Low dose naltrexone

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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 can allay neurological symptoms. Although prescriptions of LDN are becoming more popular, use other than for treating drug dependence is considered off-label. Some patients claim LDN helps reduce their symptoms of ME/CFS, Multiple Sclerosis, fibromyalgia and autoimmune disease.

Evidence[edit | edit source]

Jarred Younger published a small study that concluded "... low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia".[1][2]

A second study concluded that "specific and clinically beneficial impact on fibromyalgia pain".[3]

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."[4]

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.[5]

There is an online patient community where patients with various diseases discuss their experiences taking Low-dose Naltrexone.

Jarred Younger's research suggests that people with an 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.[6]

How it works[edit | edit source]

Clinical use[edit | edit source]

Naltrexone is a prescription drug in many countries.[7] 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]

"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."[8] Calcium Carbonate filler should NOT be used. "Avicel, lactose (if lactose intolerance is not a problem), or sucrose fillers as useful fast-release fillers."[9]

Do not take with opioids[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), immunosuppressive drugs, or immunomodulator drugs.[10]

Expiration date[edit | edit source]

Expiration date for LDN is 5-6 months depending on pharmacy procedures.[11]

Australia[edit | edit source]

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

UK[edit | edit source]

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.

US[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.[12]

When, How To Take[edit | edit source]

The ideal dose is different for each person. Common dosages are 1.5mg, 3mg, 4.5mg, 6mg. Dosages above 9mg are often ineffective.[13]

LDN is usually taken at bedtime. Some people take LDN in the morning to minimise insomnia.[14]

Start Low, Go Slow[edit | edit source]

When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake.[15]

  • Begin with a small dose of 0.5-1.5mg (eg 1/3 of 3mg capsule = 1mg).
    • Gently twist the capsule open, remove the required amount of powder.
    • Put powder into a small amount of water, stir well and drink immediately.
    • Alternatively, place the powder on a teaspoon and swallow.
  • If the LDN keeps you awake, try a lower dose (eg 0.5mg)
  • If you have strong side-effects, try a micro-dose (eg 0.1mg or less)
  • After 1-2 weeks, if there are no adverse effects, step up the dose (eg add 1mg).
  • Repeat every 1-2 weeks until you reach your ideal dose - ie maximum benefit, minimal side-effects.

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ Younger, Jarred; Mackey, Sean (April 22, 2009), "Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study", Pain Med, 2009 May–Jun (10(4)): 663–672, doi:10.1111/j.1526-4637.2009.00613.x, PMID 2891387
  2. ↑ 2.0 2.1 Mackey, Sean (May 1, 2009), "An Update on Fibromyalgia - from Sean Mackey, Chief, Division of Pain Management, Stanford University", Research Channel (USA)
  3. ↑ 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, 2013 Feb (65(2)): 529-38, doi:10.1002/art.37734, PMID 23359310
  4. ↑ 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, 2014 Apr (33(4)): 451-9, doi:10.1007/s10067-014-2517-2, PMID 24526250
  5. ↑ Results of Biovista Work Released
  6. ↑ Younger, Jarred; Cohen, Joseph M (March 29, 2016), "Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue", Self Hacked Blog (video interview with transcript)
  7. ↑ Naltrexone
  8. ↑ Welcome to the Low Dose Naltrexone (LDN) Home Page
  9. ↑ Welcome to the Low Dose Naltrexone (LDN) Home Page - IMPORTANT: Make sure to specify that you do NOT want LDN in a slow-release form.
  10. ↑ Drugs To Avoid When Taking Low Dose Naltrexone
  11. ↑ reference needed
  12. ↑ Finding a Compounding Pharmacy - WIKI How
  13. ↑ reference needed
  14. ↑ reference needed
  15. ↑ What is Low-Dose Naltrexone?

central nervous system (CNS) - One of the two parts of the human nervous system, the other part being the peripheral nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of nerves that travel from the central nervous system into the various organs and tissues of the body.

microglia A type of immune cell, called a macrophage, that lives in the brain. For historical reasons, macrophages have different names based on the part of the body that they normally live in. Macrophages that normally live in the blood are called monocytes. Macrophages that normally live in the skin are called Langerhans cells. Macrophages that normally live in the liver are called Kupffer cells. And macrophages that normally live in the central nervous system are called microglia. Microglia were originally classified as glial cells, under the assumption that the cells had a merely structural function, before it was realized that the cells were in fact immune cells. As the "sentinel cells" of the central nervous system, microglia survey their environment for abnormalities such as infection or tissue damage, and then initiate an immune response to fight the infection or repair the tissue damage.

immunomodulator An immunomodulator is a substance that affects the functioning of the immune system

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