Low Dose Naltrexone: An Overview

What is Low Dose Naltrexone?

Low Dose Naltrexone (LDN) is a prescription drug that helps to regulate a dysfunctional immune system. It reduces pain and fights inflammation. It is not a narcotic or a controlled substance. It is an opioid receptor antagonist that is taken orally to block opioid receptors. An antagonist is a chemical that acts within the body to reduce the physiological activity of another chemical substance.


Naltrexone was approved by the FDA in 1984 for the treatment of opioid

addiction, usually at a dose of 50-100mg a day. It blocks the receptors that opioids like oxycodone bind to negating the euphoric effect. However, at much lower doses, naltrexone has been used for autoimmune disorders like

Hashimoto’s disease as well as chronic pain.

Image Credit:https://pubchem.ncbi.nlm.nih.gov/compound/Naltrexone

How does LDN work?

Before we discuss how LDN works, we need to go over the role of endorphins in the body. Endorphins are opiate-like molecules in the body. They are produced in most cells in the body and are important regulators of cell growth and the immune system. Disorders of the immune system, like autoimmune disorders, can occur with unusually low levels of endorphins. The particular endorphin that has been found to influence cell growth is called Opioid Growth Factor (OGF). For an endorphin such as OGF to exert its beneficial effects, it must interact with the body’s cells. It does this by binding to a receptor on the surface of the cells.


Naltrexone is an orally administered drug that binds to opioid receptors. In doing so, it displaces the endorphins which were previously bound to the receptors. Specifically, by binding to the OGF receptors, it displaces the body’s naturally produced OGF. As a consequence of this displacement, the affected cells become

deficient in OGF and three things happen:

1) Receptor production is increased, in order to try to capture more OGF.

2) Receptor sensitivity is increased, also to try to capture more OGF.

3) Production of OGF is increased, in order to compensate for the perceived shortage of OGF.

Since LDN blocks the OGF receptors only for a few hours before it is naturally excreted, what results is a rebound effect; in which both the production and utilization of OGF is greatly increased. Once the LDN has been metabolized, the elevated endorphins produced as a result of the rebound effect can now interact with the more-sensitive and more-plentiful receptors and assist in regulating cell growth and immunity. The elevated level of endorphins can result in an enhanced feeling of well-being as well as a reduction in pain and inflammation. The duration of the rebound effect varies from person to person but generally lasts about one day. This effect can only be utilized by taking a low dose of naltrexone and not a high dose or extended-release naltrexone.

What is LDN commonly used to treat?

LDN is commonly used to treat autoimmune disorders, central nervous

system disorders, and chronic pain. Research is currently being conducted on other conditions as a potential treatment option. Some of the conditions that it is currently being used for include:

• Hashimoto’s disease

• Psoriasis

• Complex Regional Pain Syndrome (RSD)

• Crohn’s Disease

• Rheumatoid Arthritis

• Multiple Sclerosis

• Ulcerative Colitis

Image Credit: https://www.garvan.org.au/research/collaborative-programs/hope/autoimmune-disease

What are the side effects or drug interactions of LDN?

Most side effects seen with naltrexone occur in higher doses and not in the lower doses. Generally, LDN is well tolerated with minimal side effects. LDN can cause sleep disturbances when taken at night. This is most likely the result of an increase in endorphin release. These disturbances are usually experienced as vivid dreams or insomnia and dissipate after approximately one week.

Patients cannot take any opioids while taking LDN as LDN blocks the receptors necessary for opioids to work. If you are considering switching from opioids to LDN to treat your pain, then you must speak with your doctor first. Your doctor will most likely taper your off of opioids before starting LDN.

For patients on LDN: If you have an injury or accident that requires short-term opioid pain relievers, then you need to tell the treating practitioner that you are taking low dose naltrexone.

How do I take LDN?

As the name suggests, low dose naltrexone is commonly given at very low doses that can range from 0.5 mg-10 mg. However, in clinical experience, the most common dose is 4.5 mg. LDN is unavailable commercially meaning that it cannot be found in your usual pharmacy. It can be compounded at any strength that your doctor prefers. Some doctors prefer to begin at a lower dose, such as 1.5 mg, and slowly increase the dose.


It can be compounded into capsules or in a liquid.

Does LDN affect surgical procedures?

If you are planning on having surgery or a medical procedure like a colonoscopy, the doctor needs to be notified prior to surgery. Because of the type of medications typically used during surgeries, LDN will need to be stopped prior to the procedure. Your doctor will determine how far in advance to stop taking LDN.

Sources:

https://www.merriam-webster.com/dictionary/antagonist

https://ldnresearchtrust.org/what-is-low-dose-naltrexone-ldn

https://ldnresearchtrust.org/how-naltrexone-works

https://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Low-Dose-Naltrexone

https://ldnresearchtrust.org/conditions

https://www.ldnscience.org/ldn/how-does-ldn-work

https://www.ldnscience.org/patients/qa/taking-ldn-and-other-substances-treatments