Disulfiram — Dr. Rawls’ Ratings
Efficacy: 3.5 stars
Safety: 1 stars
Cost: 1 out of 5 dollar signs
Ways to Administer: Oral tablet
Bottom Line: There are much better options for treating Lyme disease that don’t come with a long list of significant side effects.


Disulfiram (Tetraethylthiuram Disulfide), a sulfur-containing chemical compound, was originally used in the vulcanization of rubber during the late 1800s. Sulfur is toxic to bacteria, and early on, it was noted to have antibacterial properties. Its use as an antibiotic, however, was abandoned when penicillin was discovered because of the high incidence of side effects associated with it.

In the twentieth century, it again found a use as a treatment for alcohol dependence (Antabuse). Disulfiram blocks alcohol dehydrogenase, the enzyme that breaks down alcohol in the body. If an alcoholic taking disulfiram drinks alcohol, that person will become severely ill. The drug was never very popular, again because of the high rate of undesirable side effects.

More recently, the drug was found to have activity against Borrelia burgdorferi in an in vitro (test tube) study, and it was reintroduced as a treatment for Lyme disease. In a study released from the University of Paris in April 2020, sixteen patients who used disulfiram for the treatment of Lyme disease were polled. All sixteen participants experienced toxic side effects, and only seven patients reported relief of Lyme disease symptoms. Another study published in December 2020 reported higher efficacy (92% of participants reported benefit), with some participants (36%) reporting “enduring benefit,” but they experienced a similarly high rate of side effects.


No doubt, disulfiram has antimicrobial properties against borrelia and a range of other microbes, but the high incidence of potentially severe side effects limits its use to treat Lyme disease. There are much less toxic therapies that are just as effective. (As a side note, disulfiram has also been shown to be toxic to cancer cells and is currently being evaluated as a cancer drug.)


As with other uses in humans, the increased likelihood of side effects limits the use of the drug for chronic Lyme. Reported side effects include anxiety, paranoid delirium, suicidal thoughts, insomnia, joint pain, tinnitus, fatigue, tachycardia, speech difficulties, flu-like symptoms, elevated liver enzymes, and peripheral neuropathy. Neurological side effects can be severe and persist long after the drug is discontinued.


The cost of disulfiram will vary depending on your insurance coverage and the length of time you take it. Patients will likely have a higher out-of-pocket cost when the drug comes from a compounding pharmacy.

Dr. Bill Rawls Treatment Guide

Dr. Bill Rawls’ Treatment Guide

Want to see more Lyme disease treatment ratings? See What Dr. Rawls has to say about popular treatments and therapies in his Lyme Disease Treatment Guide.

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.

1. Trautmann A, Gascan H, Ghozzi R. Potential Patient-Reported Toxicities With Disulfiram Treatment in Late Disseminated Lyme Disease. Front Med (Lausanne). 2020;7:133. Published 2020 Apr 20. doi: 10.3389/fmed.2020.00133
2. Gao J, Gong Z, Montesano D, Glazer E, Liegner K. “Repurposing” Disulfiram in the Treatment of Lyme Disease and Babesiosis: Retrospective Review of First 3 Years’ Experience in One Medical Practice. Antibiotics (Basel). 2020;9(12):868. Published 2020 Dec 4. doi: 10.3390/antibiotics9120868
3. Potula HSK, Shahryari J, Inayathullah M, Malkovskiy AV, Kim KM, Rajadas J. Repurposing Disulfiram (Tetraethylthiuram Disulfide) as a Potential Drug Candidate against Borrelia burgdorferi In Vitro and In Vivo. Antibiotics (Basel). 2020;9(9):633. Published 2020 Sep 22. doi: 10.3390/antibiotics9090633
4. Farooq MA, Aquib M, Khan DH, et al. Recent advances in the delivery of disulfiram: a critical analysis of promising approaches to improve its pharmacokinetic profile and anticancer efficacy. Daru. 2019;27(2):853-862. doi: 10.1007/s40199-019-00308-w
5. Sheppard JG, Frazier KR, Saralkar P, Hossain MF, Geldenhuys WJ, Long TE. Disulfiram-based disulfides as narrow-spectrum antibacterial agents. Bioorg Med Chem Lett. 2018;28(8):1298-1302. doi: 10.1016/j.bmcl.2018.03.023