Dr. Cowden starts his patients at 1 drop of Nutramedix Cumanda per day in ½ cup (120ml) of water or sublingual 30 minutes before mealtime (whether the patient eats or not), increasing to 1 drop twice a day after 1 to 3 days. Dr. Cowden also has his patients swallow proteolytic enzymes with water twice daily 30 minutes before mealtime. The most common proteolytic enzyme Dr. Cowden uses is Bromelain -5 or 6 tablets or capsules twice a day (400-600 mg. per tablet or capsule). Cumanda and the proteolytic enzymes can be taken at the same time.

http://www.samento.com.ec/sciencelib/4sam/samprotocol_lyme.html