Daniel A. Kinderlehrer MD, PC_____________________________ kinderlehrer@gmail.com 668 South Newport Street Denver Colorado 80224 303-444-4877 tele 303-440-7639 fax Guidelines for patients taking disulfiram Disulfiram is an incredibly powerful tool to treat tick-borne infections, but it also has the potential to cause problems. If we are careful with the way it is taken, then the risk is minimal. Here are guidelines to ensure its safety. It is imperative to avoid alcohol as well as topical products containing alcohol. Also, avoid fermented foods such as kombucha, pickles, sauerkraut, olives, soy sauce and vinegar as well as all sugar products and green tea. The first and most common issue is Herxheimer reactions. If the Herxheimer reaction is severe we decrease the dose. If the Herxheimer reaction is mild, then we wait until it has resolved before increasing the dose. We treat Herxheimer reactions the same way we treat Herx reactions from other antimicrobials: 1. Binders, e.g. charcoal 2. Alkalinazation with lots of water and lemon as well as Alka Selzer Gold or TriSalts 3. Hot baths with epsom salts and baking soda 4. Detox and drainage remedies 5. Glutathione Disulfiram can cause “minor” side effects in some patients. These include constipation and bloating, acne, bad breath, body odor, nausea, weight gain, metallic taste, mood issues, headaches and fatigue. Unless severe, these symptoms are not reason to stop the medication. Disulfiram can cause neurotoxicity. At times this can be difficult to distinguish from a Herxheimer reaction. These drug reactions typically occur at higher doses, often right after a dose increase, but some patients experience neurotoxicity at lower doses. If symptoms of pins and needles, numbness, stabbing, shooting, or burning pain develop, this could represent disulfiram induced neuropathy. If symptoms of brain fog/impaired cognition, headache, mood changes or vision issues develop, this could represent toxic encephalopathy, which is brain toxicity. There are reports that it can cause hypertension and even psychosis, as well as irritation of the liver. It is important to get blood tests monthly to monitor liver function. If the disulfiram dose is lowered or if the drug is stopped within days of the onset of neurotoxic symptoms, they will remit quickly. It is essential that you contact me immediately if any of these symptoms develop. Most of my patients do not suffer from these neurotoxic drug reactions. But because disulfiram has this potential, I am now recommending the following supplements which can protect the nervous system: Zinc Alpha Lipoic Acid Melatonin Vitamin C Take disulfiram only at the recommended dose, and check in every two weeks. The check in should include the following: DSF dose, frequency, and duration Any changes noticed on that dosing schedule A complete updated med list In addition, keep all emails in a chain with my responses so that I can easily refer to your past history as needed. Thank you, 2
