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 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.
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.
- 2018 Low Dose Naltrexone for Fibromyalgia
- 2019, In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain, NPR, All Things Considered by Alex Smith
Clinical use[edit | edit source]
Naltrexone is a prescription drug in many countries including the United States.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.
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.
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
- Low Dose Naltrexone and chronic pain
- Wikipedia - Naltrexone
- LDN Now
- 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
- https://www.facebook.com/groups/200010163370187/?hc_location=ufi where patients with various diseases discuss their experiences taking Low-dose Naltrexone.
References[edit | edit source]
- 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
- 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.
- 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
- Mackey, Sean (May 1, 2009), "An Update on Fibromyalgia", Research Channel (USA)
- 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
- "Low Dose Naltrexone for Fibromyalgia". Systems Neuroscience and Pain Lab. Retrieved October 4, 2018.
- Solve ME/CFS Initiative. "Biovista work released".
- 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)
- 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.
- "The Low Dose Naltrexone Homepage". www.lowdosenaltrexone.org. Retrieved January 21, 2019.
- "Drugs To Avoid When Taking Low Dose Naltrexone". Yourverity's Blog. July 7, 2009. Retrieved March 17, 2021.
- Chopra, Pradeep. "Low Dose Naltrexone and chronic pain". LDN Research Trust. Retrieved January 31, 2019.
- Finding a Compounding Pharmacy - WIKI How
- "Clinical Trials". LDN Research Trust. Retrieved January 21, 2019.
- LDN Now. "LDN Dosing". Retrieved February 1, 2018.
- Myers, Amy (May 2, 2017). "Low-Dose Naltrexone for Autoimmunity?". Amy Myers MD. Retrieved February 2, 2019.
- Dr Whitaker. "What is Low-Dose Naltrexone?". www.drwhitaker.com. Retrieved January 21, 2019.
- "Low Dose Naltrexone (LDN) – Collier Drug Store". collierdrug.com. What dose of Low Dose Naltrexone (LDN) is best?. Retrieved February 2, 2019.
- "LDNscience® Presents - How LDN (Low Dose Naltrexone) Works". YouTube. LDNscience. December 20, 2012.
- Carnahan, Jill; Vasquez, Alex (November 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. October 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 2891387. 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 (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.
- 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: 1–11. doi:10.1080/21641846.2019.1692770. ISSN 2164-1846.
- 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.
- "LDN Research Trust - Low Dose Naltrexone |". www.ldnresearchtrust.org. Retrieved February 2, 2019.
- "Low Dose Naltrexone | The Ultimate Resource | LDNscience". www.ldnscience.org. Retrieved February 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 (February 21, 2016). "Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia". Rheumatology Advisor. Retrieved February 2, 2019.
- Elsegood, Lisa (February 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.
double blinded trial A clinical trial is double blinded if neither the participants nor the researchers know which treatment group they are allocated to until after the results are interpreted. This reduces bias. (Learn more: www.nottingham.ac.uk)
BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.