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 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.
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.
Evidence[edit | edit source]
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.
Articles[edit | edit source]
- 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
- 2019 Low Dose Naltrexone Resource Center for Fibromylgia and ME/CFS
Clinical use[edit | edit source]
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[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." 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[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. LDN blocks the effect of opioid drugs. Some opioid drugs are codeine, tramadol, oxycodone, vicodin, hydrocodone, fentanyl and morphine.
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.
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.
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. 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.
Talks and webinars[edit | edit source]
Notable studies[edit | edit source]
- 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study - (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 - (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)
- 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) - (Abstract)
- 2020, Low-dose naltrexone as a treatment for chronic fatigue syndrome - (Full text)
See also[edit | edit source]
Learn more[edit | edit source]
- LDN Research Trust
- 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
- Facebook patient community where patients with various diseases discuss their experiences taking Low-dose Naltrexone.
References[edit | edit source]
- Younger, Jarred; Parkitny, Luke; McLain, David (Feb 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
- Toljan, Karlo; Vrooman, Bruce (Sep 21, 2018). "Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization". Medical Sciences. 6 (4). doi:10.3390/medsci6040082. ISSN 2076-3271. PMID 30248938.
- Younger, Jarred; Mackey, Sean (Apr 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
- Mackey, Sean (May 1, 2009), "An Update on Fibromyalgia - from Sean Mackey, Chief, Division of Pain Management, Stanford University", Research Channel (USA)
- Younger, Jarred; Noor, Noorulain; McCue, Rebecca; Mackey, Sean (Jan 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
- "Low Dose Naltrexone for Fibromyalgia". Systems Neuroscience and Pain Lab. Retrieved Oct 4, 2018.
- Solve ME/CFS Initiative. "Biovista work released".
- Younger, Jarred; Cohen, Joseph M (Mar 29, 2016), "Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue", Self Hacked Blog (video interview with transcript)
- "Naltrexone". Wikipedia. Dec 24, 2018.
- "The Low Dose Naltrexone Homepage". www.lowdosenaltrexone.org. Retrieved Jan 21, 2019.
- "The Low Dose Naltrexone Homepage". www.lowdosenaltrexone.org. Retrieved Jan 21, 2019.
- Drugs To Avoid When Taking Low Dose Naltrexone
- "Low Dose Naltrexone and chronic pain - Pradeep Chopra, MD | LDN Research Trust - Low Dose Naltrexone". www.ldnresearchtrust.org. Retrieved Jan 31, 2019.
- Finding a Compounding Pharmacy - WIKI How
- "Clinical Trials | LDN Research Trust - Low Dose Naltrexone". www.ldnresearchtrust.org. Retrieved Jan 21, 2019.
- LDN Now. "LDN Dosing". Retrieved Feb 1, 2018.
- www.well-donedesign.com (May 2, 2017). "Amy Myers MD". Amy Myers MD. Retrieved Feb 2, 2019.
- Dr Whitaker. "What is Low-Dose Naltrexone?". www.drwhitaker.com. Retrieved Jan 21, 2019.
- "Low Dose Naltrexone (LDN) – Collier Drug Store". collierdrug.com. What dose of Low Dose Naltrexone (LDN) is best?. Retrieved Feb 2, 2019.
- "LDNscience® Presents - How LDN (Low Dose Naltrexone) Works". YouTube. LDNscience. Dec 20, 2012.
- Carnahan, Jill; Vasquez, Alex (Nov 30, 2015). "Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez". YouTube. Alex Vasquez.
- "1:05 / 7:05 Is Low Dose Naltrexone (LDN) for you?". YouTube. Oct 11, 2015.
- 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 . PMID 19453963.
- 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, doi:10.1080/21641846.2018.1477034
- Toljan, Karlo; Vrooman, Bruce (Sep 21, 2018). "Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization". Medical Sciences. 6 (4): 82. doi:10.3390/medsci6040082. ISSN 2076-3271. PMC . PMID 30248938.
- Polo, Olli; Pesonen, Pia; Tuominen, Essi (Nov 19, 2019). "Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)". Fatigue: Biomedicine, Health & Behavior: 1–11. doi:10.1080/21641846.2019.1692770. ISSN 2164-1846.
- Bolton, Monica Jane; Chapman, Bryan Paul; Van Marwijk, Harm (Jan 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 . PMID 31911410.
- "LDN Research Trust - Low Dose Naltrexone". www.ldnresearchtrust.org. Retrieved Feb 2, 2019.
- "Low Dose Naltrexone | The Ultimate Resource | LDNscience". www.ldnscience.org. Retrieved Feb 2, 2019.
- Ringerike, Tove; Pike, Eva; Nevjar, Janicke; Klemp, Marianne (2015). The Use of Naltrexone in Low Doses Beyond the Approved Indication. NIPH.
- Arlotta, CJ (Feb 21, 2016). "Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia". Rheumatology Advisor. Retrieved Feb 2, 2019.
- Elsegood, Lisa (Feb 15, 2016). The LDN Book: How a Little-Known Generic Drug — Low Dose Naltrexone — Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression, and More. Chelsea Green Publishing. ISBN 9781603586658.
immunomodulator - a substance that affects the functioning of the immune system
myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.
chronic fatigue syndrome (CFS) - A controversial term, invented by the U.S. Centers for Disease Control, that generally refers to a collection of symptoms as “fatigue”. There have been multiple attempts to come up with a set of diagnostic criteria to define this term, but few of those diagnostic criteria are currently in use. Previous attempts to define this term include the Fukuda criteria and the Oxford criteria. Some view the term as a useful diagnostic category for people with long-term fatigue of unexplained origin. Others view the term as a derogatory term borne out of animus towards patients. Some view the term as a synonym of myalgic encephalomyelitis, while others view myalgic encephalomyelitis as a distinct disease.