Email : admin@mskdoc.co.nz | Phone : 02727 00100
Opening Hours : Mon-Friday : 10 AM – 4 PM
Email : admin@mskdoc.co.nz | Phone : 02727 00100 | Opening Hours : Mon-Friday : 10 AM – 4 PM
Email : admin@mskdoc.co.nz | Phone : 02727 00100
Opening Hours : Mon-Friday : 10 AM – 4 PM
Email : admin@mskdoc.co.nz | Phone : 02727 00100 | Opening Hours : Mon-Friday : 10 AM – 4 PM
By: Dr Zaid Matti
Musculoskeletal Medicine Specialist
What is low dose naltrexone?
– Low dose naltrexone is a medication that might help you with chronic pain. You can take low dose naltrexone by mouth as a tablet or drops.
– In the past naltrexone has only been used at very high doses. At high doses naltrexone reduces cravings for drugs or alcohol for people with addiction problems. To help people with drug or alcohol problems naltrexone is given at doses between 25mg and 50mg each day.
– Using naltrexone at a low dose for people with chronic pain is new.
– A low dose of naltrexone is between 0.5 and 4.5mg each day. This dose is about one tenth the dose used for people with drug or alcohol problems. When used at a low dose naltrexone has nothing to do with drug or alcohol addiction.
How does low dose naltrexone work?
– Low-dose naltrexone works in a different way in the body to high dose naltrexone.
– At a low dose naltrexone changes how your body deals with pain.
– There are lots of ways that your body helps you to deal with pain. Low dose naltrexone works by helping your body to be better at dealing with pain.
– One way that low dose naltrexone might work is to help your body to make more natural pain killers which are called endogenous opioids. Making more natural pain killers might help you to feel less pain.
– Another way that low dose naltrexone might work is to help your body to create less inflammation.3-6. Having less inflammation in your body might also help you to feel less pain.
What are the benefits of taking low dose naltrexone?
– If you have chronic pain taking low dose naltrexone may help you to:
– If you have tried many other treatments for chronic pain you may feel better using low dose naltrexone.
Who can take low dose naltrexone?
– Anyone with chronic pain from any type of health problem might be able to try low dose naltrexone.
– People with all kinds of chronic health problems have said they feel better taking low dose naltrexone.
– Children as young as eight years old have used low dose naltrexone for chronic pain.
– Talk with your doctor about whether low dose naltrexone might be helpful for you.
What does research show?
– Information about the benefits of low dose naltrexone comes from good research on chronic pain for people with fibromyalgia, Crohn’s disease and multiple sclerosis.(8-13)
– Case studies that look at a small number of people have also shown benefits for people with chronic pain from other chronic diseases: complex regional pain syndrome, low back pain an diabetic neuropathy.(14-17)
– Research has found that low dose naltrexone is safe to use. (8, 18, 19)
– Scientists think that more research needs to be done to study how low dose naltrexone helps with chronic pain. (6,20) Doing more research will help people to be confident in what the benefits of low dose naltrexone are.
– Until more research is done low dose naltrexone can be thought of as a safe emerging medication.
Are there any side effects?
– Most people have no side effects from using low dose naltrexone. (8 ,18)
– Some people have unpleasant dreams or have problems with sleeping. (6) These problems usually go away if they take an even lower dose
of naltrexone or if they take their usual dose in the morning instead of the evening.
– Some people with multiple sclerosis might feel more tired or have more muscle spasms when they first start taking low dose naltrexone.(21) Usually they feel better by continuing to take it for a few days or weeks or by taking an even lower dose until they feel better.
– If the dose of low dose naltrexone needs to be lowered because of side effects it can be increased slowly once you feel better.
Can I take low dose naltrexone if I’m using other medications?
– Talk with your doctor about whether you can continue with your usual medications while taking low dose naltrexone.
– It is best not to take low dose naltrexone if you are taking any opioid medications.6
– If you are taking a special medication called a disease-modifying or immunomodulator medication these are likely safe to continue to take with low
dose naltrexone.(22)
Where can I get low dose naltrexone?
– Low dose naltrexone is available in New Zealand with a doctor’s prescription. All doctors can prescribe low dose naltrexone.
– Your doctor will fax the prescription to a special compounding pharmacy. The compounding pharmacy will make the low dose naltrexone and post it to you.
– Low dose naltrexone comes as a liquid or as tablets. It costs about $40 per month.
– Because low dose naltrexone is a new medication, it is best to seek advice from a doctor with experience in treating chronic pain and experience in prescribing low dose naltrexone.
– High dose tablets of naltrexone (25mg or 50mg tablets) must not be watered down to get a low dose of naltrexone. It is not safe to water down high dose tablets because it is not possible to get the correct low dose each day.Where can I get more information?
– The LDN Research Trust has lots of information on low dose naltrexone. Visit their website for more information: https://www.ldnresearchtrust.org/
References
1. Zagon I, Verderame M, McLaughlin P. The biology of the opioid growth factor receptor (OGFr). Brain Research Reviews 2002;38(3):351-76.
2. Brown N, Panksepp J. Low-dose naltrexone for disease prevention and quality of life. Medical Hypotheses 2009;72(3):333-37.
3. Cant R, Dalgleish AG, Allen RL. Naltrexone inhibits IL-6 and TNFα production in human immune cell subsets following stimulation with ligands for intracellular toll-like receptors. Frontiers in Immunology 2017;8:809.
4. Wang X, Zhang Y, Peng Y, et al. Pharmacological characterization of the opioid inactive isomers (+)‐naltrexone and (+)‐naloxone as antagonists of toll‐like receptor 4. British Journal of Pharmacology 2016;173(5):856-69.
5. Parkitny L, Younger J. Reduced pro-inflammatory cytokines after eight weeks of low-dose naltrexone for fibromyalgia. Biomedicines 2017;5(2):16.
6. Younger J, Parkitny L, McLain D. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clinical Rheumatology 2014;33(4):451-59.
7. LDN Research Trust. Conditions that are helped by low dose naltrexone (LDN): LDN Research Trust,; 2019 [Available from: https://www.ldnresearchtrust.org/conditions accessed 10/11/2019.
8. Smith JP, Bingaman SI, Ruggiero F, et al. Therapy with the opioid antagonist naltrexone promotes mucosal healing in active Crohn’s disease: a randomized placebo-controlled trial. Digestive Diseases and Sciences 2011;56(7):2088-97.
9. Parkitny L, Moosavi R, Younger J. (405) A potential anti-inflammatory effect of low-dose naltrexone in fibromyalgia. The Journal of Pain 2015;16(4):S77.
10. Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Medicine 2009;10(4):663-72.
11. Parker CE, Nguyen TM, Segal D, et al. Low dose naltrexone for induction of remission in Crohn’s disease. Cochrane Database of Systematic Reviews 2014(2)
12. Younger J, Noor N, McCue R, et al. Low‐dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double‐blind, placebo‐controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis & Rheumatism 2013;65(2):529-38.
13. Metyas S, Chen CL, Yeter K, et al. Low dose naltrexone in the treatment of fibromyalgia. Current Rheumatology Reviews 2018;14(2):177-80.
14. Chopra P, Cooper MS. Treatment of complex regional pain syndrome (CRPS) using low dose naltrexone (Low Dose Naltrexone). Journal of Neuroimmune Pharmacology 2013;8(3):470-76.
15. Sturn K, Collin M. Low-Dose Naltrexone: A New Therapy Option for Complex Regional Pain Syndrome Type I Patients. International Journal of Pharmaceutical Compounding 2016;20(3):197-201.
16. Hota D, Srinivasan A, Dutta P, et al. Off-label, low-dose naltrexone for refractory painful diabetic neuropathy. Pain Medicine 2015;17(4):790-91.
17. Ghai B, Bansal D, Hota D, et al. Off-label, low-dose naltrexone for refractory chronic low back pain. Pain Medicine 2014;15(5):883-84.
18. Sharafaddinzadeh N, Moghtaderi A, Kashipazha D, et al. The effect of low-dose naltrexone on quality of life of patients with multiple sclerosis: a randomized placebo-controlled trial. Multiple Sclerosis Journal
2010;16(8):964-69.
19. Bolton M, Hodkinson A, Boda S, et al. Serious adverse events reported in placebo randomised controlled trials of oral naltrexone: a systematic review and meta-analysis. BioMed Central Medicine 2019;17(1):10.
20. Patten DK, Schultz BG, Berlau DJ. The safety and efficacy of low‐dose naltrexone in the management of chronic pain and inflammation in multiple sclerosis, fibromyalgia, crohn’s disease, and other chronic pain disorders. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 2018;38(3):382-89.
21. LDN Research Trust. How low dose naltrexone works: LDN Research Trust,; 2019 [Available from: https://www.ldnresearchtrust.org/how-naltrexone-works accessed 09/11/2019.
22. Turel AP, Oh KH, Zagon IS, et al. Low dose naltrexone for treatment of multiple sclerosis: a retrospective chart review of safety and tolerability. Journal of Clinical Psychopharmacology 2015;35(5):609-11.