I wish there was a magic bullet when it came to Lyme disease treatment, sadly if it exists it’s being very elusive! However, there is a new treatment that is showing promise – it’s a medication called disulfiram, also known as Antabuse. It’s actually a medication that is given for alcohol abuse, since it gives the taker a horrible hangover with just a small amount of alcohol. That is the deterrent to drinking while taking it. But it seems that disulfiram also has antimicrobial properties and has shown efficacy against Borrelia burgdorferi and possibly co-infections too.
In it’s traditional use, Disulfiram works by inhibiting the enzyme acetylaldehyde dehydrogenase, which breaks alcohol down to acetylaldehyde and then to acetic acid. Acetylaldehyde is the compound that’s responsible for hangovers, which is why it’s used to curb excessive drinking habits.
Studies show that the medication also has antimicrobial activity against gram-positive bacteria including some Staphylococcus and Streptococcus, as well as Plasmodium falciparum, the bacteria we know as Malaria. The mechanism by which this happens is largely unknown. However, in a study that compared four different antibiotics – doxycycline, ceftriaxone, vancomycin and disulfiram, disulfiram actually came out as the leader in reducing bacterial cell numbers.
And what’s even better is that completely sterilized the culture – there were no persisters left at all. For those of us who are familiar with chronic Lyme and it’s treatment, suffice it to say that persisters are very persistent in hanging around the body and preventing complete recovery.
So what about co-infections?
Well, we know that Babesiosis is very similar to malaria, and studies have shown disulfiram to be effective against the bacteria that causes malaria. So that’s promising. It also appears that disulfiram may be effective against Bartonella.
Disulfiram can cause Herxheimer reactions and thus should be started gradually – 62.5 or 125mg every 3 days, increasing doses gradually until a full daily dose of 500mg is achieved.
There may also be some side effects. While disulfiram is considered generally safe with a fairly low side effect profile, it is still wise to check liver enzymes regularly. There is a slight possibility of psychiatric side effects. And of course, there is a zero alcohol allowance when on disulfiram. Most Lyme patients are fairly alcohol intolerant anyway so that part isn’t the big issue; but herbal tinctures preserved with alcohol, as most are, would be a no-no as well. Some herbs are available alcohol-free in glycerite form, while others are dried herbs in tablets or capsules. Both of those would be fine.
There are also no clinical studies in animals or humans on disulfiram use in Lyme treatment; the information so far is largely based on case reports from a few key doctors who are using it. Dr. Brian Fallon at Columbia University plans to conduct a trial, so we can stay tuned for those results.
In a nutshell, it does seem that disulfiram is a promising treatment option – however, it is way too early yet to know how that will pan out for the Lyme community as a whole, over the long term. I have not yet prescribed it for my patients, but plan to start slowly, especially in patients who are not responding to other treatments, and for some who have done long-term antibiotics, have had big gains, but are struggling to get that last 10-20% recovery; and also in those who relapse or backslide as soon as antibiotics are stopped. Of course I’ll keep you all abreast of any developments as I find them, and share my experience with my own patients.
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