From the Guidelines
The recommended dosing for low-dose naltrexone (LDN) is 1.5 mg at bedtime with gradual bi-weekly increase of 1.5 mg to a final maximum dose of 4.5 mg taken at bedtime. This dosing regimen is based on the most recent and highest quality study available, which suggests that LDN can be effective in managing chronic neuropathic pain, including fibromyalgia, complex regional pain syndrome, low-back pain, and painful diabetic neuropathy 1. The study found that LDN (3–5 mg) can reduce the release of pro-inflammatory cytokines and modulate microglial activity, leading to significant decrease in pain and improved satisfaction with life.
Some key points to consider when prescribing LDN include:
- Starting with a lower dose of 1.5 mg daily and gradually increasing by 1.5 mg increments every 1-2 weeks to minimize potential side effects such as headache, tachycardia, and vivid dreams
- Taking LDN consistently at the same time each day, preferably at night, as it may affect sleep patterns
- Using a compounded formulation specifically prepared as low-dose naltrexone, as standard naltrexone tablets (50 mg) cannot be reliably split to achieve these small doses
- Avoiding taking LDN with opioid medications as it can precipitate withdrawal symptoms, and informing the healthcare provider about all medications being taken before starting LDN 1.
It's also important to note that LDN works by temporarily blocking opioid receptors, which leads to an upregulation of endorphins and enkephalins, potentially modulating immune function and reducing inflammation. However, the exact mechanism of action is still not fully understood, and more research is needed to confirm the long-term efficacy and safety of LDN 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Treatment of Alcoholism A dose of 50 mg once daily is recommended for most patients Treatment of Opioid Dependence Treatment should be initiated with an initial dose of 25 mg of naltrexone hydrochloride. If no withdrawal signs occur, the patient may be started on 50 mg a day thereafter
The recommended dosing for low-dose naltrexone (LDN) is not explicitly stated in the provided drug label. However, the label does provide dosing information for the treatment of alcoholism and opioid dependence, which is 50 mg once daily for most patients.
- Key points:
- The label recommends 50 mg once daily for the treatment of alcoholism.
- For opioid dependence, treatment should be initiated with 25 mg and increased to 50 mg if no withdrawal signs occur.
- Important note: The provided label does not specifically address low-dose naltrexone (LDN), which is typically considered to be a dose lower than the standard 50 mg dose. 2
From the Research
Recommended Dosing for Low-Dose Naltrexone (LDN)
The recommended dosing for LDN varies depending on the specific condition being treated and the individual patient's response to the medication.
- A daily dose of 1 to 5 mg is considered a typical range for LDN 3.
- Effective doses of naltrexone for chronic pain presentations range from 0.1 to 4.5 mg per day, with 4.5 mg per day being a commonly used dose 4.
- The maximally effective dose of low-dose naltrexone for the treatment of chronic pain is idiosyncratic, suggesting the need for dosage titration to establish a maximally effective dose 4.
Dosing Paradigms
Different dosing paradigms have been used in various studies, including:
- Ultra low-dose naltrexone/naloxone (ULDN): less than 1 μg per day 3.
- Very low-dose naltrexone (VLDN): between 1 μg and 1 mg per day 3.
- Low-dose naltrexone (LDN): 1 to 5 mg per day 3.
Clinical Applications
LDN has been used to treat various conditions, including: