Disulfiram is an incredibly powerful tool to treat tick-borne infections, but it also has the potential to cause problems. If we are careful with the way it is taken, then the risk is limited. Here are guidelines to ensure its safety.
It is imperative to avoid alcohol as well as topical products containing alcohol. Also, avoid fermented foods such as kombucha, pickles, sauerkraut, olives, soy sauce and vinegar as well as all sugar products and green tea.
The first and most common issue is “Herxheimer” reactions. This happens when pathogens are killed off and the body reacts to the dead pathogen debris with an immune/inflammation response. If the Herxheimer reaction is severe we decrease the dose. If the Herxheimer reaction is mild, then we wait until it has resolved before increasing the dose.
We treat Herxheimer reactions the same way we treat Herx reactions from other antimicrobials:
- Binders, e.g. charcoal
- Alkalinazation with lots of water and lemon as well as Alka Selzer Gold or Tri-Salts
- Hot baths with epsom salts and baking soda
- Detox and drainage remedies
Disulfiram can cause “minor” side effects in some patients. These include constipation and bloating, acne, bad breath, body odor, nausea, weight gain, metallic taste, headaches and fatigue. Unless severe, these symptoms are not reason to stop the medication.
Disulfiram can cause neurotoxicity. At times this can be difficult to distinguish from a Herxheimer reaction. These drug reactions typically occur at higher doses, often right after a dose increase, but some patients experience neurotoxicity at lower doses. If symptoms of pins and needles, numbness, stabbing, shooting, or burning pain develop, this could represent disulfiram induced neuropathy. If symptoms of brain fog/impaired cognition, headache, mood changes or vision issues develop, this could represent toxic encephalopathy, which is brain toxicity.
If the disulfiram dose is lowered or if the drug is stopped within days of the onset of neurotoxic symptoms, they typically remit quickly. It is essential that you contact me immediately if any of these symptoms develop.
Liver toxicity is another serious potential side effect. It is important to get blood tests monthly to monitor liver function. There are reports that it can cause hypertension and even psychosis.
Supplements to take with Disulfiram
We recommend several supplements to help prevent neurotoxicity
- Zinc, 25-30mg/day
- Alpha Lipoic Acid, liposomal 500mg 1-2x/day and/or IV
- Melatonin, 20mg 3x/day
- Vitamin C, 1000mg 3x/day or liposomal 1000mg 1-2x/day
And several supplements for liver support
- Milk thistle
Disulfiram Dosage Protocol
It is critical to not increase the Disulfiram dosage too quickly. Patience will low the chance of side effects and increase the chance of defeating Lyme. The Disulfiram caps are made by a special compounding pharmacy.
- 30mg every 3 days for 2 weeks
- 30mg every 2 days for 2 weeks
- 30mg every day for 2 weeks
- 30mg, 1 cap daily alternating with 1 cap 2x/day for 2 weeks
- 30mg 1 cap 2x/day for 2 weeks
- 30mg 1 cap am 2 caps pm for 2 weeks
- 30mg 2 caps 2x/day 2 week or 60mg 2x/day
- From here it varies, some patients continue to work up slowly to 120mg 2x/day
Take disulfiram only at the recommended dose, and check in every two weeks. The check in should include the following:
- DSF dose, frequency, and duration
- Any changes noticed on that dosing schedule
- A complete updated med list
Credit to Dr D Kinderlehrer, author of The Integrative Medicine Guide to Diagnosing and Treating Tick-Borne Infections, for letting us adapt his handout for our website and giving advice on Disulfiram for Lyme