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  • Writer's pictureDr. Harold Pierre

Everything You Need to Know About Low Dose Naltrexone

Updated: Dec 7, 2023

Low dose naltrexone (LDN) is a pharmaceutical compound available by prescription at some pharmacies that is emerging as a promising new treatment option for people with chronic health conditions, especially chronic pain and autoimmune diseases.

LDN is an off-label use of the drug naltrexone at a much less of the standard dose than what is used for FDA-approved indications to treat opioid and alcohol addiction. LDN is taken at bedtime in doses typically ranging from 1.5 mg to 4.5 mg, while the standard doses of naltrexone to treat addiction range from 50 mg to 300 mg.

A Brief History of Naltrexone and LDN

  • Naltrexone was approved by the FDA in 1984 in doses of 50mg to 100mg to treat opioid addiction. It is an opioid receptor antagonist, meaning it binds to opioid receptors and blocks them, preventing euphoric effects from opioids.

  • In the mid-1980s, Dr. Bernard Bihari began experimenting with low doses of naltrexone (LDN) to treat his patients with HIV/AIDS. He found LDN helped reduce symptoms and improve quality of life.

  • Since then, Low-dose naltrexone therapy has been used off-label and studied in clinical trials for treating various autoimmune conditions like fibromyalgia, Crohn's disease, and multiple sclerosis (MS). The exact mechanisms behind its effectiveness are still being researched.

  • LDN as a compound is not able to be patented, so major pharmaceutical companies have little financial incentive to fund research and development. However, a growing body of research supports its use.

  • LDN can be obtained through select compounding pharmacies with a doctor's prescription. Organizations like the nonprofit LDN Research Trust fund and promote research on LDN.

How Does Low Dose Naltrexone Work?

Compositionwiht alcohol, drugs, cigarettes and handcuffs on table. Illustration of addiction copy

The exact mechanisms behind LDN are complex and still being unraveled, but here's what researchers understand so far:

  • Whereas a standard dose of naltrexone blocks opioid receptors to treat addiction, LDN has a different effect by briefly blocking opioid receptors (about 4 hours) and then rapidly unblocking them.

  • The brief blockade increases production of the body's own beta-endorphins, met-enkephalins and other opioid signals, with benefits for reducing pain and inflammation.

  • LDN also appears to have anti-inflammatory effects by blocking overactive immune cells called microglia. This modulation of the immune system may help treat autoimmune conditions.

What is LDN Used For?

Though not yet FDA approved for these uses, LDN has been studied and used to treat a variety of conditions:

  • Chronic pain conditions - fibromyalgia, migraines, cluster headaches, complex regional pain syndrome

  • Autoimmune diseases - multiple sclerosis, Crohn's disease, Hashimoto's thyroiditis, Mast Cell Activation Syndrome (MCAS)

  • Mood disorders - depression, anxiety, PTSD, traumatic brain injury (TBI)

  • Gut Issues - Small intestine bacterial overgrowth (SIBO)

  • Trichotillomania - some research indicates LDN can reduce compulsive hair pulling urges.

  • Autism - a small preliminary study found LDN may improve symptoms in a subset of autistic children.

  • COVID-19 - very preliminary research suggests LDN may reduce severity of symptoms and modulate the immune response.

  • Infertility - limited evidence suggests LDN may improve pregnancy rates for some women with unexplained infertility or recurrent miscarriages. The mechanism is thought to involve modulation of immune factors.

  • Other conditions - cancer, weight loss, Parkinson's disease, Alzheimer's disease

Research is still limited, but some studies and anecdotal reports have found LDN to successfully treat these challenging conditions. More research is needed to confirm benefits.

Potential Effects and Benefits of Low Dose Naltrexone

  • Pain relief - Increased endorphin and enkephalin production in the brain help regulate pain signals and reduce discomfort

  • Anti-inflammatory effects - LDN may lower inflammatory cytokines and immunity cells that drive inflammation in autoimmune diseases

  • Improved mood - By increasing endorphins, LDN can elevate mood and emotions

  • Weight loss - Some research suggests LDN may help regulate metabolism and appetite by supporting the metabolism

  • Slows cancer cell growth - LDN reduces the ability of cancer cells to multiply quickly

  • Improves sleep - LDN influences circadian rhythms and can improve quality of sleep

These benefits have been seen in research studies, but individual response to LDN can vary widely.

Low Dose Naltrexone Side Effects and Risks

  • Most people taking LDN report minimal side effects, but some have experienced headaches, sleep disturbances, digestive upset, vivid dreams, anxiety, or fatigue.

  • LDN can interact with other medications, so it's important to tell your prescribing doctor about any other medications or supplements you take.

  • Rarely, LDN may cause liver problems or allergic reactions, though liver function testing is recommended to monitor for any liver issues.

  • People dependent on opioids should not take LDN due to risk of withdrawal symptoms.

Overall, research suggests LDN is very safe when taken under medical guidance, with few short-term side effects. Long-term side effects are unknown.

Who Can Benefit from Low Dose Naltrexone?

People struggling with the following conditions despite conventional treatment may find LDN helpful:

  • Fibromyalgia - LDN may reduce widespread pain, headaches, and fatigue. Small studies have found benefits. Patients with elevated SED rates may receive the best improvement.

  • Crohn's disease - LDN reduced symptom severity and helped induce remission in Crohn's disease patients in small studies.

  • Multiple sclerosis - In small studies, LDN reduced MS symptoms like spasticity and improved quality of life and cognition.

  • Complex regional pain syndrome - For this debilitating, chronic neuropathic pain condition, LDN provided significant pain relief in case reports.

  • Autoimmune thyroid diseases - By modulating the immune system, LDN holds promise for improving Hashimoto's, Graves' diseases and Mast Cell Activation Syndrome (MCAS).

  • Opiate dependence - One study has found that LDN may help prevent relapse in recovering opiate addicts.

While LDN may not work for everyone with these conditions, it presents a promising new option when other treatments fail. Talk to your doctor.

How Do You Take Low Dose Naltrexone?

Close up view of doctor giving pills to patient while looking at the information on medical record copy

  • LDN must be obtained by prescription from a doctor, typically through a compounding pharmacy.

  • It comes as a capsule or liquid to take by mouth, typically around bedtime. Adult doses range from 1.5 mg to 4.5 mg daily.

  • Topical naltrexone cream is another option for more localized issues in the skin and for those who can't tolerate an oral option.

  • Treatment typically starts at a lower dose like 1.5 mg and increases gradually to 4.5 mg unless side effects develop.

  • For some conditions, like Crohn’s disease, lower doses around 1.5 mg may be optimal. Higher doses around 4.5 mg are often used for fibromyalgia and multiple sclerosis.

  • LDN should be taken every 24 hours. Missing doses can result in poorer response. Taking LDN too frequently can cause side effects.

  • Effects may take several weeks or months to notice. It may take some trial and error under medical supervision to find your optimal dose. 4.5 mg is not necessarily better.

How Long Should You Try LDN Before Assessing Effects?

  • Some people notice subtle benefits from LDN after just a few weeks. But most experts recommend trying LDN for at least 2-3 months to gauge effects.

  • LDN's effects appear to build up and become more pronounced over time. Provided side effects are minimal, it is worth staying on it for several months.

  • After 2-3 months, if you don't notice any changes in symptoms, your doctor may recommend adjusting the dosage or discontinuing the medication.

  • Be patient, as LDN can take 3-6 months to take full effect for conditions like autoimmune diseases. Keep notes on any symptom changes to discuss with your doctor.

What Percentage of People Respond Positively to LDN Treatment?

  • It’s difficult to estimate the percentage of people who respond to LDN, as research is still limited. Response varies a lot based on the condition being treated.

  • In one fibromyalgia study, 57% of patients were considered responders to LDN with significant symptom improvement.

  • In one small Crohn’s disease study, 67% of patients achieved remission on LDN.

  • One study found 77% of multiple sclerosis patients reported symptom improvement from LDN.

  • Many doctors estimate that 50-70% of patients notice some benefits from LDN, while 30% may notice no difference. Individual results vary widely.

  • If LDN hasn't helped within 2-3 months, it may be worth asking your doctor about adjusting the dosage or trying a medication switch.

Is Low Dose Naltrexone Expensive?

  • The monthly cost of LDN is typically between $30-$60 through a compounding pharmacy with insurance coverage. The medication itself is inexpensive.

  • The main costs are the required doctor's visit to get the prescription and compounding fees by the pharmacy. So it is one of the more affordable treatment options available.

  • LDN advocates recommend searching for the most affordable local compounding pharmacies that can provide reliable LDN prescriptions. Compared to other treatments, LDN is typically very affordable.

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Most Important Things To Remember About Low Dose Naltrexone

  • LDN is a low dose of the drug naltrexone

  • It is used off-label to treat chronic pain and autoimmune diseases

  • LDN works by briefly blocking then increasing opioid receptors

  • This boosts endorphins and reduces inflammation

  • LDN has helped people with fibromyalgia, Crohn’s, and multiple sclerosis

  • Side effects are typically mild like headaches or sleep problems

  • LDN must be prescribed by a doctor and made at compounding pharmacies

  • It’s taken daily at bedtime in doses from 1.5 mg to 4.5 mg

  • Effects take 2-3 months to notice so be patient

  • About 50-70% of people see some benefits from LDN

  • Talk to your doctor to see if LDN is right for you

Frequently Asked Questions About Low Dose Naltrexone

How does LDN work for weight loss?

Some research suggests LDN may help regulate metabolism, appetite signaling, and food cravings in a way that supports weight loss. It may also reduce inflammation which can interfere with weight loss.

Can LDN be used to treat ulcerative colitis?

A few preliminary studies have found LDN reduced inflammation and symptoms in ulcerative colitis patients. More research is still needed.

Is LDN safe while breastfeeding?

Small amounts of naltrexone can pass into breastmilk. Most doctors recommend discontinuing LDN while breastfeeding due to lack of safety research.

Can LDN treat chronic fatigue syndrome (ME/CFS)?

A few doctors have reported LDN helps reduce fatigue in some Myalgic encephalomyelitis/Chronic Fatigue Syndrome patients. But no formal studies have been conducted yet.

Does LDN treat Lyme disease?

Anecdotally some Lyme patients report improvement on LDN. It has not been formally studied for Lyme.

Can LDN regrow hair?

Very limited evidence from one study in mice suggests LDN may help reverse balding. But no human studies have examined LDN for hair regrowth.

Does LDN help eczema or psoriasis?

LDN’s effects on the immune system may help reduce inflammation involved in eczema and psoriasis. But there are no studies yet examining this.

Can men with erectile dysfunction use LDN?

Yes, LDN has not been shown to cause sexual side effects. By reducing inflammation, it may potentially improve erectile function.

About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.

This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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