Low dose naltrexone

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 neurologica l 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.

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.

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

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

A 2014 review by Stanford researchers suggests that "LDN may operate as a novel qjanti-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." 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.

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.

Notable studies

 * 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study
 * 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
 * 2018, Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization
 * 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) - (Abstract)

Articles

 * 2016, Top 15 Scientific Health Benefits of Low Dose Naltrexone
 * 2016, Low Dose Naltrexone Drug Combination Proposed for Chronic Fatigue Syndrome, Health Rising, by Cort Johnson
 * 2016, Low dose naltrexone: side effects and efficacy in gastrointestinal disorders by CFS Remission
 * Opioid blocking and alcohol - FAQ About Naltrexone Treatment for Alcoholism - 10.
 * 2019, In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain, NPR, All Things Considered by Alex Smith

Talks and videos

 * An Update on Fibromyalgia - from Sean Mackey, Stanford University (2009)

Clinical use
Naltrexone is a prescription drug in many countries. 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
"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." Calcium Carbonate filler should NOT be used. "Avicel, lactose (if lactose intolerance is not a problem), or sucrose fillers as useful fast-release fillers."

Do not take with opioids
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. LDN blocks the effect of opioid drugs. Some opioid drugs are codeine, tramadol, oxycodone, vicodin, hydrocodone, fentanyl and morphine.

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

UK
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
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.

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 (IBS), Ulcerative Colitis, Skin Disorders and a range of other illnesses.

When, How To Take
Dr Whitaker states that the ideal dose is different for each person. Some doctors recommend starting at 1mg. Common dosages are 1.5mg, 3mg, 4.5mg. 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.

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

Talks and webinars
https://www.youtube.com/watch?v=z0p0ykSzy9o
 * 2012, LDNscience® Presents - How LDN (Low Dose Naltrexone) Works

https://www.youtube.com/watch?v=8a-ULCaarCQ
 * 2015, Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez

https://www.youtube.com/watch?v=Qnr51yU9ih8
 * 2015, Is Low Dose Naltrexone (LDN) for you?

Notable studies

 * 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 (Full text)
 * 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain (Full text)


 * 2018, Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness (Abstract)

Learn more

 * LDN Research Trust
 * Low Dose Naltrexone and chronic pain
 * Wikipedia - Naltrexone
 * Wikipedia - Low dose Naltrexone
 * MedInsight Research Institute Homepage
 * 2015, The Use of Naltrexone in Low Doses Beyond the Approved Indication
 * 2016, Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia
 * Chronic fatigue syndrome and Fibromyalgia - The LDN Book