Disulfiram or Antabuse, well known to pretty much every medical doctor over 40 who has used it at one time or another for treatment of alcohol abuse. It fell out of favor decades ago because alcoholics would just stop taking it instead of suffering the consequences of severe abdominal wretching.
Thanks to the Steven and Alexandra Cohen foundation and Dr Kim Lewis leader of Northeastern University's antimicrobial discovery center efforts in finding drugs effective against borrelia. Normally alcohol is metabolized into acetaldehyde and then acetic acid by acetaldehyde dehydrogenase. This enzyme gets inhibited by Disulfiram causing a build-up of acetaldehyde which is the same compound responsible for the symptoms that we relate as hangover. Disulfiram has known antimicrobial effects against gram-positive bacteria as well as malaria.
In 2016 doctors at Stanford University screened multiple drugs rating their activity against borrelia and found that Disulfiram was at the top of their list. Specifically when tested against doxycycline ceftriaxone, and vancomycin, Disulfiram seemed to clear the culture of all evidence of borrelia including any persisters, unlike any of the other antimicrobials. The mechanism of action of Disulfiram as far as antimicrobial activity is still unclear.
Clinical trials on Disulfiram should be forthcoming, however there are physicians and patients that feel it is unnecessary to wait. A patient of Dr Ken Liegner of Pawling New York reviewed Dr Kim Lewis's lecture on YouTube and requested to be placed on Disulfiram. This patient was infected in 2008 and has required multiple antibiotics as well as IVIG due to his immune suppression. He has done well on antibiotics only to have his symptoms return 2 weeks after being off antibiotics. After 4 months on Disulfiram the patient stated that he was cured and remained symptom free for 2 years off all antibiotics and off Disulfiram. He did however suffer hospitalization for psychiatric problems although it is not clear if Disulfiram was causal. The patient himself said he would have taken it anyway.
In my practice in Concord I have five patients on Disulfiram. I start at a very low dose of 62.5 mg every third day for 9 days and then increase it to 125 mg every third day for 9 days and reassess at that time. In this way most patients have minimal to know side effects. However side effects specifically peripheral neuropathy and psychosis can be common at higher doses. Side effects can also be dependent on patient's body weight. Patients also must be very cognitive avoiding any alcohol particularly occult alcohol which can be found in ketchup, vinegar, cough syrup, and many common sauces. Avoid taking with metronidazole, Isoniazide, Phenytoin, lithium, tricyclic antidepressants, monoamine oxidase inhibitors(MAOI), benzodiazepines, warfarin, and theophylline. Other precautions should also be taken such as testing for dopamine beta hydroxylase, and treatment to reduce aldehydes such as N-acetyl Cysteine, Taurine, and Pyridoxine 5 phosphate.
If you are a chronic lyme patient with persistent symptoms I encourage you to do your own investigations with Disulfiram and find a medical physician for a treatment trial.
Dr Toth is a family practice and hyperbaric oxygen medical doctor in Concord, who has treated many Lyme patients over the past 14 years.