I have been aware of Low Dose Naltrexone (LDN) for some time, and I have prescribed it to a handful of patients in past years. I knew that it has been said to improve mood, help with weight loss and decrease chronic pain. But I had never considered prescribing it to my patients with autoimmune disorders until about a year ago. For the past year, I have been using this medication routinely in my patients that have autoimmune and other inflammatory disorders including but not limited to: multiple sclerosis (MS), myasthenia graves, Hashimoto’s disease, Grave’s disease, rheumatoid arthritis (RA), psoriasis, fibromyalgia, ulcerative colitis (UC) and migraine headaches. LDN is a conventional pharmaceutical, is readily available, safe, inexpensive and has wide applicability and efficacy.
Naltrexone is an opiate antagonist. Originally Naltrexone 50 mg was prescribed to treat opioid addiction and alcoholism by blocking opioid receptors. This opioid receptor blockade made opioid addicts and alcohol users unable to get high. Unfortunately, patients did not like how Naltrexone made them feel and refused to take it. LDN is completely different in concept and mechanism than its counterpart Naltrexone. LDN is prescribed at doses between 0.5-4.5 mg which, at that low dose, briefly blocks the opioid receptors for a few hours. Subsequently a rebound effect occurs, with increased production of endorphins, resulting in an enhanced feeling of well being, as well as a reduction in pain and inflammation. Endorphins are naturally occurring substances that create a feeling of well being. They also play an important role in modulating the immune response, and in reducing pain and inflammation.
There are very few side effects of LDN. The most common side effect I have seen is vivid dreams. When I say common — three out of my fifty plus patients using it have reported such dreams. These dreams typically resolve after a few days, but recurs when the dose is increased. Other side effects that have been reported include headaches, GI symptoms and insomnia. But side effects are typically mild and transient, if in fact, any are experienced at all.
Low Dose Naltrexone is contraindicated in patients who are taking pain medications and immune suppressive therapies. It must be obtained from a compounding pharmacy and generally costs less than one dollar a day.
A lot of patients who come to see me have symptoms caused by a leaky gut, a leaky brain and inflammation. The risk of a trial of LDN is low and the potential benefit high. Over the past 9-12 months, I have prescribed it to a number of patients. My patient’s results have been promising. One woman with a severe case of prurigo nodularis (a skin disease of unknown etiology that causes hard, itchy nodules to form on the skin) began to have fewer lesions and less intense symptoms a short time after starting LDN. Also, another patient with myasthenia gravis (a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs) began to have noticeably improved symptoms a short time after starting the LDN. Other patients I treat have seen improvements in fibromyalgia, psoriasis, and chronic pain. Several of my autoimmune thyroid patients have been able to decrease doses of medication or obtained better control when previously we had struggled to control their condition. Another patient with terrible premenstrual syndrome with severe cycle-related depression and irritability has not experienced these mood symptoms during her last two cycles since she started using LDN. Accounts of the astounding results go on and on among my patients who have started using it.
Not surprisingly, the efficacy of LDN seems to be increased by eating an autoimmune-type diet. It is particularly important to avoid gluten and casein, as they interact with the opioid receptors. Consequently, these food-types tend to cause mosts inflammatory or autoimmune conditions to flare.