Disulfiram: Part 3 Nutrition And Personal Care

Disulfiram: Part 3

Nutrition And Personal Care

With disulfiram, a discussion regarding dietary restrictions is essential. These include common foods including fermented foods, kombucha, and certain baked goods with, e.g. vanilla extract, and vinegars. It is important to read food labels when buying groceries to avoid accidental exposure. Also, be aware when eating out at restaurants where alcohol might be hidden in sauces, salad dressings or desserts.

All-alcoholic beverages and alcohol-based tinctures, and even certain household products must be avoided. Consumption and accidental exposure can lead to a severe reaction that can have serious consequences.

As disulfiram stays in the body up to 14 days after cessation of use, the below information is pertinent for two weeks thereafter:

  1. Do not use alcohol-containing foods, products, or medicines, such as elixirs, tonics, sauces, vinegar, cough syrups, mouthwashes, or gargles. 
  2. Do not come in contact with or breathe in the fumes of chemicals that may contain alcohol, acetaldehyde, paraldehyde, or other related chemicals, such as paint thinner, paint, varnish, or shellac.
  3. Do not use any alcohol-containing products on raw skin or open wounds.
  4. Use caution when using alcohol-containing products that are applied to the skin, such as some transdermal (stick-on patch) medicines or rubbing alcohol, back rubs, after-shave lotions, colognes, perfumes, toilet waters, or after-bath preparations.

Using such products while you are taking disulfiram may cause headache, nausea, or local redness or itching because the alcohol in these products may be absorbed into your body. Before using alcohol-containing products on your skin, first, test the product by applying some to a small area of your skin. Allow the product to remain on your skin for 1 or 2 hours. If no redness, itching, or other unwanted effects occur, you should be able to use the product.

Currently, there are many unknowns regarding the use of disulfiram in the treatment of Lyme disease and Babesiosis: What is its action against the above infections? Is disulfiram more effective against particular manifestations of Lyme disease infections, e.g. neuroborreliosis? Are positive results because of disulfiram penetrating biofilm?

More scientific studies will need to be done, however, results have been encouraging for many who have embarked on, in the words of Dr. Liegner, this “novel off-label use of an already FDA-approved agent.”

Rika Keck

NY Integrated Health

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Disulfiram: Part 2 What you need to know

Disulfiram: Part 2 What you need to know

Some of the side effects could potentially be linked to various enzyme disruptions in the body, e.g.: Disulfiram is known to inhibit of the dopamine β-hydroxylase (DBH) enzyme, which is involved in the conversion of dopamine to norepinephrine.  A urine test from a specialized laboratory can test for functional levels this enzyme, while a genetic test can show genetic vulnerabilities of the DBH enzyme.  The combination of both tests provides helpful information whether treatment with disulfiram is appropriate, or not.


Disulfiram also has heavy metal, copper and nickel chelating properties, and this might also be a contributing factor with reported neuropathy. Individuals are now supplementing with zinc, to improve the zinc/ copper ratio.  A dietary intervention, i.e. a reduction of high copper foods, is also discussed by Dr. Rajadas. Copper, ceruloplasmin (an enzyme required for copper transport) and zinc can be checked in a blood test. In addition, elevated iron levels increase inflammation, and these are also best monitored in a blood test.

Hair mineral analysis testing (HTMA) can be a helpful as a component within this complex picture. Genetic testing (saliva testing done at home) adds another dimension as it can show up vulnerabilities in various enzyme and detoxification pathways involving, e.g. copper, ceruloplasmin, vitamin A, nitric oxide, heme, and iron. There is a lot we do not know at this time.

Disulfiram is widely known as Antabuse, a drug used in the treatment of alcohol dependence in conjunction with cognitive-behavioral therapy. Its action is by inhibiting an enzyme that metabolizes alcohol in the body. Through this inhibitory effect, any exposure to alcohol accumulates in the body in the form of acetaldehyde. Within 5-10 minutes after alcohol exposure, acute reactions can occur that can last for a few hours. These reactions have also been described as “hangover symptoms’ and symptoms can range from mild to severe. The below are examples:

  • Flushing
  • Throbbing in the head
  • Vomiting
  • Chest palpations
  • Metallic taste in the mouth
  • Fainting
  • Vertigo
  • Convulsions
  • Hyperventilation
  • Neck pain
  • Psychosis
  • Seizures
  • Refractory headaches

Other side effects from use of Disulfiram (Antabuse) can be found at this website: https://www.rxlist.com/antabuse-side-effects-drug-center.htm

Thyroid function must be monitored, in particular iodine levels, as disulfirmam has anti-thyroid properties. It induces an iodine deficiency resulting in thyroid dysfunction that was already documented as early as 1954.  Based on this information, a thorough evaluation of thyroid function and optimizing of iodine levels would be warranted.  (An iodine-loading test can be ordered by the physician to assess current iodine levels, and thyroid function is assessed with a blood test.)

Rika Keck

NY Integrated Health

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Disulfiram Part 1: A Novel Lyme Disease Treatment?

Disulfiram: A Novel Approach To Lyme Disease Treatment (part 1)

Not everyone is a candidate for this drug treatment, and it requires careful screening by the prescribing physician. Candidates include patients who had responded well to antibiotic and anti-babesiosis medications, but relapsed upon cessation of drug therapy and improved after re-introduction of medications.

The treatment dosage of disulfiram is based on body weight. The medication is titrated up over days and weeks until the target dose has been reached for the patient (if tolerated.)  The prescribing physician must monitor the patient carefully throughout this process. Once the target dose has been reached, currently the goal is to maintain the dose for 6-12 weeks, depending on the patient’s response. After treatment is discontinued, laboratory testing is done for 3-6 months post-treatment to check for remission. Some severely compromised individuals showed positive effects after a lower dose and prolonged treatment, greater than six months. It must be noted that are still many questions surrounding a specific treatment protocol with Disulfiram.

Weekly blood labs are required when starting disulfiram, then every other week, after which, as recommended by the prescribing physician. Your doctor may want you to carry an identification card stating that you are using this medicine.

Other physicians involved in the patient’s care must be notified if disulfiram therapy is introduced, as other medications currently in the patient’s program might be contra-indicated with disulfiram. These can include select antihistamines, sedatives, warfarin, sleep and pain medications, narcotics, and anesthetics.

Treatment observations vary from patient to patient, as well as dosing tolerance. Enteric – coated Disulfiram, and small doses during the day is being discussed in various groups online. Its use in children under 16 has not been tested regarding safety, and thus only adults are eligible as potential candidates. 

With a candidate, it is essential to discuss the benefit/risk ratio in perspective of the medical history and current clinical symptoms. Side effects that resulted in stopping the use of disulfiram included peripheral neuropathy, mood disturbances, fatigue, and edema. Side effects such as neuropathy have been severe, and slow to subside after cessation of treatment. At this time, there are still many unknowns.

Rika Keck

NY Integrated Health

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