From the Guidelines
Low-dose naltrexone has been explored as a potential treatment for long-term COVID-19 symptoms, with some studies suggesting improvements in fatigue, pain, and cognitive dysfunction, although the current evidence is based on small-scale studies and substantial anecdotal reports within the patient community. The most recent and highest quality study on this topic is from 2023, published in Nature Reviews Microbiology 1, which provides a summary of candidate treatments for long COVID, including low-dose naltrexone. According to this study, low-dose naltrexone is considered a potential treatment for pain, fatigue, and neurological symptoms in long COVID patients, with substantial anecdotal reports of success.
Some key points to consider when evaluating the use of low-dose naltrexone for long-term COVID-19 symptoms include:
- The dosing of low-dose naltrexone typically ranges from 1-4.5mg daily, with a gradual increase in dose over several weeks
- The proposed mechanism of action involves anti-inflammatory effects through blocking toll-like receptor 4 and temporarily inhibiting endorphin receptors
- Common side effects include sleep disturbances, headaches, and gastrointestinal issues, which typically resolve within days to weeks
- More rigorous, large-scale randomized controlled trials are needed to establish the efficacy and safety of low-dose naltrexone for long COVID treatment
It's also important to note that long COVID is a complex condition with multiple potential causes and mechanisms, and treatment approaches may need to be individualized based on a patient's specific symptoms and needs. As stated in another recent study from 2023 1, there are currently no validated effective treatments for long COVID, and further research is needed to understand the pathogenesis of the condition and to develop effective treatments. Patients interested in low-dose naltrexone or other treatments for long COVID should consult with their healthcare providers to discuss the potential benefits and risks and to determine the best course of treatment.
From the Research
Study Types on Low-Dose Naltrexone for Treating Long-Term COVID-19
- Interventional pre-post study: A study was conducted to explore the safety of Low Dose Naltrexone (LDN) in patients with Post COVID-19 Syndrome (PCS) 2.
- Double-blind, randomised trial: A prospective, randomised, double-blind, parallel arm, placebo-controlled phase II trial is being performed to assess the efficacy of LDN for improving fatigue in post-COVID fatigue syndrome (PCFS) 3.
- Retrospective cohort study: A study was conducted to compare treatments in patients from a post-COVID-19 clinic, including low-dose naltrexone, amitriptyline, duloxetine, and physical therapy 4.
- Systematic review and meta-analysis: A systematic review and meta-analysis was conducted to determine the prevalence of neuropsychiatric symptoms in survivors of COVID-19, including fatigue, sleep disturbance, and anxiety 5.
Key Findings
- Improvement was seen in 6 of 7 parameters measured in patients with PCS treated with LDN, including recovery from COVID-19, limitation in activities of daily living, energy levels, pain levels, levels of concentration, and sleep disturbance 2.
- LDN may improve well-being and reduce symptomatology in patients with PCS, and randomised control trials are needed to further explore this 2.
- The trial on LDN for PCFS aims to assess the efficacy of LDN for improving fatigue in PCFS, with primary outcome measured by the Fatigue Severity Scale 3.
- Low-dose naltrexone was found to improve post-COVID-19 condition symptoms, including fatigue and pain, in a retrospective cohort study 4.
- Naltrexone has been identified as a potential therapeutic candidate for COVID-19, with potential to inhibit viral entry and viral infectivity 6.