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What is Low-Dose Naltrexone (LDN) and Can It Help Me?

Ten years ago April marks the anniversary of the first time I wrote about low-dose naltrexone (LDN). I described it as an orphan drug, meaning that its patent had long ago expired, that it was generic, and that it was not owned by any one company. For these reasons and because they’d never recoup their investment, no Big Pharma company was interested in pursuing the costly clinical trials that might have proven LDN’s usefulness.

Full-strength naltrexone (in a 50-mg capsule) was approved by the FDA for patients addicted to opioid medications, and with the opioid crisis still with us, it is for this that full-strength naltrexone is prescribed.

But an interesting phenomenon was observed among some patients taking full-strength naltrexone for opioid addiction. Those who also had Crohn’s disease or multiple sclerosis reported an improvement in symptoms. Many, in fact, were able to reduce their doses of conventional medications to treat those conditions, and some went off their meds completely.

(A similar phenomenon occurred among patients taking beta blockers for cardiac arrhythmias who noticed their migraines were occurring less frequently. Three years and many clinical trials later, beta blockers got FDA approval for migraine prevention. Since the beta blockers were still protected by patents, the clinical trials were paid for by Big Pharma.)

There was one interesting sidelight: when the naltrexone was given in lower doses (as low as 1/10th or even 1/20th of the usual dose), it actually worked better for the Crohn’s and MS. Hence, low-dose naltrexone, which you’ll see everywhere as LDN.

LDN use dramatically increases
In the decade after I wrote that original article, the list of conditions that reportedly could be helped by LDN has exploded. LDN isn’t available at your local Walgreens or CVS, where the pharmacist is basically a pill counter, bottling up medications manufactured in India, Turkey, and even occasionally the US.

For LDN you need to seek out a compounding pharmacist. Here the pharmacist is making up the capsules individually for your needs precisely as prescribed by your physician.

It’s not necessarily easy to find a physician-prescriber for LDN. Many doctors, especially those employed in the mega-groups like Northwestern or Advocate, have agreed to limit prescribing to FDA-approved drugs. Just to be clear: LDN is not FDA-approved for anything and will not work for opioid addiction. A person struggling with opioid addiction will always be prescribed full-strength (50 mg) naltrexone.

Ten years ago, at the time of my original article, I asked gastroenterologists and neurologists if they’d heard about LDN. Yes, their patients mentioned it. Did they prescribe it? No.

A decade later, reflecting on the significant increase in the number of conditions helped by LDN, we can add allergists, dermatologists, rheumatologists, psychiatrists, pain management specialists, endocrinologists, cancer specialists, kidney specialists, pulmonologists (lung), and infectious disease specialists.

This link opens to the non-profit LDN Research Trust and lists the conditions for which LDN has been prescribed.

Is LDN 100% effective for this startling catalog of human (and pet) ailments? Of course not. If this were the case, health care would grind to a halt and everyone would be taking LDN for everything.

The list is meant to show that trying two to three months of LDN might be an important addition to your current chronic condition treatment regimen.

How does LDN actually work?
Standard-dose naltrexone, the 50-mg size, blocks the landing sites called opioid receptors in the brain and nervous system. The most widely prescribed opioids include medications like Vicodin, Norco, Oxycontin, and morphine. Full-strength naltrexone acts as an antagonist, stopping the effects of opioids.

Low-dose naltrexone, on the other hand, is incapable of blocking opioids. However, it is well recognized as an excellent choice for chronic pain management. LDN is totally non-addicting and has minimal side effects (vivid dreams are among the most commonly mentioned).

How LDN works for chronic pain gives physicians some idea of how it works for other conditions.

First, understand that you’re actually taking a mixture of two forms of LDN in every capsule, a levo form, where the molecule is twisted to the left, and a dextro form, twisted to the right. These are called isomers.

The levo form acts to block the opioid receptors. In the process, it also raises the brain’s level of neurotransmitters, especially dopamine, one of the so-called happy molecules, which explains its recent increase by psychiatrists for treating resistant depression. Raising endorphins also reduces inflammation and in turn reduces pain and improves the overall sense of well-being.

The dextro form of LDN is more useful for autoimmune conditions, because of its effect on cytokine-modulated immune cells. “Cytokine” is a very general term for a type of protein released by white cells that either lessens or increases inflammation. A balance of both pro- and anti-inflammatory cytokines is ideal. An excess of inflammatory cytokines spells trouble. Here’s one study showing how LDN reduced the cytokine inflammation (and pain) of fibromyalgia. And here is another study that was started last year when it was recognized that Covid-19’s attack on the body was one massive cytokine storm.

Chronic conditions and LDN
If you have just about any chronic condition, it’s worth learning if LDN can be a useful adjunct to your treatment. A quick way to do this is to type the name of your condition (or symptom if you don’t have an official diagnosis) into your search bar along with either “low-dose naltrexone” or “LDN.” Just now I did this with psoriasis and came up with several quality research articles, among them this one. Get the drift?

You can ask your primary care doc or specialist for an LDN prescription, but don’t count on an enthusiastic response. Expect instead a lecture about “off-label drugs” and “unproven drugs,” ending with “just take what I tell you to take.”

If you’d like to pursue a course of LDN, schedule a WholeHealth Chicago appointment, either in person or via telemed, with practitioners Caley Scott, Wendy Ploegstra, Parisa Samsami, Rachel Gates, Katie McManigal, or me.

All of us at WholeHealth Chicago are familiar with the benefits of LDN and can connect you with one of our MDs or nurse practitioners who can send your prescription to a compounding pharmacy. Compounders are preparing thousands of prescriptions for LDN around the US and worldwide, so if you have a favorite, we’ll be happy to send it there.

Be well,
David Edelberg, MD

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DIAGNOSE-IT-YOURSELF: COVID-19

Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.

ALLERGIES

• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

COLD
• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

STREP THROAT
• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

CORONAVIRUS-COVID 19
• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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