Low-Dose Naltrexone

Used with permission from the book From Fatigued to Fantastic by Jacob Teitelbaum MD (Avery/Penguin 2021)

[You may want to look at this study review and print out either the first page or even whole study to take to your physician along with the information on this page.]

This remarkable compounded medication can be very helpful for anybody with fibromyalgia, autoimmune illness, or chronic pain.

Put simply, virtually anybody with severe chronic pain should be put on low-dose naltrexone (LDN) if they are not already taking narcotics. Interestingly, narcotics block the effect of the LDN, whereas high-dose naltrexone blocks the effect of narcotics.

There is a very large body of both research and clinical experience showing this low-cost medication to be profoundly beneficial for chronic pain and autoimmune illness. Two studies have shown this for fibromyalgia alone.

The problem? The medication is off patent and relatively inexpensive, so it is nearly impossible to put through our regulatory process, regardless of the available research. But your physician can prescribe it through any compounding pharmacy. I like to use Skip’s Pharmacy. Skip is very knowledgeable about LDN.

If this was a patentable medication (and God knows they are trying to patent it, despite it being generic), it would have sailed through the FDA process, the treatment would cost a good $25,000 per person per year (instead of the current $250 a year), and every physician would be convinced by the pharmaceutical industry’s PR department that everyone should be on it.

Bottom line? Your physician has likely never heard about it except for its blocking the effect of narcotics. But you might be able to talk them into writing you a prescription for 50-milligram pills (see below) so that you don’t ask for narcotics.

A few key things to know about this treatment:

1. It won’t work if you are taking narcotics.
2. Work your way up slowly to 3 milligrams a night Doses over 4.5 milligrams at nighttime usually lose effectiveness (although we do see exceptions). A recent study of veterans with chronic pain found the 3-millgram dose to be more effective than 4.5 millgrams. The standard dose used by most physicians (to block the effect of narcotics in drug addicts) is 200 milligrams a day, and they come in 50-milligram pills from the standard pharmacy. I consider the 3 mg at bedtime dose to be optimal. By getting it in the liquid form (or making your own as discussed below), you can start at very tiny doses and work up as is comfortable. I start with ½ mg a night and increase by a half mg every 1-4 weeks as is comfortably tolerated. If side effects are problematic, lower the dose and raise it more slowly. Optimal dose varies considerably from person to person. So it is OK to stay on what feels best to you.
3. Some people find that it disrupts sleep in the beginning of treatment and may even trigger vivid dreams. This side effect does go away with time for most. Because of this concern, many compounding pharmacies offer a “starting pack” of low-dose naltrexone, which starts you at an even lower dose and slowly moves your dose up to avoid this problem. Overall, that’s a good idea. Better yet? I like to have the compounding pharmacy make a liquid LDN. Then one can start with even a hundredth of a milligram. I recommend those I treat see what is comfortable, even just carrying the bottle in their pocket for a week first so the psyche/body can get used to it. Then, when the “Uh oh, what’s this gonna do?” feeling has passed, even sensitive people can often start with a really tiny dose and work up slowly as is comfortable. If one can’t take the full dose, that’s OK. In many who are sensitive, even 1 mg or less often works. Again, you need to give it 2 months on the full “comfortable “ dose. Why…
4. It takes two full months to start working. When I first started using the treatment about twenty-five years ago, I only gave it three to four weeks to work, so I didn’t see the effectiveness and abandoned it prematurely. Give it time.
5. After two months on the full dose, or whatever dose feels best to each individual, I give people the option of getting naltrexone 50-milligram tablets from their regular pharmacy so it will be covered by insurance. I have them grind the tablet up very finely with a mortar and pestle, then mix it with about 3 ounces of water (83 milliliters, if you want to be exact) and shake it well. Taking 1 teaspoon (5 milliliters) a night will supply the 3-milligram dose. For the 4.5-milligram dose, mix the ground 50-milligram tablet in with 55 milliliters (just under 2 ounces) of water and take 1 teaspoon a night. This will give eleven doses. This YouTube video can show you how to make your own LDN from the 50 mg pills.

After two months, this treatment not only can dramatically decrease pain, but it can improve the overall process including energy, cognition, and numerous other symptoms.

More Helpful Tips

LDN: Find a Pharmacy 

Get a list of LDN pharmacists at the LDN Research Trust website.

SKIPS (800-533-7429) and ITC Compounding ( 303-663-4224 ) are my favorite compounding pharmacies for LDN.

Can’t Find a Doctor to Prescribe It?

• See if your physician will write for the 50 mg pills and people can then make their own. Again, here’s a YouTube video that can show you how to make your own LDN from 50 mg pills.
• For help fining an online doctor who can prescribe. visit AgelesssRX.

Other Resources

There is an excellent Facebook group called the LDN Support Group.

Other helpful information can be found at the LDN Research website.