Low Dose Naltrexone (LDN)

FOR THE TREATMENT OF AUTOIMMUNE DISEASE AND FIBROMYALGIA (not covered by OHIP)

Naltrexone is commercially available to treat addiction to opioid drugs, such as morphine, or for the treatment of alcohol use disorder.  It is typically used in a dose of 50-100 mg orally daily for these indications.

Low dose naltrexone (used at doses of 4.5 mg or less) has been used since the mid 1980s in the USA, originally discovered by Dr. Bernard Bihari, MD (1931-2010) who specialized in internal medicine/psychiatry/neurology.  Dr. Bihari’s research pointed to the clinical effectiveness of LDN in normalizing immune system function.

There is research currently underway, to prove the hypothesis that naltrexone improves or modulates the immune system – by acting on a receptor called TLR4. Several published papers have shown that naltrexone binds to the TLR4 receptor, and has a clinically measurable effect. This is evident in Crohn’s disease and ulcerative colitis. REFERENCES: http://www.ncbi.nlm.nih.gov/pubmed/22826216; http://www.ncbi.nlm.nih.gov/pubmed/23188075; http://www.ncbi.nlm.nih.gov/pubmed/17222320

Perhaps the most well-known indication for LDN is fibromyalgia.  This chronic pain disorder can cause significant debilitation in patients and can be resistant to the usual treatments (i.e., pregabalin and duloxetine); LDN has been shown to provide benefit to fibromyalgia patients.  See the following pilot study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ and https://www.medscape.com/viewarticle/759253 .  There is currently a randomized controlled trial underway that is investigating the effect of LDN on fibromyalgia with an estimated completion date of June 2023 (see: https://clinicaltrials.gov/ct2/show/NCT04270877).

Treatment is usually started at an ultra-low dose and increased  gradually over a period of weeks – until you are stable and side effect free. The starting dose can vary from 0.5mg to 1.5mg – and is usually increased over 4 – 8 weeks to 4.5mg.

For more information on LDN see: https://ldnresearchtrust.org/ and https://www.ldnscience.org/ 

If you suffer from fibromyalgia or an autoimmune disease that has been poorly controlled with other treatment modalities, book a consultation today to discuss whether LDN is right for you.