First experiences with disulfiram

by Sigrid Blehle MD, MBA

Since 2019, disulfiram has been increasingly used for the therapy of Lyme disease. According to experience to date, disulfiram is effective against infection with Borrelia and Babesen. An infection with Bartonella can only be insufficiently treated with it. I report on the experience of a total of 70 patients who have been treated with disulfiram at the BCA Augsburg since November 2019. These patients had usually been treated for years and still had persistent symptoms or only partial success with the previous therapies.- Many patients were HLA-DR positive as a genetic predisposition for antibiotic-resistant Lyme disease.


Prerequisites for this therapy are no alcohol consumption, normal liver values, a positive medical history or a no known psychosis in the family. It has been observed that in some cases even the use of solutions containing alcohol leads to side effects on the skin. The therapy is not recommended for pregnant women and children under 16 years of age.


At the start of the therapy the previous therapy was completely stopped. Symptoms were treated with food supplements. It is described that under disulfiram a probiotic is not necessary. However, it was felt that the tolerability was better with the use of a probiotic, especially with regard to possible gastrointestinal side effects.

It is important that Candida problems are treated before starting therapy because fungi produce alcohol. In this case, it is necessary for patients to follow a strictly yeast-free diet and take antimycotics (antifungals). This should be clarified especially if antibiotics are taken beforehand.

The dosage was started gradually. Initially, the patients received 125mg or 50mg or 62.5mg every three days, from the third week every two days, and from the fifth week daily. In order to avoid neurotoxic side effects, high doses of zinc were also administered.

The increase in dosage was determined by the clinic (by the patient’s symptoms). If the patient showed signs of a pronounced Herxheimer’s reaction, the dose was reduced. Overall, the dose was increased carefully. There were patients who were sufficiently treated with 75mg and others who needed 500mg. It was also observed that an increase of 50mg each is recommended at doses of 250mg, as toxic side effects are more common. The daily dosage should be chosen in such a way that a Herxheimer’s reaction can just be avoided or tolerated. If the Herxheimer’s reaction becomes too strong, the administration of disulfiram should be paused. Liver values and blood counts had to be checked regularly during therapy.


The following side effects have been described with disulfiram: Liver failure, psychosis, pronounced Herxheimer reactions, neuropathies, visual disturbances, sulphurous body odour, insomnia, increased appetite but also loss of appetite, headache, fatigue, nausea, acne, metallic taste, skin reddening, reduced libido, depression, constipation and flatulence.

There were also experiences with overdoses. Thus, in addition to neuropathic complaints, severe visual disturbances as an expression of inflammation of the optic nerve, severe disturbances of balance as an expression of inflammation of the acoustical nerve, severe psychological disturbances, breathing problems and elevated liver values were observed. When these side effects occurred, the therapy was stopped. These side effects were reversible, but some of them persisted for weeks. Glutathione and alpha lipoic acid were used therapeutically.

Would you like to read more about disulfiram? Ms Sigrid Blehle gave a detailed lecture on this topic at the “4th national conference about chronic infections” on 06.09.2020.

We provide you with the presentation slides here:


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