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 can allay neurologica l 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 (MS), fibromyalgia (FMS) and autoimmune disease.

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 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."

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.

How it works

 * LDN (Low Dose Naltrexone) - How it Works - Animation, Video
 * LDN (Low Dose Naltrexone) with Drs Carnahan and Vasquez, Video

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.

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

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. Common dosages are 1.5mg, 3mg, 4.5mg, 6mg. Dosages above 9mg are often ineffective.

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

Start Low, Go Slow
When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake.
 * 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.

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
 * Wikipedia - Naltrexone
 * Wikipedia - Low dose Naltrexone
 * MedInsight Research Institute Homepage
 * 2016, Top 15 Scientific Health Benefits of Low Dose Naltrexone
 * Low Dose Naltrexone Drug Combination Proposed for Chronic Fatigue Syndrome, Health Rising, by Cort Johnson.
 * Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia, Rheumatology Advisor, by CJ Arlotta
 * An Update on Fibromyalgia - from Sean Mackey, Stanford University (2009)
 * Low dose naltrexone: side effects and efficacy in gastrointestinal disorders
 * Low dose naltrexone (Naltrexone) will block opioids i.e., Tramadol. Answers to FAQ About Naltrexone Treatment for Alcoholism - 10. Can I take other medications with naltrexone?
 * The Use of Naltrexone in Low Doses Beyond the Approved Indication by Tove Ringerike, Eva Pike, Janicke Nevjar, and Marianne Klemp