From the Guidelines
Patients taking low-dose naltrexone off-label for Mast Cell Activation Syndrome (MCAS) and Ehlers-Danlos Syndrome (EDS) should be monitored for liver function, pain levels, inflammatory markers, sleep quality, mood changes, and gastrointestinal symptoms, as well as potential side effects such as headache, vivid dreams, sleep disturbances, and anxiety. According to the most recent evidence 1, liver function tests are crucial when using naltrexone, even at low doses, due to the risk of hepatotoxicity. Although the risk is lower with low-dose naltrexone (LDN), typically dosed at 1-4.5mg daily, patients should report any symptoms of liver problems such as abdominal pain, yellowing of skin/eyes, or dark urine. Key parameters to monitor include:
- Liver function through blood tests
- Pain levels and inflammatory markers to evaluate effectiveness
- Sleep quality, mood changes, and gastrointestinal symptoms
- Mast cell mediator levels (such as tryptase, histamine, or prostaglandins) and frequency/severity of mast cell reactions for MCAS
- Joint pain, hypermobility complications, and overall connective tissue symptoms for EDS
- Potential side effects including headache, vivid dreams, sleep disturbances, and anxiety Regular follow-up appointments every 1-3 months are recommended to adjust dosing as needed, which typically starts at 0.5-1.5mg and gradually increases to an optimal dose, usually 4.5mg or less, as supported by the study 1 that highlights the importance of monitoring and adjusting naltrexone dosing.
From the Research
Monitoring for Patients Taking Low-Dose Naltrexone
When considering the use of low-dose naltrexone for patients with Mast Cell Activation Syndrome (MCAS) and Ehlers-Danlos Syndrome (EDS), several factors need to be monitored:
- Liver function: Studies have shown that naltrexone can affect liver enzyme levels, although the impact may be minimal at low doses 2, 3. Monitoring liver transaminase levels, such as serum glutamic oxalacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT), is essential.
- Disease interaction: The relationship between MCAS, EDS, and postural tachycardia syndrome (POTS) is complex, with a significant percentage of patients experiencing MCAS also having POTS and EDS 4. Monitoring for these interactions is crucial.
- Side effects: Low-dose naltrexone has been shown to have minimal side effects in some studies 5. However, monitoring for any adverse effects, such as changes in mood or gastrointestinal symptoms, is necessary.
- Efficacy: The effectiveness of low-dose naltrexone in treating MCAS and EDS symptoms should be regularly assessed to determine the optimal dosage and treatment duration.
Key Considerations
- The dosing range for low-dose naltrexone can vary, but typical doses are between 1-5 mg/day 6.
- Patients with liver disease, including cirrhosis, may require closer monitoring when taking naltrexone 3.
- The use of low-dose naltrexone in patients with MCAS and EDS is off-label, and its efficacy and safety in these populations are not fully established 6, 4.