Lyme disease infections. While it is not an antibiotic, the drug has been shown to have potent antibacterial properties.

Efficacy in Killing B. Burgdorferi

In a study of a wide variety of drug products that examined their efficacy in killing borrelia burgdorferi, the causative agent of Lyme disease, it was found that the approved drug disulfiram was a strong candidate for its ability to eliminate the infection. A select 20 products that reduced > 90% of B. burgdorferi were chosen for further study because they are FDA approved and considered safe. Disulfiram was one of these drugs that showed excellent potential for treating Lyme and was considered unique in the group in that it was not an antibiotic. Antibiotics are the most common treatment for persistent Lyme disease infections. Unlike antibiotics, disulfiram has shown no potential for creating resistance to the drug.

Disulfiram Dosing

Starting doses of disulfiram for treating Lyme are generally lower than those used for treating alcohol dependency. Doses may start as low as 30mg every three days and be titrated up to a maximum of 250mg daily based on how well the patient tolerates the drug. The exact dose depends on the patient and will be determined by the prescribing doctor. It is not necessary to push the dose as high as possible, as the drug may be effective at a lower dose with less side effects. We compound disulfiram in enteric acid-resistant capsules.

Regular monitoring is necessary during treatment to ensure there are no serious adverse effects. Patients should be reminded to not self-medicate any drug without physician supervision. There are several known side effects and drug interactions of disulfiram that your doctor will describe when deciding if this medication is right for you.

The Alcohol-Disulfiram Reaction

The alcohol-disulfiram reaction is a potent reaction and any patient taking disulfiram must be advised of its effects before taking the drug. When alcohol is consumed with disulfiram it produces flushing, throbbing in the head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. Patients must avoid alcohol and alcohol-containing products when using disulfiram – whether they are using it to treat Lyme or any other condition.

Research

Identification of new drug candidates against Borrelia burgdorferi using high-throughput screening. – Drug Design, Development and Therapy

Antibacterial activity of disulfiram and its metabolites – Journal of Applied Microbiology

Disulfiram effective drug against Borrelia burgdorferi – Biomaterials and Advanced Drug Delivery, Stanford

Disulfiram (Tetraethylthiuram Disulfide) in the Treatment of Lyme Disease and Babesiosis: Report of Experience in Three Cases – Antibiotics

Video

Dr Kinderlehrer’s experience treating Lyme patients with disulfiram – YouTube