Low dose naltrexone is used to treat a variety of chronic conditions that often do not respond to other treatments. The drug has been getting a lot of attention lately from both prescribers and patients due to its demonstrated efficacy and safety and also its low monthly cost. However there is a lot of misinformation out there about the correct dosing for naltrexone. While the research on low dose naltrexone is ongoing and not yet conclusive, there have been standardized dosages developed that are effective for most patients. The FDA-approved naltrexone dosage is more than 10x the dosage of LDN and has been shown to be safe and effective. Therefore most researchers have hypothesized that the lower doses of 4.5mg and less are also safe. This has proven to be true as few side effects have been reported in studies to-date. There are some unique attributes of LDN dosing that should be understood before a patient starts treatment.
Naltrexone Dosage vs. Low Dose Naltrexone Dosage
The drug naltrexone is FDA-approved for managing opioid addiction. The FDA approved dose of this medication is made in 50mg tablets for this indication. The daily dosage can actually be over 100mg up to as high as 300mg. As the name implies, low dose naltrexone uses a much lower dose of this drug. The most common dosages are 1.5mg, 3mg, and 4.5mg. Patients may be titrated up or down based on how they respond to treatment. Some prescribers will start patients at 0.5mg per day and then titrate up gradually until the patient is taking 4.5mg.
Dosing with LDN is unique in that the goal is not to take the highest dose that can be tolerated. Because of its unique effects, the right dose for one individual may be 1.5mg and for another 4.5mg. This can be true even when both individuals are suffering from the same chronic condition.
The Paradoxical Properties of LDN Dosages
Naltrexone’s effects at low dosages are different than the 50mg dose. Low doses of naltrexone encourage endogenous opioid production and produce anti-inflammatory and analgesic effects. These types of activity do not occur at higher dosages. The effects of low dose naltrexone have sometimes been described as “paradoxical,” because it might be assumed that a low dose would decrease the analgesic effects of endogenous opioids. Instead of decreasing the analgesic effect, however, the drug actually increases their production. Because of its ability to decrease pain and inflammation, LDN has been studied for treating a variety of conditions including fibromyalgia, psoriasis, and Crohn’s disease.
Side Effects and Low Dose Naltrexone Dosage
Although naltrexone has a different mechanism of action at a lower dose, it has still been shown to be just as safe. There have been very few adverse reactions reported in studies of low dose naltrexone. Problems with sleep and headaches sometimes occur, but there have been no documented serious adverse effects. Many prescribers have started using LDN because it is just a lower dose of an FDA-approve drug, and as such it has been vetted through the rigorous new drug application process. This process required research be conducted to confirm that naltrexone was safe and effective for its intended use.
There are many types of drugs that have long lists of common side effects. LDN is a rare as its list of side effects is much shorter. Besides occasional sleep problems and mild headaches, there are few documented side effects associated with this treatment. Because there have been no long-term studies yet, the long-term side effects are not known. However, most researchers conclude that there is not a significant chance of any long-term complications from daily dosing of low dose naltrexone. The one situation where LDN is considered not safe is when it is combined with opioids. Patients taking any opioid-containing drugs should not take low dose naltrexone.
Manufactured vs. Compounded Dosage
The 50mg dose of naltrexone has been shown only to help treat opioid addiction and certain other types of addiction and cravings. It does not help treat chronic pain or inflammation. However the higher dose is the only one that is commercially available. Because of that, a prescription for 1.5mg, 3mg, or 4.5mg of LDN must be custom-made by a compounding pharmacy. While sometimes alternatives are prescribed to these standardized dosages, there is not significant evidence supporting their use for the treatment of chronic inflammatory conditions. Some patients may benefit from a higher dose than 4.5mg, but in most cases patients should start at one of the standard doses and titrate up or down.
A higher 8mg dose of low dose naltrexone is actually a part of the FDA-approved drug Contrave, along with bupropion for helping with weight management. However it is rare for a patient to start at 8mg with LDN. Instead a lower dose is started and, if needed, the patient’s dose may be increased.
When is LDN Taken?
Low dose naltrexone is most often prescribed to be taken once before bedtime (after 9pm). If the patient experiences insomnia the dose may be moved to the morning. There is no known abuse potential for this drug, however patients should understand that taking more than their dose will not help. Using the drug in a way that it was not prescribed will not lead to a faster improvement in symptoms. Any change in dosage should be carefully monitored by the patient’s healthcare provider.
Dissolving, Breaking, Splitting Capsules – What Not to Do
Because there is no commercially available preparation of low dose naltrexone, some patients purchase the 50mg tablets and attempt to break or dissolve them to get a 4.5mg dose. This can lead to variability between doses that could decrease the efficacy of the treatment. When a compounding pharmacy makes LDN capsules, they weigh out the drug carefully so that each dose is consistent. The compounding protocols call for the checking and re-checking of a prescription to ensure the patient gets the right dose of LDN. Because of the numerous other inactive ingredients that are included in manufactured tablets, and the lack of reliability of at-home measuring methods, it is very hard for a patient to get accurate dosing by trying to make it themselves.
How to Get LDN
Patients who are interested in low dose naltrexone should speak to their healthcare provider. As with all prescription drug treatments, careful monitoring by a healthcare provider is essential to getting the best outcome. Our compounding pharmacy provides LDN and custom-makes prescriptions for each individual patient. Our team is made up of experienced pharmacy professionals who have been working with LDN for many years. Contact us today to get your low dose naltrexone prescription filled.
- The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain – PMC Article, Clinical Rheumatology