Overview

Dapsone (diaminodiphenyl sulfone) is in the class of drugs known as sulfones, with a sulfur atom connected to two carbon atoms. Dapsone was first synthesized in 1908, but its antimicrobial properties weren’t known until 1937, when the drug began to be used to treat bacterial infections, including leprosy. In addition to its antimicrobial properties, dapsone has demonstrated anti-inflammatory qualities and is also used to treat chronic inflammatory conditions.

In 2016, dapsone was brought into the spotlight for Lyme disease when researchers began testing it with patients and evaluating its ability to target borrelia persister cells. The study included 100 patients diagnosed either with chronic Lyme disease or post-treatment Lyme disease syndrome (PTLDS). Fifty-six patients also had positive tests for the coinfection babesia. During the study, patients were placed on dapsone doses of 100 mg or less in combination with drugs such as rifampin, tetracyclines, and others. One month after the completion of dapsone combination therapy, 59% of patients reported improvements in a range of symptoms.

Then, in 2020, the same researchers completed a second study, involving three cases and a retrospective chart review in which 40 patients were given higher doses of dapsone — “double dapsone” in the amounts of 150-200 mg in combination with medications and supplements for a total of 7-8 weeks. After completing the treatment, 98% of patients reported improvements in long-term Lyme disease symptoms, and 45% achieved remission lasting one year or longer.

Efficacy

Dapsone therapy can be a challenging treatment for many people. After speaking with patients who’ve tried it, I haven’t seen the same benefits as those reported in the study. For patients who complete the protocol, it may take weeks or months to recover from the intensity of treatment and see lab values return to the normal ranges.

Although it might be helpful to some as a last-resort intervention, many people find it extremely difficult to tolerate and need to stop altogether in favor of trying less aggressive forms of treatment.

Safety

It’s not unusual for patients to report severe Herxheimer reactions, elevated liver enzymes, anemia, low red and white blood cell counts, and more while doing the protocol. Though it’s considered rare, I’ve encountered patients who have experienced methemoglobinemia, a serious blood disorder where not enough oxygen makes it to the cells. Methemoglobinemia requires prompt, emergency treatment.

Additionally, dapsone therapy requires a close watch by your healthcare provider, including weekly to biweekly labs, to monitor the safety of the drug regimen.

Cost

The price of dapsone will vary depending on your insurance coverage and the length of time you take it, but it’s a relatively inexpensive antibiotic. However, the cost for the complete dapsone protocol — with an extensive array of supplements and medications — is exorbitant, costing several hundreds of dollars monthly. Some patients I’ve spoken with have reported spending in excess of $1,000 to $1500 per month for a treatment that yielded few to no improvements for them.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

REFERENCES
1. Horowitz R, Freeman P. The Use of Dapsone as a Novel “Persister” Drug in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome. Journal of Clinical & Experimental Dermatology Research. 2016; 7:3. doi: 10.4172/2155-9554.1000345
2. Horowitz RI, Freeman PR. Efficacy of Double-Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-infections: A Report of Three Cases and Retrospective Chart Review. Antibiotics (Basel). 2020 Oct 22;9(11):725. doi: 10.3390/antibiotics9110725
3. Wozel G, Blasum C. Dapsone in dermatology and beyond. Arch Dermatol Res. 2014;306(2):103-124. doi: 10.1007/s00403-013-1409-7