Low Dose Naltrexone?

Hello,
I wondered what your stance was on the use of the drug Low Dose Naltrexone for the management of FMS and CFS and other maladies? Do you think it is just a placebo pill? Or do you think it actually has the potential of helping reverse the pain and fatigue in these disorders? I have FMS, OA, DDD, Degenerative Facet Disease Sciatica, and some nerve dysfunction at the base of my spine. I also have a numb left foot, which I believe is due to this.

I am wondering if LDN is just a hype right now in your opinion? Or is there scientific bases for doctor to start prescribing this for their patients? I am meeting many people who are swearing by this stuff already and most doctors have no idea what it is.

[Garth L Nicolson, PhD]

I really don't have a position on this drug. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence.  In low doses, it can apparently boost the immune system (there is a website, http://www.lowdosenaltrexone.org, that describes the benefits of low dose Naltrexone [LDN]).  It is also thought to act by restoration of the body's normal production of endorphins, and this is thought to be the major therapeutic action of LDN.  Although Naltrexone is an FDA approved drug, LDN has not yet been approved by the FDA.

Some patients apparently benefit from LDN, and there is a list of testimonials.  There are, however, some cautionary declarations about LDN:

1. Because LDN blocks opioid receptors throughout the body for three or four hours, people using medicine that is an opioid agonist, i.e. narcotic medication — such as Ultram (tramadol), morphine, Percocet, Duragesic patch or codeine-containing medication — should not take LDN until such medicine is completely out of one's system. Patients who have become dependant on daily use of narcotic-containing pain medication may require 10 days to 2 weeks of slowly weaning off of such drugs entirely (while first substituting full doses of non-narcotic pain medications) before being able to begin LDN safely.

2. Those patients who are taking thyroid hormone replacement for a diagnosis of Hashimoto’s thyroiditis with hypothyroidism ought to begin LDN at the lowest range (1.5mg for an adult). Be aware that LDN may lead to a prompt decrease in the autoimmune disorder, which then may require a rapid reduction in the dose of thyroid hormone replacement in order to avoid symptoms of hyperthyroidism.

3. Full-dose naltrexone (50mg) carries a cautionary warning against its use in those with liver disease. This warning was placed because of adverse liver effects that were found in experiments involving 300mg daily. The 50mg dose does not apparently produce impairment of liver function nor, of course, do the much smaller 3mg and 4.5mg doses.

4. People who have received organ transplants and who therefore are taking immunosuppressive medication on a permanent basis are cautioned against the use of LDN because it may act to counter the effect of those medications.

Whenever considering a new approach that is not generally used, patients and their physicians need to exercise caution.  What works for some patients may not work for you.

[dustybrown]

This is pretty much the information that is already available. I was hoping to hear some different thoughts. Hmmm...Well thank you for responding. I respect your comments and appreciate your time.
-Dusty

[Garth L Nicolson, PhD]

This is really not my area of expertise, so my response has to be conservative.  Sorry I could not help you more, but a specialist in this area could give you different insights.

[dustybrown]

Thank you again. A friend of mine actually put me up to asking you this question and after I did, she told me I goofed the question a bit. She said she once met you somewhere quite sometime ago at a convention or something I am not sure. Her question actually was "since many with CFS are getting such good results from LDN do you think that it may help overcome mycoplasma infections?"

[katarina777]

ARE YOU SERIOUSLY EXPECTING DR. NICOLSON TO RESPOND TO YOU AGAIN? JUST WONDERING! KAT