Dealing with Herxheimer reaction

Side effects of Lyme disease treatment: Herxheimer reaction

A hallmark of a number of chronic infectious ailments, including chronic borreliosis/Lyme disease, is a low-grade inflammatory reaction triggered by microbial toxins, products of microbial metabolism, and fragments of microbial cells. These toxins are released because the antimicrobial therapy is causing bacteria to die and you will likely feel a worsening of your symptoms.

This reaction can reach extreme manifestation during the initial stages of antimicrobial therapy (both antibiotic and/or herbal), or when a new antibiotic is introduced, and is known as Jarisch–Herxheimer reaction or “herx” or “die-off” reaction.

Herxheimer reaction symptoms:

  • Anxiety
  • Chills
  • Diarrhea
  • Dizziness
  • Extreme brain fog and fatigue
  • Fever
  • Headache
  • Lightheadedness
  • Low blood pressure
  • Muscle and joint pain
  • Nausea
  • Palpitations
  • Skin rashes


  1. Gastrointestinal tract preparation. The gastrointestinal tract is the major reservoir of various microorganisms in our body. Antimicrobial therapy, including antibiotics and anti-microbial herbs, is not specific to only lyme related symptoms and will also affect your gut. Therefore, the Herxheimer reaction can be amplified by microbial toxins released from the gut.
  2. The preparation of the gut starts several weeks before initiation of the antimicrobial therapy.
    It incorporates probiotics, prebiotics, motility enhancers (Triphala), Colostrum,Bovine Immunoglobulins and, optionally, supplements targeting candida (Candidacillin, Black Walnut Hulls).
  3. Sufficient hydration via oral or intravenous routs.
  4. Methylation specific food supplements. Methylation processes are vital components of the detoxification pathway. Consumption of sufficient amounts of the methylation facilitators (TMG, Methylcobalamin (B12), SAMe, L-Methylfolate) decreases the severity of Herxheimer reaction.
  5. Intravenous magnesium decreases the severity of Herxheimer reaction.
  6. Antioxidant supplementation. The Herxheimer reaction is accompanied by the massive release of free radicals that can have damaging effects on various tissues and organs. Antioxidants (Glutathione, Alpha Lipoic Acid, Turmeric) neutralize free radicals and diminish the Herheimer’s symptoms.
  7. Liver protection. Liver is the main organ neutralizing and removing microbial toxins from the organism. Liver protectants are vital components of the toxin neutralizing therapy. Typically, they include: Milk Thistle and its active ingredients, Schisandra, SAMe, Glutathione, Taurine, Alpha Lipoic Acid
  8. Adaptogenic herbs. These are medicinal herbs that decrease cellular sensitivity to stress, including stress due to microbial toxin exposure. Typical adaptogenic herbs are: Rhodiola,Eleutherococcus Cordyceps Sinensis, Ashwagandha, Licorice Root
  9. Low dose naltrexone. Naltrexone attenuates endoplasmic reticulum stress and serves as an antagonist of Toll-like type 4 receptor, one of the key molecules mediating microbial toxin-triggered inflammatory pathways.


Moderate cases of Herxheimer reaction need to be treated very aggressively.

Typical therapy includes:

  1. Antihistamines
  2. Corticosteroids
  3. Intravenous fluids
  4. Intravenous immunoglobulins
  5. Oral succinic acid

Severe cases of Herxheimer reactions associated with hypotension, severe volume depletion and various cardiac or pulmonary problems may require urgent hospitalization.


Typically, the use of slow escalating dose protocols of antibiotics for Lyme disease or anti-microbial herbs allows us to significantly reduce or even abolish moderate to severe Herxheimer reactions.