If Disulfiram is the cure for Lyme disease,  should Disulfiram be prescribed to all Lyme disease patients? 

by Alain Mass, M.D.

Disulfiram is particularly effective on Borrelia Burgdorferi, the Lyme disease bacteria, and Babesia, far more potent than any antibiotics. The difficulty in treating Lyme disease has always been not only to choose the appropriate antibiotics to kill the active bacteria responsible for the disease but also a subpopulation of Lyme disease bacteria, called "persister-cells", known to stay in a dormant, latent state, avoiding the destructive effect of antibiotics, waking up after the course of antibiotics to cause relapses of the disease. Persisters are largely responsible for high levels of biofilm impeding the effects of antimicrobials. Disulfiram has not only an excellent effect on active Lyme bacteria but also on persister-cells and may, therefore,  be regarded as a true breakthrough in the treatment of Lyme disease not only to treat efficiently but also potentially to eradicate Lyme disease.

Disulfiram is not new and unknown medication. It is an FDA approved- drug that has been used since 1949 for the treatment of alcoholism. Researchers regularly screen medicinal compound libraries to identify molecules that may be effective against specific bacteria. After screening about 4366 drug molecules, Disulfiram was identified as highly active against both B. burgdorferi and babesiosis, a common Lyme disease coinfection. Its use in the treatment of Lyme disease and other tick-borne diseases is, however, off-label meaning that there is no FDA approval for these indications. The obvious question is why should Disulfiram not be prescribed to all Lyme disease patients?

The first reports presented, first, by Dr. Liegner and later by other clinicians are astonishing by a dramatic and persisting improvement of patients who resisted multiple treatments and by the scarcity of side effects. It does not mean, however, that the medication is safe and can be prescribed without precaution. In order to state that Disulfiram can be considered as a new treatment of choice of Lyme disease, Disulfiram must prove its safety or at least that the benefits outweigh the risks. The significance of side effects should be related to the frequency of these side effects, the dose of the medication, the targeted population, and the indication. The side effects that are reported by the medical literature occurred were rare, for much higher doses than those used for Lyme disease, in severely alcoholic patients prone to liver disease, psychosis, malnutrition, and other comorbidities.

As long as these questions are not answered, the benefits would not outweigh the risks by starting with Disulfiram before giving a chance to other drugs known to be safer.  Selection of the right patient, patience, prudence, monitoring clinical signs and laboratory markers are key to success.

Alain Mass, M.D.                                                                                                                                                                                      Member of the International Lyme and Associated Disease Society (ILADS),                                                          Diplomate of International Society for Environmentally Acquired Illness (ISEAI)                                                              400 Rella Boulevard, suite 165                                                                                                                                                                             Montebello, NY                                                                                                                                                                                                                      Tel: (845) 623-0047                                                                                                                                 contact@massfunctionalmd.com