Low dose naltrexone: Difference between revisions

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'''Low Dose Naltrexone''' (LDN) refers to very small doses of the generic drug, '''naltrexone''', normally used to treat drug dependence. When taken at much smaller doses it may allay [[Nervous system|neurological]] symptoms. Although prescriptions of LDN are becoming more popular, any use other than for treating drug dependence is considered off-label. Some patients report that LDN helps reduce their symptoms of [[ME/CFS]], [[multiple sclerosis]] (MS), [[fibromyalgia]] (FMS) and [[autoimmune disease]].  Although its mechanism of action is unclear, some have speculated that it may act as an anti-inflammatory.<ref name="Younger2014" />
'''Low Dose Naltrexone''' (LDN) refers to very small doses of the drug '''naltrexone hydrochloride''', which is normally used to treat drug or [[alcohol]] dependence. When taken at much smaller doses naltrexone may reduce [[pain]], or potentially [[Nervous system|neurological]] symptoms. Brand names of naltrexone include '''ReViva''', '''Depade''', and '''Vivitrol'''.<ref name="brands">{{Cite web|url=https://www.drugs.com/ingredient/naltrexone.html | title = Naltrexone - brand name list from Drugs.com|website=Drugs.com|language=en|access-date=2022-01-17}}</ref>
LDN use other for treating drug dependence is considered off-label. Some patients report that LDN helps reduce their symptoms of [[ME/CFS]], [[multiple sclerosis]] (MS), [[fibromyalgia]] (FMS), or [[autoimmune disease]].  Although its mechanism of action is unclear, some have speculated that it may act as an anti-inflammatory.<ref name="Younger2014" />
 
==Prescription forms ==
LDN is typically prescribed using generic naltrexone hydrochloride or branded naltrexone, divided into much smaller doses. LDN may be taken in the form of liquid solution/syrup, sublingual doses or 1.5mg capsules, or a compounding pharmacy can create smaller sized capsules or tablets. LDN in the form of naltrexone cream, subcutaneous injections, IV naltrexone and eye drops (for [[Sjögren's syndrome|dry eyes]]) are also available.<ref name="forms">{{Cite web|url=https://ldnresearchtrust.org/types-of-ldn | title = Types of LDN | last = | first = | authorlink = | date = | website = LDN Research Trust |language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-17}}</ref>


== VLDN and ULDN ==
== VLDN and ULDN ==
'''Very Low Dose Naltrexone''' (VLDN) and '''Ultra-Low Dose Naltrexone''' (ULDN) have recently been used in limited trials, both VLDN and ULDN involve doses of naltrexone significantly below 1mg.<ref>{{Cite journal|last=Toljan|first=Karlo|author-link=Karlo Toljan|last2=Vrooman|first2=Bruce|author-link2=Bruce Vrooman|author-link3=|author-link4=|author-link5=|date=Sep 21, 2018|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/|journal=Medical Sciences|volume=6|issue=4|pages=|doi=10.3390/medsci6040082|issn=2076-3271|pmc=|pmid=30248938|quote=|via=}}</ref>
'''Very Low Dose Naltrexone''' (VLDN) and '''Ultra-Low Dose Naltrexone''' (ULDN) have recently been used in limited trials, both VLDN and ULDN involve doses of naltrexone significantly below 1mg.<ref>{{Cite journal | last = Toljan | first = Karlo | author-link =Karlo Toljan | last2 = Vrooman | first2 = Bruce | authorlink2 = Bruce Vrooman | date = Sep 21, 2018 | title = Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/|journal=Medical Sciences|volume=6|issue=4|pages=|doi=10.3390/medsci6040082|issn=2076-3271|pmc=|pmid=30248938|quote=|via=}}</ref>
 
Very Low Dose Naltrexone is increasingly being used under 1mg for people who cannot titrate from 0.5mg to find their individual optimal dose.
 
'''Dr. John Kim has great experience with LDN and shares his latest results in combining ULDN (Ultra-Low Dose Naltrexone) with acupuncture and Vitamin C. shares his latest results in combining ULDN (Ultra-Low Dose Naltrexone)''' [https://www.youtube.com/watch?v=npYPfLs4-kM&fbclid=IwAR2EJwyKp-Pyxqg9vjsW0QWV1e4pfwQ6aYus6MMRseih1nIGl64NrudJsro Dr. John Kim has great experience with LDN and shares his latest results in combining ULDN (Ultra-Low Dose Naltrexone) with acupuncture and Vitamin C.]
 
'''An Archived LDN Presentation- ULDN, Micro Dosing with Dr John Kim'''
 
[https://the-ldn-radio-show.captivate.fm/episode/an-ldn-prescribers-experience-uldn-micro-dosing-with-dr-john-kim?fbclid=IwAR09ptgFzkxG17UfZ0R0kBtGx98iYWq3hv8HTO5MWeN8ZtQc_zA1X-O_g0c https://the-ldn-radio-show.captivate.fm/.../an-ldn...]
 
'''Dr John Kim on The LDN Trust site''' [https://ldnresearchtrust.org/search/exclude?keys=John%20kim&page=1&fbclid=IwAR1H3xMKog5OAONnAl9kb0ufdKSZXGJrenYVNPaA84MQiOa_jUxysRE62m0 https://ldnresearchtrust.org/search/exclude?keys=John%20kim&page=1]
 
Patients who wish to cease opioids use and transition onto LDN can first use ULDN using facebook group and explainer document below.
 
'''[https://www.facebook.com/groups/1593950197487522/permalink/1594322687450273 Using Ultra Low Dose Naltrexone to reduce opiate use and transition to LDN].''' - Using Ultra Low Dose Naltrexone to transition to Low Dose Naltrexone by Michael D Robinson. Link to https://www.scribd.com/document/195139174/ULDN-Inverse-Titration-Protocol-FINAL?fbclid=IwAR3qG2YSjrl6WB2dpiNi4fKw96Loj8yC8x79TVp5tGX3_PR2itFyrNWjbiY 


==Evidence==
==Evidence==
[[File:LDN-Fibro2014.jpg|alt=Data shows a graph with 10% worse after treatment, 57% improved or much improved, and 12% very much improved. Darker colors are the most improved sections.|thumb|350x350px|Low Dose Naltrexone results for 29 patients with [[Fibromyalgia]]. Fibromyalgia participants’ (N = 29) self-reported improvement in symptoms after daily LDN treatment.  
[[File:LDN-Fibro2014.jpg|alt=Data shows a graph with 10% worse after treatment, 57% improved or much improved, and 12% very much improved. Darker colors are the most improved sections.|thumb|350x350px|Low Dose Naltrexone results for 29 patients with [[Fibromyalgia]]. Fibromyalgia participants’ (N = 29) self-reported improvement in symptoms after daily LDN treatment.  
Source: Clin Rheumatol 2014; 33(4):452-459. Fig 1.<ref name="Younger2014" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/figure/Fig1/ PMC3962576]]]
Source: Clin Rheumatol 2014; 33(4):452-459. Fig 1.<ref name="Younger2014" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/figure/Fig1/ PMC3962576] ]]


[[Jarred Younger]] published a small study that concluded "... low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia".<ref name="Younger2009" /><ref name="Mackey2009" />
[[Jarred Younger]] published a small study that concluded "...low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia".<ref name="Younger2009" /><ref name="Mackey2009" />


A second study concluded that "specific and clinically beneficial impact on fibromyalgia pain".<ref name="Younger2013" /><ref>{{Cite web|url=https://med.stanford.edu/pain/snapl/completed-research/naltrexone2.html|title=Low Dose Naltrexone for Fibromyalgia|website=Systems Neuroscience and Pain Lab|language=en|access-date=2018-10-04}}</ref>
A second study concluded that "specific and clinically beneficial impact on fibromyalgia pain".<ref name="Younger2013" /><ref>{{Cite web|url=https://med.stanford.edu/pain/snapl/completed-research/naltrexone2.html | title = Low Dose Naltrexone for Fibromyalgia|website=Systems Neuroscience and Pain Lab {{!}} Stanford Medicine|language=en|access-date=2018-10-04 | date = |last = | first = | authorlink = |archive-url=|archive-date=|url-status=}}</ref>


A 2014 review by Stanford researchers suggests that "LDN may operate as a novel anti-inflammatory agent in the [[central nervous system]], via action on [[microglia]]l cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on [[opioid]] receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated."<ref name="Younger2014" />
A 2014 review by Stanford researchers suggests that "LDN may operate as a novel anti-inflammatory agent in the [[central nervous system]], via action on [[microglia]]l cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on [[opioid]] receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated."<ref name="Younger2014" />
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The [[FDA]] approved naltrexone HCL in 1984 to treat opioid addiction. Low-dose naltrexone is typically given at about 1/10th the typical dose of naltrexone. By blocking opioid receptors, naltrexone can increase pain, but at very low doses naltrexone has both pain-reducing ([[analgesic]]) and anti-inflammatory properties.
The [[FDA]] approved naltrexone HCL in 1984 to treat opioid addiction. Low-dose naltrexone is typically given at about 1/10th the typical dose of naltrexone. By blocking opioid receptors, naltrexone can increase pain, but at very low doses naltrexone has both pain-reducing ([[analgesic]]) and anti-inflammatory properties.


In 2012 [[Solve ME/CFS Initiative]] contracted [[Biovista]] to use drug models to identify existing drugs that may be worth investigating for treatment. The results suggested Naltrexone was worth considering.<ref>{{Cite web|url=http://solvecfs.org/biovista-work-released|title=Biovista work released|last=Solve ME/CFS Initiative|first=|authorlink=Solve ME/CFS Initiative|last2=|first2=|authorlink2=|date=|website=|archive-url=|archive-date=|access-date=|url-status=live}}</ref>
In 2012 [[Solve ME/CFS Initiative]] contracted [[Biovista]] to use drug models to identify existing drugs that may be worth investigating for treatment. The results suggested Naltrexone was worth considering.<ref>{{Cite web|url=http://solvecfs.org/biovista-work-released | title = Biovista work released|last = Solve ME/CFS Initiative | first = | authorlink = Solve ME/CFS Initiative | date = |website=|archive-url=|archive-date=|access-date=|url-status=live}}</ref>


There is an [https://www.facebook.com/groups/GotEndorphins/ online patient community] where patients with various diseases discuss their experiences taking Low-dose Naltrexone.
Jarred Younger's research suggests that people with an [[Erythrocyte sedimentation rate|Erythrocyte Sedimentation Rate]] (ESR) over 40 millimeters an hour, tend to be strong responders to LDN, and that there may be other predictive factors for success.<ref name="Younger20160329sh" />


Jarred Younger's research suggests that people with an [[Erythrocyte sedimentation rate|ESR]] (Erythrocyte Sedimentation Rate) over 40 millimeters an hour, tend to be strong responders to LDN, and that there may be other predictive factors for success.<ref name="Younger20160329sh" />
==News articles==
 
* 2019, [https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain] - NPR, All Things Considered
==Articles==
* September 9, 2021<nowiki/>https://www.empr.com/home/news/drugs-in-the-pipeline/low-dose-naltrexone-designated-orphan-drug-for-complex-regional-pain-syndrome/
* 2016, [https://selfhacked.com/2016/06/20/top-22-scientific-health-benefits-low-dose-naltrexone/ Top 15 Scientific Health Benefits of Low Dose Naltrexone]
*[http://www.cortjohnson.org/blog/2016/02/04/low-dose-naltrexone-combo-chronic-fatigue/ 2016, Low Dose Naltrexone Drug Combination Proposed for Chronic Fatigue Syndrome], ''Health Rising'', by [[Cort Johnson]]
*2016, [https://cfsremission.wordpress.com/2016/03/19/review-of-low-dose-naltrexone/ Low dose naltrexone: side effects and efficacy in gastrointestinal disorders] by [[CFS Remission]]
*Opioid blocking and alcohol - [http://www.well.com/user/woa/revia/reviafaq.htm FAQ About Naltrexone Treatment for Alcoholism - 10.]
*2018 [https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-for-fibromyalgia Low Dose Naltrexone for Fibromyalgia]
 
* 2018 [https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-therapy-for-crohn-s-disease Low Dose Naltrexone Therapy for Crohn’s Disease]
 
* 2019, [https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain], ''NPR, All Things Considered'' by Alex Smith
 
*2019 [https://www.healthrising.org/treating-chronic-fatigue-syndrome/drugs/low-dose-naltrexone-ldn-fibromyalgia-chronic-fatigue-syndrom/ Low Dose Naltrexone Resource Center for Fibromylgia and ME/CFS]


==Clinical use==
==Clinical use==


Naltrexone is a prescription drug in many countries including the [[United States]].<ref name="naltrexonecompliance">{{Cite journal|last=Feeney|first=G. F. X.|last2=Connor|first2=J. P.|last3=Young|first3=R. McD|last4=Tucker|first4=J.|last5=Czajkowski|first5=F.|date=2001|title=Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2710.2001.00326.x|journal=Journal of Clinical Pharmacy and Therapeutics|language=en|volume=26|issue=1|pages=73–79|doi=10.1111/j.1365-2710.2001.00326.x|issn=1365-2710}}</ref>Compounding chemists or compounding pharmacists can mix naltrexone with a powder filler or dilute in into a liquid to create the lower dose.   
Naltrexone is a prescription drug in many countries including the [[United States]].<ref name="naltrexonecompliance">{{Cite journal | last = Feeney|first = G. F. X. | last2 = Connor | first2 = J.P. | last3 = Young | first3 = R. McD | last4 = Tucker | first4 = J. | last5 = Czajkowski | first5 = F. | date = 2001 | title = Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2710.2001.00326.x|journal=Journal of Clinical Pharmacy and Therapeutics|language=en|volume=26|issue=1 | pages = 73–79|doi=10.1111/j.1365-2710.2001.00326.x|issn=1365-2710}}</ref>Compounding chemists or compounding pharmacists can mix naltrexone with a powder filler or dilute in into a liquid to create the lower dose.   


=== Fast-release fillers only ===
=== Fast-release fillers only ===
"Pharmacies should be instructed NOT to provide LDN in an "SR" or slow-release or timed-release form. Unless the low dose of naltrexone is in an unaltered form, which permits it to reach a prompt "spike" in the blood stream, its therapeutic effects may be inhibited."<ref name=":2">{{Cite web|url=http://www.lowdosenaltrexone.org/index.htm#How_can_I_obtain_LDN|title=The Low Dose Naltrexone Homepage|website=www.lowdosenaltrexone.org|access-date=2019-01-21}}</ref> Calcium Carbonate filler should NOT be used. "Avicel, lactose (if lactose intolerance is not a problem), or sucrose fillers as useful fast-release fillers."<ref name=":2" />  
The LDN Research Trust advises that:
"Pharmacies should be instructed NOT to provide LDN in an "SR" or slow-release or timed-release form. Unless the low dose of naltrexone is in an unaltered form, which permits it to reach a prompt "spike" in the blood stream, its therapeutic effects may be inhibited."<ref name="leaflet2014" /> and states that calcium carbonate filler should NOT be used because they reduce absorption, instead Avicel,  lactose, or sucrose fillers as alternative fast-release fillers."<ref name="leaflet2014">{{Cite web|url=https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf | title=Low-dose Naltrexone (LDN) Fact Sheet 2014 | website = LDN Research Trust | date = 2014}}</ref>


===Do not take with opioids===
===Do not take with===
In general, Low Dose Naltrexone (LDN) should not be taken concurrently with opioid-containing drugs (opioid receptors in brain are blocked by LDN), immunosuppressive drugs, or immunomodulator drugs.<ref>{{Cite web|url=https://yourverity.wordpress.com/2009/07/07/drugs-to-avoid-when-taking-low-dose-naltrexone/|title=Drugs To Avoid When Taking Low Dose Naltrexone|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=2009-07-07|website=Yourverity's Blog|language=en|archive-url=|archive-date=|url-status=|access-date=2021-03-17}}</ref> LDN blocks the effect of opioid drugs.<ref name=":0">{{Cite web|url=https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md|title=Low Dose Naltrexone and chronic pain|first = Pradeep |last =Chopra|website=LDN Research Trust|access-date=2019-01-31}}</ref> Some opioid drugs are [[codeine]], [[tramadol]], [[oxycodone]], [[vicodin]], [[hydrocodone]], [[fentanyl]] and [[morphine]].
In general, Low Dose Naltrexone (LDN) should not be taken concurrently with opioid-containing drugs (opioid receptors in brain are blocked by LDN), alcohol, immunosuppressive drugs, or immunomodulator drugs.{{citation needed | date = 2021}} LDN blocks the effect of opioid drugs.<ref name="chronicpain">{{Cite web|url=https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md | title = Low Dose Naltrexone and chronic pain | first = Pradeep |last =Chopra|website=LDN Research Trust|access-date=2019-01-31}}</ref> Some opioid drugs are [[codeine]], [[tramadol]], [[oxycodone]], [[vicodin]], [[hydrocodone]], [[fentanyl]] and [[morphine]].
==Pharmacies ==


==== Australia ====
=== Australia ===
''Compounding Pharmacies'' are able to fill these prescriptions, and post if needed.   
''Compounding Pharmacies'' are able to fill these prescriptions, and post if needed.   


==== UK ====
=== UK ===
[http://www.dicksonchemist.co.uk/LowDoseNaltrexone/Default.aspx Dickson Chemist] in Glasgow dispenses Low Dose Naltrexone in various forms, with a valid prescription. They will usually put patients in contact with private doctors who will consider writing a prescription.
LDN suppliers in the UK include '''Dickson Chemist''' in Glasgow, Roseway Labs, and Specialist Pharmacy (The London Specialist Pharmacy Ltd). All these are compounding pharmacies and require a perscription, they are  usually able to put patients in contact with private doctors who will consider writing a prescription, and can post medications to you.<ref name="RosewayLabs">{{Cite web |url = https://rosewaylabs.com/compounding-processes-regulations | title = Compounding processes regulations/|website =Roseway Labs}}</ref> Compounding pharmacies are regulated by the UK's General Pharmaceutical Council.<ref name="RosewayLabs" />


====United States====
===United States===
Neighborhood ''Compounding Pharmacies'' are able to fill these prescriptions and mail if needed. Your prescribing doctor can help you locate a compounding pharmacy in your area/state or you can look online.<ref>[http://www.wikihow.com/Find-a-Compounding-Pharmacy Finding a Compounding Pharmacy - WIKI How]</ref>
Neighborhood ''Compounding Pharmacies'' are able to fill these prescriptions and mail if needed. Your prescribing doctor can help you locate a compounding pharmacy in your area/state or you can look online.<ref>[http://www.wikihow.com/Find-a-Compounding-Pharmacy Finding a Compounding Pharmacy - WIKI How]</ref>
===Other countries ===
The LDN Research Trust lists pharmacies in multiple countries.<ref name="sources">{{Cite web |url = https://ldnresearchtrust.org/ldn-pharmacists|website=LDN Research Trust|title =LDN Pharmacists |access-date =}}</ref>


== Clinical trials ==
== Clinical trials ==
A large number of clinical trials have been completed for LDN recently, although none have looked at the effect of LDN on symptoms of [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]]. Research has been carried out on patients with MS, [[Chronic Regional Pain Syndrome]], FMS, [[Irritable bowel syndrome|Irritable Bowel Syndrome]] (IBS), Ulcerative Colitis, Skin Disorders and a range of other illnesses.<ref name="trials">{{Cite web|url=https://www.ldnresearchtrust.org/ldn-clinical-trials|title=Clinical Trials|website=LDN Research Trust|access-date=2019-01-21}}</ref>
A large number of clinical trials have been completed for LDN recently, although none have looked at the effect of LDN on symptoms of [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]]. Research has been carried out on patients with MS, [[Chronic Regional Pain Syndrome]], FMS, [[Irritable bowel syndrome|Irritable Bowel Syndrome]] (IBS), Ulcerative Colitis, Skin Disorders and a range of other illnesses.<ref name="trials">{{Cite web|url=https://www.ldnresearchtrust.org/ldn-clinical-trials | title = Clinical Trials|website=LDN Research Trust|access-date=2019-01-21}}</ref>


==When, How To Take ==
==When, How To Take ==
Dr Whitaker states that the ideal dose is different for each person. Some doctors recommend starting at 1mg.<ref name="LDN-now">{{Cite web|url=http://www.ldnnow.com/48591/90512.html|title=LDN Dosing|last=LDN Now|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=|access-date=2018-02-01}}</ref> Common dosages are 1.5mg, 3mg, 4.5mg.<ref>{{Cite web|url=https://www.amymyersmd.com/2017/05/low-dose-naltrexone/|title=Low-Dose Naltrexone for Autoimmunity?|last=Myers|date=2017-05-02|website=Amy Myers MD|language=en-US|access-date=2019-02-02|first=Amy|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|url-status=}}</ref><ref name=":1">{{Cite web|url=https://www.drwhitaker.com/what-is-low-dose-naltrexone|title=What is Low-Dose Naltrexone?|last=Dr Whitaker|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.drwhitaker.com|language=en|archive-url=|archive-date=|access-date=2019-01-21}}</ref><ref name=":0" /> When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake; discuss how best to do this with your doctor and pharmacist.<ref name=":1" /><ref>{{Cite web|url=https://collierdrug.com/low-dose-naltrexone-ldn/|title=Low Dose Naltrexone (LDN) – Collier Drug Store|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=collierdrug.com|at=What dose of Low Dose Naltrexone (LDN) is best?|archive-url=|archive-date=|access-date=2019-02-02}}</ref><ref name=":0" />
Dr Whitaker states that the ideal dose is different for each person. Some doctors recommend starting at 1mg.<ref name="LDN-now">{{Cite web|url=http://www.ldnnow.com/48591/90512.html | title = LDN Dosing|last = LDN Now|first = | authorlink = | date = | website = |access-date=2018-02-01}}</ref> Common dosages are 1.5mg, 3mg, 4.5mg.<ref>{{Cite web|url=https://www.amymyersmd.com/2017/05/low-dose-naltrexone/ | title = Low-Dose Naltrexone for Autoimmunity? | last = Myers | date = 2017-05-02 | website = Amy Myers MD|language=en-US|access-date=2019-02-02|first = Amy | authorlink = |archive-url=|archive-date=|url-status=}}</ref><ref name=":1">{{Cite web|url=https://www.drwhitaker.com/what-is-low-dose-naltrexone | title = What is Low-Dose Naltrexone?|last = Dr Whitaker | first = | authorlink = | date = | website = drwhitaker.com|language=en|archive-url=|archive-date=|access-date=2019-01-21}}</ref><ref name="chronicpain" /> When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake; discuss how best to do this with your doctor and pharmacist.<ref name=":1" /><ref>{{Cite web|url=https://collierdrug.com/low-dose-naltrexone-ldn/ | title = Low Dose Naltrexone (LDN) – Collier Drug Store|last = | first = | authorlink = | date = | website = collierdrug.com|at=What dose of Low Dose Naltrexone (LDN) is best?|archive-url=|archive-date=|access-date=2019-02-02}}</ref><ref name="chronicpain" />


LDN is usually taken at bedtime.  Some people take LDN in the morning to minimize [[Sleep dysfunction|sleep disturbance]], [[insomnia]], and vivid dreams.<ref name=":0" />
LDN is usually taken at bedtime.  Some people take LDN in the morning to minimize [[Sleep dysfunction|sleep disturbance]], [[insomnia]], and vivid dreams.<ref name="chronicpain" />


== Talks and webinars==
== Talks and webinars==
*2012, [https://www.youtube.com/watch?v=z0p0ykSzy9o LDNscience® Presents - How LDN (Low Dose Naltrexone) Works]<ref>{{Cite web|url=https://www.youtube.com/watch?v=z0p0ykSzy9o|title=LDNscience® Presents - How LDN (Low Dose Naltrexone) Works|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Dec 20, 2012|website=YouTube|publisher=LDNscience|archive-url=|archive-date=|access-date=}}</ref>
*2012, [https://www.youtube.com/watch?v=z0p0ykSzy9o LDNscience® Presents - How LDN (Low Dose Naltrexone) Works]<ref>{{Cite web|url=https://www.youtube.com/watch?v=z0p0ykSzy9o | title = LDNscience® Presents - How LDN (Low Dose Naltrexone) Works|last = | first = | authorlink = | date = Dec 20, 2012 | website = YouTube|publisher=LDNscience|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''LDNscience® Presents - How LDN (Low Dose Naltrexone) Works'' By LDNscience">https://www.youtube.com/watch?v=z0p0ykSzy9o</embedvideo>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''LDNscience® Presents - How LDN (Low Dose Naltrexone) Works'' By LDNscience">https://www.youtube.com/watch?v=z0p0ykSzy9o</embedvideo>


*2015, [https://www.youtube.com/watch?v=8a-ULCaarCQ Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez]<ref>{{Cite web|url=https://www.youtube.com/watch?v=8a-ULCaarCQ|title=Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez|last=Carnahan|first=Jill|authorlink=|last2=Vasquez|first2=Alex|authorlink2=|date=Nov 30, 2015|website=YouTube|publisher=Alex Vasquez|archive-url=|archive-date=|access-date=}}</ref>
*2015, [https://www.youtube.com/watch?v=8a-ULCaarCQ Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez]<ref>{{Cite web|url=https://www.youtube.com/watch?v=8a-ULCaarCQ | title = Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez|last = Carnahan | first = Jill | authorlink= | last2 = Vasquez | first2 = Alex | authorlink2 = | date = Nov 30, 2015 | website = YouTube|publisher=Alex Vasquez|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez '' By Alex Vasquez">https://www.youtube.com/watch?v=8a-ULCaarCQ</embedvideo>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez '' By Alex Vasquez">https://www.youtube.com/watch?v=8a-ULCaarCQ</embedvideo>


*2015, [https://www.youtube.com/watch?v=Qnr51yU9ih8 Is Low Dose Naltrexone (LDN) for you?]<ref>{{Cite web|url=https://www.youtube.com/watch?v=Qnr51yU9ih8|title=1:05 / 7:05 Is Low Dose Naltrexone (LDN) for you?|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Oct 11, 2015|website=YouTube|archive-url=|archive-date=|access-date=}}</ref>
*2015, [https://www.youtube.com/watch?v=Qnr51yU9ih8 Is Low Dose Naltrexone (LDN) for you?]<ref>{{Cite web|url=https://www.youtube.com/watch?v=Qnr51yU9ih8 | title = 1:05 / 7:05 Is Low Dose Naltrexone (LDN) for you?|last = | first = | authorlink = | date = Oct 11, 2015 | website = YouTube | archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Is Low Dose Naltrexone (LDN) for you?'' By Integrative Health Solutions">https://www.youtube.com/watch?v=Qnr51yU9ih8</embedvideo>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Is Low Dose Naltrexone (LDN) for you?'' By Integrative Health Solutions">https://www.youtube.com/watch?v=Qnr51yU9ih8</embedvideo>


==Notable studies==
==Notable studies==
* 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study<ref>{{Cite journal|last=Younger|first=Jarred|author-link=Jarred Younger|last2=Mackey|first2=Sean|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=May 2009|title=Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study|url=https://academic.oup.com/painmedicine/article-lookup/doi/10.1111/j.1526-4637.2009.00613.x|journal=Pain Medicine|language=en|volume=10|issue=4|pages=663–672|doi=10.1111/j.1526-4637.2009.00613.x|issn=1526-2375|pmc=2891387|pmid=19453963|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ (Full text)]
* 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study<ref>{{Cite journal|last = Younger | first = Jarred | authorlink = Jarred Younger | last2 = Mackey | first2 = Sean | authorlink2 = | date = May 2009 | title = Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study|url=https://academic.oup.com/painmedicine/article-lookup/doi/10.1111/j.1526-4637.2009.00613.x|journal=Pain Medicine|language=en|volume=10|issue=4 | pages = 663–672|doi=10.1111/j.1526-4637.2009.00613.x|issn=1526-2375|pmc=2891387|pmid=19453963|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ (Full text)]
* 2013, Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels<ref name="Younger2013" /> - [https://onlinelibrary.wiley.com/doi/full/10.1002/art.37734 (Full text)]
* 2013, Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels<ref name="Younger2013" /> - [https://onlinelibrary.wiley.com/doi/full/10.1002/art.37734 (Full text)]
* 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain<ref name="Younger2014" /> - [http://link.springer.com/article/10.1007%2Fs10067-014-2517-2 (Full text)]
* 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain<ref name="Younger2014" /> - [http://link.springer.com/article/10.1007%2Fs10067-014-2517-2 (Full text)]
*2018, Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat [[Gulf War Illness]]<ref name="Brewer, 2018" /> -  [https://www.tandfonline.com/doi/full/10.1080/21641846.2018.1477034 (Abstract)]
*2018, Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat [[Gulf War Illness]]<ref name="Brewer, 2018" /> -  [https://www.tandfonline.com/doi/full/10.1080/21641846.2018.1477034 (Abstract)]


* 2018, Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization<ref>{{Cite journal|last=Toljan|first=Karlo|last2=Vrooman|first2=Bruce|date=2018-09-21|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=http://www.mdpi.com/2076-3271/6/4/82|journal=Medical Sciences|language=en|volume=6|issue=4|pages=82|doi=10.3390/medsci6040082|issn=2076-3271|pmc=6313374|pmid=30248938}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/#!po=19.1057 (Full text)]
* 2018, Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization<ref>{{Cite journal | last = Toljan | first = Karlo | last2 = Vrooman | first2 = Bruce | date = 2018-09-21 | title = Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization | url = http://www.mdpi.com/2076-3271/6/4/82|journal=Medical Sciences|language=en|volume=6|issue=4 | pages = 82|doi=10.3390/medsci6040082|issn=2076-3271|pmc=6313374|pmid=30248938}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/#!po=19.1057 (Full text)]


* 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)<ref>{{Cite journal|last=Polo|first=Olli|author-link=Olli Polo|last2=Pesonen|first2=Pia|author-link2=|last3=Tuominen|first3=Essi|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2019-11-19|title=Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=|issue=|pages=1–11|doi=10.1080/21641846.2019.1692770|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/21641846.2019.1692770?journalCode=rftg20 (Abstract)]
* 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)<ref name="Polo2019">{{Cite journal | last = Polo|first = Olli | authorlink = Olli Polo | last2 = Pesonen | first2 = Pia | authorlink2 = | last3 = Tuominen | first3 = Essi | authorlink3 = | date = 2019-11-19 | title = Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=7|issue=4|pages=207-217|doi=10.1080/21641846.2019.1692770|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/21641846.2019.1692770?journalCode=rftg20 (Abstract)]
* 2020, Low-dose naltrexone as a treatment for chronic fatigue syndrome<ref>{{Cite journal|last=Bolton|first=Monica Jane|author-link=|last2=Chapman|first2=Bryan Paul|author-link2=|last3=Van Marwijk|first3=Harm|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Jan 2020|title=Low-dose naltrexone as a treatment for chronic fatigue syndrome|url=http://casereports.bmj.com/lookup/doi/10.1136/bcr-2019-232502|journal=BMJ Case Reports|language=en|volume=13|issue=1|pages=e232502|doi=10.1136/bcr-2019-232502|issn=1757-790X|pmc=6954765|pmid=31911410|access-date=|quote=|via=}}</ref> - [https://casereports.bmj.com/content/bmjcr/13/1/e232502.full.pdf (Full text)]
* 2020, Low-dose naltrexone as a treatment for chronic fatigue syndrome<ref>{{Cite journal|last = Bolton | first = Monica Jane | authorlink = | last2 = Chapman | first2 = Bryan Paul | authorlink2 = | last3 = Van Marwijk | first3 = Harm | authorlink3 = | date = Jan 2020 | title = Low-dose naltrexone as a treatment for chronic fatigue syndrome|url=http://casereports.bmj.com/lookup/doi/10.1136/bcr-2019-232502|journal=BMJ Case Reports|language=en|volume=13|issue=1| pages = e232502|doi=10.1136/bcr-2019-232502|issn=1757-790X|pmc=6954765|pmid=31911410|access-date=|quote=|via=}}</ref> - [https://casereports.bmj.com/content/bmjcr/13/1/e232502.full.pdf (Full text)]
*2021, Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment<ref name="Cabanas2021">{{Cite journal | title = Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment | date = 2021|url=https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806|journal=Frontiers in Immunology|volume=12|issue= | pages = 687806|last = Cabanas | first = Helene | authorlink = Hélène Cabanas | last2 = Muraki | first2 = Katsuhiko | authorlink2 = | last3 = Eaton-Fitch | first3 = Natalie | authorlink3 = Natalie Eaton-Fitch | last4 = Staines | first4 = Donald Ross  | authorlink4 = Donald Staines | last5 = Marshall-Gradisnik | first5 = Sonya | authorlink5 = Sonya Marshall-Gradisnik|doi=10.3389/fimmu.2021.687806|pmc=PMC8313851|pmid=34326841|access-date=|issn=1664-3224|quote=|via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806/full (Full text)]


==See also==
==See also==
Line 90: Line 103:


==Learn more==
==Learn more==
*[https://www.ldnresearchtrust.org LDN Research Trust]<ref>{{Cite web|url=https://www.ldnresearchtrust.org/|title=LDN Research Trust - Low Dose Naltrexone {{!}}|website=www.ldnresearchtrust.org|access-date=2019-02-02}}</ref>
*[https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf Low-dose Naltrexone (LDN) Doctor's Fact Sheet 2014] - LDN Research Trust
*[https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md Low Dose Naltrexone and chronic pain]<ref name=":0" />  
*[https://www.ldnresearchtrust.org LDN Research Trust]<ref>{{Cite web|url=https://www.ldnresearchtrust.org/ | title = Low Dose Naltrexone {{!}}|website=LDN Research Trust|access-date=2019-02-02}}</ref>
*[https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md Low Dose Naltrexone and chronic pain]<ref name="chronicpain" />  
*[https://en.wikipedia.org/wiki/Naltrexone Wikipedia - Naltrexone]
*[https://en.wikipedia.org/wiki/Naltrexone Wikipedia - Naltrexone]
*[http://www.ldnnow.com/ LDN Now]
*[http://www.ldnnow.com/ LDN Now]
*[https://www.ldnscience.org/ LDN Science - MedInsight Research Institute]
*[https://www.ldnscience.org/ LDN Science - MedInsight Research Institute]
*2015, [https://www.ncbi.nlm.nih.gov/books/NBK390569/ The Use of Naltrexone in Low Doses Beyond the Approved Indication]<ref name="NBK390569">{{Citation|url=https://www.ncbi.nlm.nih.gov/books/NBK390569/|title=The Use of Naltrexone in Low Doses Beyond the Approved Indication|last=Ringerike|first=Tove|last2=Pike|first2=Eva|last3=Nevjar|first3=Janicke|last4=Klemp|first4=Marianne|publisher=NIPH|year=2015|isbn=|editor-link=|location=|pages=|chapter=|quote=|editor-last2=|editor-link2=}}</ref>
*2015, [https://www.ncbi.nlm.nih.gov/books/NBK390569/ The Use of Naltrexone in Low Doses Beyond the Approved Indication]<ref name="NBK390569">{{Citation | url = https://www.ncbi.nlm.nih.gov/books/NBK390569/ | title = The Use of Naltrexone in Low Doses Beyond the Approved Indication|last = Ringerike | first = Tove | last2 = Pike | first2 = Eva | last3 = Nevjar | first3 = Janicke | last4 = Klemp | first4 = Marianne|publisher=NIPH| year = 2015 |isbn=|location=}}</ref>
* [https://selfhacked.com/2016/06/20/top-22-scientific-health-benefits-low-dose-naltrexone/ Top 15 Scientific Health Benefits of Low Dose Naltrexone] (2016)
*[https://www.healthrising.org/treating-chronic-fatigue-syndrome/drugs/low-dose-naltrexone-ldn-fibromyalgia-chronic-fatigue-syndrom/ Low Dose Naltrexone Resource Center for Fibromylgia and ME/CFS] (2019)
*2016, [http://www.rheumatologyadvisor.com/fibromyalgia/using-low-dose-naltrexone-in-fibromyalgia/article/478182/ Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia]
*2016, [http://www.rheumatologyadvisor.com/fibromyalgia/using-low-dose-naltrexone-in-fibromyalgia/article/478182/ Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia]
*[https://books.google.co.uk/books?id=CQ2oCwAAQBAJ&lpg=PR9&lr&pg=PA69#v=onepage&q&f=true Chronic fatigue syndrome and Fibromyalgia]<ref>{{Cite book|url=https://www.amazon.com/LDN-Book-Little-Known-Naltrexone-Revolutionize/dp/1603586644|title=The LDN Book: How a Little-Known Generic Drug — Low Dose Naltrexone — Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression, and More|last=Elsegood|first=Lisa|date=2016-02-15|publisher=Chelsea Green Publishing|isbn=9781603586658|editor-last=|editor-first=|editor-link=|location=|language=en|author-link=}}</ref> - [[The LDN Book]]
*[[The LDN Book]] - Lisa Elsegood (2016)
*[http://www.cortjohnson.org/blog/2016/02/04/low-dose-naltrexone-combo-chronic-fatigue/ 2016, Low Dose Naltrexone Drug Combination Proposed for Chronic Fatigue Syndrome] - Health Rising, by [[Cort Johnson]] (2016)
*[https://cfsremission.wordpress.com/2016/03/19/review-of-low-dose-naltrexone/ Low dose naltrexone: side effects and efficacy in gastrointestinal disorders] by [[CFS Remission]] (2016)
*Opioid blocking and alcohol - [http://www.well.com/user/woa/revia/reviafaq.htm FAQ About Naltrexone Treatment for Alcoholism - 10.]
*[https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-for-fibromyalgia Low Dose Naltrexone for Fibromyalgia] (2018)
* [https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-therapy-for-crohn-s-disease Low Dose Naltrexone Therapy for Crohn's Disease] (2018)
* [https://www.facebook.com/groups/200010163370187 LDN LOW DOSE NALTREXONE FOR ME/CFS MYALGIC ENCEPHALOMYELITIS & FIBROMYALGIA]


==References==
==References==
<references>
<references>
<ref name="Brewer, 2018">{{Citation
<ref name="Brewer, 2018">{{Cite journal | last1 = Brewer | first1 = Kori L. | authorlink1 = | last2 = Mainhart | first2 = Allison | authorlink2 = | last3 = Meggs | first3 = William J. | authorlink3 = | title = Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness | journal = Fatigue: Biomedicine, Health & Behavior | volume = 6 | issue = | pages = 132-140 | date = 2018 | pmid = | url = https://ldnresearchtrust.org/double-blinded-placebo-controlled-cross-over-pilot-trial-naltrexone-treat-gulf-war-illness-abstract | doi = 10.1080/21641846.2018.1477034}}</ref>
| last1   = Brewer           | first1 = Kori L.           | authorlink1 =  
<ref name="Younger2009">{{Cite journal | last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger | last2 = Mackey | first2 = Sean | authorlink2 = Sean Mackey | title = Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study | journal = Pain Med | volume = 10 | issue = 4 | pages = 663–672 | date = Apr 22, 2009 | pmid = 2891387 | doi = 10.1111/j.1526-4637.2009.00613.x | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ }}</ref>
| last2   = Mainhart         | first2 = Allison           | authorlink2 =  
<ref name="Younger2013">{{Cite journal | last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger | last2 = Noor | first2 = Noorulain | authorlink2 = Noorulain Noor | last3 = McCue | first3 = Rebecca| authorlink3 = Rebecca McCue | last4 = Mackey | first4 = Sean | authorlink4 = Sean Mackey | title = Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels | journal = Arthritis Rheum | volume = 65 | issue = 2 | pages = 529-38 | date = Jan 28, 2013 | pmid = 23359310 | doi = 10.1002/art.37734 | url = http://onlinelibrary.wiley.com/enhanced/doi/10.1002/art.37734/}}</ref>
| last3   = Meggs             | first3 = William J.       | authorlink3 =  
<ref name="Mackey2009">{{Cite web | last1 = Mackey | first1 = Sean | authorlink1 = Sean Mackey | title = An Update on Fibromyalgia
| title   = Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness
| publisher = Research Channel (USA) | date = May 1, 2009 | url = https://www.youtube.com/watch?v=jtc2JARVpPw}}</ref>
| journal = Fatigue: Biomedicine, Health & Behavior     | volume =   | issue =   | page =  
<ref name="Younger2014">{{Cite journal | last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger | last2 = Parkitny | first2 = Luke | authorlink2 = Luke Parkitny | last3 = McLain | first3 = David | authorlink3 = David McLain | title = The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain | journal = Clin Rheumatol | volume = 33 | issue = 4 | pages = 451-459 | date = Feb 15, 2014 | pmid = 24526250 | doi = 10.1007/s10067-014-2517-2 | url = http://link.springer.com/article/10.1007%2Fs10067-014-2517-2}}</ref>
| date   = 2018
<ref name="Younger20160329sh">{{Cite web | last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger | last2 = Cohen | first2 = Joseph M | authorlink2 = Joseph Cohen | title = Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue
| pmid   =  
| doi     = 10.1080/21641846.2018.1477034
}}
</ref>
<ref name="Younger2009">{{citation
| last1   = Younger         | first1 = Jarred             | authorlink1 = Jarred Younger
| last2   = Mackey           | first2 = Sean               | authorlink2 = Sean Mackey
| title   = Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study
| journal = Pain Med | volume = 10 | issue = 4 | page = 663–672
| date   = 22 Apr 2009
| pmid   = 2891387 | doi = 10.1111/j.1526-4637.2009.00613.x
| url     = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/  
}}</ref>
<ref name="Younger2013">{{citation
| last1   = Younger         | first1 = Jarred             | authorlink1 = Jarred Younger
| last2   = Noor             | first2 = Noorulain         | authorlink2 = Noorulain Noor
| last3   = McCue           | first3 = Rebecca           | authorlink3 = Rebecca McCue
| last4   = Mackey           | first4 = Sean               | authorlink4 = Sean Mackey
| title   = Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels
| journal = Arthritis Rheum | volume = 65 | issue = 2 | page = 529-38
| date   = Jan 28, 2013
| pmid   = 23359310 | doi = 10.1002/art.37734
| url     = http://onlinelibrary.wiley.com/enhanced/doi/10.1002/art.37734/
}}</ref>
<ref name="Mackey2009">{{citation
| last1   = Mackey           | first1 = Sean               | authorlink1 = Sean Mackey
| title   = An Update on Fibromyalgia
| journal = Research Channel (USA)
| date   = May 1, 2009
| url     = https://www.youtube.com/watch?v=jtc2JARVpPw
|last2=|first2=|volume=|issue=|pages=|chapter=|edition=|isbn=}}</ref>
<ref name="Younger2014">{{citation
| last1   = Younger         | first1 = Jarred             | authorlink1 = Jarred Younger
| last2   = Parkitny         | first2 = Luke               | authorlink2 = Luke Parkitny
| last3   = McLain           | first3 = David             | authorlink3 = David McLain
| title   = The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain
| journal = Clin Rheumatol | volume = 33 | issue = 4 | page = 451-459
| date   = Feb 15, 2014
| pmid   = 24526250 | doi = 10.1007/s10067-014-2517-2
| url     = http://link.springer.com/article/10.1007%2Fs10067-014-2517-2
|pages=|chapter=|edition=|isbn=}}</ref>
<ref name="Younger20160329sh">{{citation
| last1   = Younger         | first1 = Jarred             | authorlink1 = Jarred Younger
| last2   = Cohen           | first2 = Joseph M           | authorlink2 = Joseph Cohen
| title   = Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue
| type    = video interview with transcript
| type    = video interview with transcript
| journal = Self Hacked Blog
| publisher = Self Hacked Blog | date = Mar 29, 2016 | url = http://selfhacked.com/2016/03/29/dr-jared-younger-cutting-edge-research-on-cfs-neuroinflammation-pain-and-fatigue/#Leptin_and_Chronic_Fatigue_Syndrome}}</ref>
| date   = 29 Mar 2016
| url     = http://selfhacked.com/2016/03/29/dr-jared-younger-cutting-edge-research-on-cfs-neuroinflammation-pain-and-fatigue/#Leptin_and_Chronic_Fatigue_Syndrome
}}</ref>
</references>
</references>



Latest revision as of 13:51, July 25, 2023

Low Dose Naltrexone (LDN) refers to very small doses of the drug naltrexone hydrochloride, which is normally used to treat drug or alcohol dependence. When taken at much smaller doses naltrexone may reduce pain, or potentially neurological symptoms. Brand names of naltrexone include ReViva, Depade, and Vivitrol.[1] LDN use other for treating drug dependence is considered off-label. Some patients report that LDN helps reduce their symptoms of ME/CFS, multiple sclerosis (MS), fibromyalgia (FMS), or autoimmune disease. Although its mechanism of action is unclear, some have speculated that it may act as an anti-inflammatory.[2]

Prescription forms[edit | edit source]

LDN is typically prescribed using generic naltrexone hydrochloride or branded naltrexone, divided into much smaller doses. LDN may be taken in the form of liquid solution/syrup, sublingual doses or 1.5mg capsules, or a compounding pharmacy can create smaller sized capsules or tablets. LDN in the form of naltrexone cream, subcutaneous injections, IV naltrexone and eye drops (for dry eyes) are also available.[3]

VLDN and ULDN[edit | edit source]

Very Low Dose Naltrexone (VLDN) and Ultra-Low Dose Naltrexone (ULDN) have recently been used in limited trials, both VLDN and ULDN involve doses of naltrexone significantly below 1mg.[4]

Very Low Dose Naltrexone is increasingly being used under 1mg for people who cannot titrate from 0.5mg to find their individual optimal dose.

Dr. John Kim has great experience with LDN and shares his latest results in combining ULDN (Ultra-Low Dose Naltrexone) with acupuncture and Vitamin C. shares his latest results in combining ULDN (Ultra-Low Dose Naltrexone) Dr. John Kim has great experience with LDN and shares his latest results in combining ULDN (Ultra-Low Dose Naltrexone) with acupuncture and Vitamin C.

An Archived LDN Presentation- ULDN, Micro Dosing with Dr John Kim

https://the-ldn-radio-show.captivate.fm/.../an-ldn...

Dr John Kim on The LDN Trust site https://ldnresearchtrust.org/search/exclude?keys=John%20kim&page=1

Patients who wish to cease opioids use and transition onto LDN can first use ULDN using facebook group and explainer document below.

Using Ultra Low Dose Naltrexone to reduce opiate use and transition to LDN. - Using Ultra Low Dose Naltrexone to transition to Low Dose Naltrexone by Michael D Robinson. Link to https://www.scribd.com/document/195139174/ULDN-Inverse-Titration-Protocol-FINAL?fbclid=IwAR3qG2YSjrl6WB2dpiNi4fKw96Loj8yC8x79TVp5tGX3_PR2itFyrNWjbiY

Evidence[edit | edit source]

Data shows a graph with 10% worse after treatment, 57% improved or much improved, and 12% very much improved. Darker colors are the most improved sections.
Low Dose Naltrexone results for 29 patients with Fibromyalgia. Fibromyalgia participants’ (N = 29) self-reported improvement in symptoms after daily LDN treatment. Source: Clin Rheumatol 2014; 33(4):452-459. Fig 1.[2] PMC3962576

Jarred Younger published a small study that concluded "...low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia".[5][6]

A second study concluded that "specific and clinically beneficial impact on fibromyalgia pain".[7][8]

A 2014 review by Stanford researchers suggests that "LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on opioid receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated."[2]

Relationship between ESR, a marker inflammation, and LDN treatment in 29 patients with Fibromyalgia.

The FDA approved naltrexone HCL in 1984 to treat opioid addiction. Low-dose naltrexone is typically given at about 1/10th the typical dose of naltrexone. By blocking opioid receptors, naltrexone can increase pain, but at very low doses naltrexone has both pain-reducing (analgesic) and anti-inflammatory properties.

In 2012 Solve ME/CFS Initiative contracted Biovista to use drug models to identify existing drugs that may be worth investigating for treatment. The results suggested Naltrexone was worth considering.[9]

Jarred Younger's research suggests that people with an Erythrocyte Sedimentation Rate (ESR) over 40 millimeters an hour, tend to be strong responders to LDN, and that there may be other predictive factors for success.[10]

News articles[edit | edit source]

Clinical use[edit | edit source]

Naltrexone is a prescription drug in many countries including the United States.[11]Compounding chemists or compounding pharmacists can mix naltrexone with a powder filler or dilute in into a liquid to create the lower dose.

Fast-release fillers only[edit | edit source]

The LDN Research Trust advises that: "Pharmacies should be instructed NOT to provide LDN in an "SR" or slow-release or timed-release form. Unless the low dose of naltrexone is in an unaltered form, which permits it to reach a prompt "spike" in the blood stream, its therapeutic effects may be inhibited."[12] and states that calcium carbonate filler should NOT be used because they reduce absorption, instead Avicel, lactose, or sucrose fillers as alternative fast-release fillers."[12]

Do not take with[edit | edit source]

In general, Low Dose Naltrexone (LDN) should not be taken concurrently with opioid-containing drugs (opioid receptors in brain are blocked by LDN), alcohol, immunosuppressive drugs, or immunomodulator drugs.[citation needed] LDN blocks the effect of opioid drugs.[13] Some opioid drugs are codeine, tramadol, oxycodone, vicodin, hydrocodone, fentanyl and morphine.

Pharmacies[edit | edit source]

Australia[edit | edit source]

Compounding Pharmacies are able to fill these prescriptions, and post if needed.

UK[edit | edit source]

LDN suppliers in the UK include Dickson Chemist in Glasgow, Roseway Labs, and Specialist Pharmacy (The London Specialist Pharmacy Ltd). All these are compounding pharmacies and require a perscription, they are usually able to put patients in contact with private doctors who will consider writing a prescription, and can post medications to you.[14] Compounding pharmacies are regulated by the UK's General Pharmaceutical Council.[14]

United States[edit | edit source]

Neighborhood Compounding Pharmacies are able to fill these prescriptions and mail if needed. Your prescribing doctor can help you locate a compounding pharmacy in your area/state or you can look online.[15]

Other countries[edit | edit source]

The LDN Research Trust lists pharmacies in multiple countries.[16]

Clinical trials[edit | edit source]

A large number of clinical trials have been completed for LDN recently, although none have looked at the effect of LDN on symptoms of myalgic encephalomyelitis/chronic fatigue syndrome. Research has been carried out on patients with MS, Chronic Regional Pain Syndrome, FMS, Irritable Bowel Syndrome (IBS), Ulcerative Colitis, Skin Disorders and a range of other illnesses.[17]

When, How To Take[edit | edit source]

Dr Whitaker states that the ideal dose is different for each person. Some doctors recommend starting at 1mg.[18] Common dosages are 1.5mg, 3mg, 4.5mg.[19][20][13] When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake; discuss how best to do this with your doctor and pharmacist.[20][21][13]

LDN is usually taken at bedtime. Some people take LDN in the morning to minimize sleep disturbance, insomnia, and vivid dreams.[13]

Talks and webinars[edit | edit source]

LDNscience® Presents - How LDN (Low Dose Naltrexone) Works By LDNscience
Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez By Alex Vasquez
Is Low Dose Naltrexone (LDN) for you? By Integrative Health Solutions

Notable studies[edit | edit source]

  • 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study[25] - (Full text)
  • 2013, Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels[7] - (Full text)
  • 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain[2] - (Full text)
  • 2018, Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness[26] - (Abstract)
  • 2018, Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization[27] - (Full text)
  • 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)[28] - (Abstract)
  • 2020, Low-dose naltrexone as a treatment for chronic fatigue syndrome[29] - (Full text)
  • 2021, Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment[30] - (Full text)

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. "Naltrexone - brand name list from Drugs.com". Drugs.com. Retrieved January 17, 2022.
  2. 2.0 2.1 2.2 2.3 Younger, Jarred; Parkitny, Luke; McLain, David (February 15, 2014). "The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain". Clin Rheumatol. 33 (4): 451–459. doi:10.1007/s10067-014-2517-2. PMID 24526250.
  3. "Types of LDN". LDN Research Trust. Retrieved January 17, 2022.
  4. Toljan, Karlo; Vrooman, Bruce (September 21, 2018). "Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization". Medical Sciences. 6 (4). doi:10.3390/medsci6040082. ISSN 2076-3271. PMID 30248938.
  5. Younger, Jarred; Mackey, Sean (April 22, 2009). "Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study". Pain Med. 10 (4): 663–672. doi:10.1111/j.1526-4637.2009.00613.x. PMID 2891387.
  6. Mackey, Sean (May 1, 2009). "An Update on Fibromyalgia". Research Channel (USA).
  7. 7.0 7.1 Younger, Jarred; Noor, Noorulain; McCue, Rebecca; Mackey, Sean (January 28, 2013). "Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels". Arthritis Rheum. 65 (2): 529–38. doi:10.1002/art.37734. PMID 23359310.
  8. "Low Dose Naltrexone for Fibromyalgia". Systems Neuroscience and Pain Lab | Stanford Medicine. Retrieved October 4, 2018.
  9. Solve ME/CFS Initiative. "Biovista work released".
  10. Younger, Jarred; Cohen, Joseph M (March 29, 2016). "Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue" (video interview with transcript). Self Hacked Blog.
  11. Feeney, G. F. X.; Connor, J.P.; Young, R. McD; Tucker, J.; Czajkowski, F. (2001). "Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme". Journal of Clinical Pharmacy and Therapeutics. 26 (1): 73–79. doi:10.1111/j.1365-2710.2001.00326.x. ISSN 1365-2710.
  12. 12.0 12.1 "Low-dose Naltrexone (LDN) Fact Sheet 2014" (PDF). LDN Research Trust. 2014.
  13. 13.0 13.1 13.2 13.3 13.4 Chopra, Pradeep. "Low Dose Naltrexone and chronic pain". LDN Research Trust. Retrieved January 31, 2019.
  14. 14.0 14.1 "Compounding processes regulations/". Roseway Labs.
  15. Finding a Compounding Pharmacy - WIKI How
  16. "LDN Pharmacists". LDN Research Trust.
  17. "Clinical Trials". LDN Research Trust. Retrieved January 21, 2019.
  18. LDN Now. "LDN Dosing". Retrieved February 1, 2018.
  19. Myers, Amy (May 2, 2017). "Low-Dose Naltrexone for Autoimmunity?". Amy Myers MD. Retrieved February 2, 2019.
  20. 20.0 20.1 Dr Whitaker. "What is Low-Dose Naltrexone?". drwhitaker.com. Retrieved January 21, 2019.
  21. "Low Dose Naltrexone (LDN) – Collier Drug Store". collierdrug.com. What dose of Low Dose Naltrexone (LDN) is best?. Retrieved February 2, 2019.
  22. "LDNscience® Presents - How LDN (Low Dose Naltrexone) Works". YouTube. LDNscience. December 20, 2012.
  23. Carnahan, Jill; Vasquez, Alex (November 30, 2015). "Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez". YouTube. Alex Vasquez.
  24. "1:05 / 7:05 Is Low Dose Naltrexone (LDN) for you?". YouTube. October 11, 2015.
  25. Younger, Jarred; Mackey, Sean (May 2009). "Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study". Pain Medicine. 10 (4): 663–672. doi:10.1111/j.1526-4637.2009.00613.x. ISSN 1526-2375. PMC 2891387. PMID 19453963.
  26. Brewer, Kori L.; Mainhart, Allison; Meggs, William J. (2018). "Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness". Fatigue: Biomedicine, Health & Behavior. 6 (3): 132–140. doi:10.1080/21641846.2018.1477034.
  27. Toljan, Karlo; Vrooman, Bruce (September 21, 2018). "Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization". Medical Sciences. 6 (4): 82. doi:10.3390/medsci6040082. ISSN 2076-3271. PMC 6313374. PMID 30248938.
  28. Polo, Olli; Pesonen, Pia; Tuominen, Essi (November 19, 2019). "Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)". Fatigue: Biomedicine, Health & Behavior. 7 (4): 207–217. doi:10.1080/21641846.2019.1692770. ISSN 2164-1846.
  29. Bolton, Monica Jane; Chapman, Bryan Paul; Van Marwijk, Harm (January 2020). "Low-dose naltrexone as a treatment for chronic fatigue syndrome". BMJ Case Reports. 13 (1): e232502. doi:10.1136/bcr-2019-232502. ISSN 1757-790X. PMC 6954765. PMID 31911410.
  30. Cabanas, Helene; Muraki, Katsuhiko; Eaton-Fitch, Natalie; Staines, Donald Ross; Marshall-Gradisnik, Sonya (2021). "Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment". Frontiers in Immunology. 12: 687806. doi:10.3389/fimmu.2021.687806. ISSN 1664-3224. PMC 8313851. PMID 34326841.
  31. "Low Dose Naltrexone |". LDN Research Trust. Retrieved February 2, 2019.
  32. Ringerike, Tove; Pike, Eva; Nevjar, Janicke; Klemp, Marianne (2015), The Use of Naltrexone in Low Doses Beyond the Approved Indication, NIPH