Dallas Rheumatology Practice of Scott Zashin, MD

8230 Walnut Hill Lane, Suite 614 Dallas, TX 75231   Phone: (214) 363-2812   Fax: (214) 692-8591

Low Dose Naltrexone (LDN): A new treatment for fibromyalgia and pain from other autoimmune/inflammatory conditions

Naltrexone HCL is an FDA approved medication that has been used for a long time to treat patients addicted to pain medications. In 2009, a small study was published by doctors at Stanford University (Younger and Mackey) showing that using very low doses of naltrexone helped relieve pain in patients with Fibromyalgia.

In this study, patients took 4.5 mg of naltrexone daily (50 mg is the standard dose used to treat narcotic addiction) and after 8 weeks they had reduced pain and fatigue. Other symptoms that often accompany fibromyalgia such as sleep problems, gastrointestinal complaints and headaches also improved. The authors followed up this study with a slightly larger randomized double blind placebo controlled trial published in Arthritis and Rheumatism 2013 and found that LDN had a beneficial effect on fibromyalgia pain and concluded that the medication is “inexpensive, safe and well tolerated. Additional studies were recommended to fully determine the efficacy of the medication.”

In a review published in the Clinical Rheumatology 2014 doctors Younger, Parkitny and McClain concluded that LDN is a promising treatment for not only fibromyalgia but chronic pain conditions that have inflammation. These include Chrohns disease, multiple sclerosis and CRPS (complex regional pain syndrome).They postulate that its benefit is due to its anti-inflammatory effect on the central nervous system via action on microglial cells.

Currently no pharmaceutical company manufactures naltrexone in the low doses used to help pain. As a result, your doctor will need to write you a prescription that you must take to a pharmacy that has expertise in compounding medications. Many of the larger pharmacies such as CVS and Walgreens will not offer this service. While the recommended dose is 4.5 mg, the starting dose may range anywhere from 0.5 mg to 1.5 mg and is slowly increased over a period of 3 to 8 weeks. The medicine is often taken in the evening one hour before bedtime. Initially, symptoms may get worse before they get better. Sometimes sleep disturbances such as vivid dreams can occur when taken at night possibly due to an increase in endorphin release. If this is the case, taking the medication in the morning may help. Standard dose naltrexone has been reported to elevate liver function tests. While LDN may be less likely to elevate liver tests, it makes sense to monitor liver function tests periodically especially if one is taking other medications that may elevate liver function tests. In this regard, patients with preexisting liver or kidney issues may require additional evaluation before treatment with LDN. In addition, because it is a narcotic inhibitor, it can negate the effect of opiate based pain relievers.

In summary, the use of LDN for chronic disorders is considered experimental and the long term safety of LDN is unknown. That being said, the doctors who published the review of LDN in the Clinical Rheumatology Journal concluded that LDN is a” promising treatment approach for chronic pain conditions thought to involve inflammatory processes. The clinical data supporting its use are very preliminary and more research is needed before the treatment approach can be widely recommended.”

Types of Arthritis

Conditions treated by Dr. Zashin in Dallas, TX: