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The Podell Medical Practice - Providing Personalized Integrative Medical Care

Dr. Podell Explains Low-Dose Naltrexone (LDN)

Low dose naltrexone (LDN) is an alternative medicine treatment used for Fibromyalgia, Chronic Fatigue Syndrome, Lupus, multiple sclerosis, cancer and other health problems. But, unlike most alternative medicine treatments, low dose naltrexone (LDN) is becoming mainstream, especially for treating Fibromyalgia pain and Chronic Fatigue Syndrome.

Naltrexone is an FDA approved medicine. At its usual high dose of 50 mg naltrexone acts to block the effects of narcotics. At these doses Naltrexone tends to increase feelings of pain. But at low doses, 1.5 to 4.5 mg a day, naltrexone acts very differently.

We now have good evidence from two double blind studies and many reports from patients that LDN can decrease Fibromyalgia pain. Studies from Stanford Medical School suggest that about 30% of Fibromyalgia patients improve with LDN. Thirty percent might not sound great, but 30% compares fairly well with other effective Fibromyalgia treatments such as Cymbalta and Lyrica.

Preliminary studies also suggest benefit from low dose naltrexone for treating multiple sclerosis, Crohn’s disease and perhaps also autism. Dr. Bihari, who introduced low dose naltrexone treatment in the 1980s, reported success with a wide variety of illnesses including certain forms of cancer, auto-immune problems such as Lupus and Rheumatoid arthritis, psoriasis, ulcerative colitis, irritable bowel syndrome, parkinson’s disease, Alzheimer’s disease and autism spectrum disorders. Dr. Bihari’s most impressive reports were with using LDN to treat fatigue associated with Human immune deficiency virus (HIV) or AIDs.

We don’t know for sure whether LDN is truly effective for all these conditions. But, low dose naltrexone has an overwhelming virtue. LDN is very safe. Side effects, if they occur, are usually modest and tolerable. It’s not very expensive, and you can usually tell if it’s helping within one or two months.

There are three practical problems. First, only a relatively few doctors have experience prescribing low dose naltrexone. Second, naltrexone is available in drug stores as a 50 mg tablet, but the low doses we want to use are typically in the range of 1.5 to 4.5 mg daily. Fortunately, most compounding pharmacists have experience putting low dose naltrexone into an easy to swallow capsule, or diluting it into a liquid drinkable form. We can recommend several compounding pharmacies who prepare LDN in New Jersey, New York, and Pennsylvania.

Third, patients who take frequent doses of narcotic pain medicines should usually not take naltrexone even at low doses. Persons who use short acting narcotics such as Percocet or codeine no more than once a day, can usually handle LDN if they space LDN and the narcotic far enough apart.

Our main focus prescribing LDN is for persons with Fibromyalgia or Chronic Fatigue Syndrome. We are happy to prescribe LDN for persons with autoimmune problems such as Lupus, rheumatoid arthritis, Crohn’s disease or psoriasis, but only if their arthritis or GI specialist do not object. Similarly, for persons with neurological conditions such as multiple sclerosis, infectious diseases such as HIV or AIDs, we can prescribe LDN with the approval of your treating doctor. We have not used LDN for treating cancer. We are willing to do so, in principle, but, before seeing a cancer patient, we would require your oncologist to call us to discuss this treatment option.

Side effects from low dose naltrexone

Low dose naltrexone is to be taken in the evening. However, a substantial proportion of persons who take LDN find that it increases the intensity of their dreams to an unwanted degree. Usually, but not always, this goes away with time. Other side effects tend to be much less frequent with low dose naltrexone than with the standard higher doses. Please consult the drug package insert for Naltrexone for a review of potential side effects.