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

Fifteen years ago or so was the first time I wrote about the endlessly fascinating multi-purpose inexpensive Low Dose Naltrexone (LDN). Among the majority of conventional physicians, the “needle” has moved slightly from “never heard of it” to “I’ve heard of it but don’t prescribe it.” I guess you could call it a ‘guarded improvement.’ Still, since tens of thousands of LDN Rxs are written each month, somebody must be prescribing it. Can’t just be we at WholeHealth Chicago.

 I described LDN as an “orphan drug,” meaning that the patent had long expired on the original molecule and it had been generic for years, not owned by any one company. For this reason and unable to recoup their investment, no Big Pharma company was interested in pursuing costly clinical trials that might have proven LDN’s usefulness.

Naltrexone itself (in a 50 mg capsule, and not 4.5 mg. “low dose”) had been FDA approved for patients addicted to opioid medications. It worked by blocking opioid receptors in the brain. With the opioid crisis still here, it is for this that naltrexone is prescribed.

But an interesting phenomenon was observed among some patients taking naltrexone. Those with two chronic conditions, Crohn’s Disease and Multiple Sclerosis reported improvement of symptoms. Many, in fact, by taking naltrexone were able to reduce their doses of conventional medications, and some could go off their meds completely.

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. Hence: Low Dose Naltrexone which you’ll see everywhere as LDN.

During the years after I wrote the original Health Tip, the list of conditions that might be helped by LDN has, to put it bluntly, exploded. Although this might change eventually, LDN is not available at your local Walgreen’s or CVS, nor is it covered by your insurance. You must seek out a compounding pharmacist (there are hundreds throughout the U.S.). Here the pharmacist is making the capsules individually for your needs as prescribed by your physician. The price varies, usually about $50-60 a month.

Harder than finding a pharmacy is finding a physician-prescriber for LDN. Many physicians, especially those employed in the mega-groups like Northwestern or Advocate, have agreed to limit prescribing only to those meds with FDA approval. So, for example, when treating an autoimmune condition like rheumatoid arthritis or ankylosing spondylitis, you’ll receive a ‘biologic’ like Humira, whose side effect might be a major infection like TB, pneumonia or even death. Whereas, the commonest side effect of LDN (really) is “vivid dreams”.

Also at the time of my original article, I asked gastroenterologists and neurologists if they’d heard about LDN for Crohn’s, ulcerative colitis, multiple sclerosis, fibromyalgia and other chronic conditions. Yes, their patients mentioned it. Did they prescribe it? No.

Now, years later, reflecting the vast increase in the number of conditions helped 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 a non-profit LDN Research Trust and lists all 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. 

However, this list is meant to show that at least trying 2-3 months of LDN might be an important addition to your current treatment regimen.

Okay. How does LDN actually work?

As I said earlier, the regularly dosed naltrexone, the 50 mg. size, simply blocks those landing sites in the brain and nervous system called ‘opioid receptors.’ The most widely prescribed opioids include medications like Vicodin, Norco, Oxycontin, and morphine. Naltrexone acts as an ‘antagonist,’ stopping opioid effects. Low dose naltrexone is incapable of blocking opioids and, in fact, is well recognized to be an excellent choice for chronic pain management by the mechanism which I describe later. It is totally non addicting (not being an opioid) and has minimal side effects (those ‘vivid dreams’ have been mentioned by a third of patients).

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

First, you need to understand that you’re really 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 two forms are called ‘isomers’ of the molecule. 

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 it’s recent increase among psychiatrists for treatment resistant depression. Raising endorphins also reduces inflammation and in turn reduces pain and improves overall sense of well being

The ‘dextro’ form of LDN is more useful for autoimmune diseases, antagonizing cytokine modulated immune cells. ‘Cytokines” 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 best. An excess of inflammatory cytokines spells trouble. Here’s one study showing how LDN reduced the cytokine inflammation (and the pain) of fibromyalgia. Here’s another study that was started last year when it was realized the COVID’s attack on the body was one massive cytokine storm. And (trying desperately not to bore you with this), inflammatory cytokines also damage mitochondria, the energy center within each and every cell. The results of mitochondrial damage are “fatigue,” “muscle pain,” and “brain fog.” 

So that not by coincidence, the symptoms of fibromyalgia and the symptoms of long COVID are pretty much the same with this important difference: long COVID does clear up after about 3-4 months and fibro can last for years.

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 alone if you don’t have an ‘official’ diagnosis) into your Google bar along with either ‘low dose naltrexone’ or LDN. Just now I did this with ‘psoriasis’ and came up with several quality research articles. Get the drift?

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

However, if you want to pursue a course of LDN, schedule a WholeHealth Chicago appointment, either in-person or telemed, with any of fifteen practitioners. All of us are familiar with the benefits of LDN. Virtually all compounders are preparing thousands of prescriptions LDN around the U.S. (and worldwide) so if you have a favorite pharmacist, we’ll be happy to send it there.

Be well,
David Edelberg, MD