Disulfiram (Antabuse) Monotherapy
A repurposed alcoholism drug for long-term treatment failures
- Targets
- Lyme
- Intensity
- Intensive
- Components
- 1
- Prescription
- Required
For people who have taken a year or more of antibiotics and remain ill without an active co-infection. Lab studies at Stanford and Johns Hopkins showed disulfiram kills Borrelia persisters, and Dr. Kenneth Liegner reported lasting remissions in some patients. It is a difficult drug to take.
The regimen
Duration: Slow build over 3–4 months, then several months at target dose
Key points
- Best suited to people who failed long courses of standard antibiotics
- Dr. Ross estimates about 36% of patients reach remission; more see improvement
- A 2025 Columbia pilot trial found significant side effects, especially at higher doses
- No alcohol at all — even small hidden amounts cause severe reactions
- Does not treat Bartonella and is weak against Babesia
The evidence
- Lab: Disulfiram killed Borrelia in culture and in mice (Potula et al., 2020).
- Case reports: Dr. Liegner described three patients who could stop open-ended treatment and stay well for 6–23 months after a finite disulfiram course (2019).
- Pilot trial: A small randomized Columbia University study (Kuvaldina et al., 2025) saw meaningful fatigue improvement in 6 of 9 participants, but also withdrawals for worsening symptoms and lab abnormalities. Lower doses were better tolerated.
Why it's hard
Side effects can include fatigue, mood changes, neuropathy and liver irritation, so close medical supervision and lab monitoring are essential. Dr. Ross's full disulfiram guide details his dosing schedule.
Discussion
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Not medical advice. This protocol is summarized from Dr. Marty Ross, MD — Disulfiram guide for educational purposes. Doses are for adults; children need different dosing. Discuss any treatment with a qualified, Lyme-literate clinician, who can monitor labs and adjust for your health and medications.