From the Guidelines
Low dose naltrexone (LDN) typically does not require tapering when discontinuing use, as it does not cause physical dependence or addiction, and most patients can safely stop taking it abruptly without experiencing withdrawal symptoms. The mechanism of action of LDN, which temporarily blocks opioid receptors at low doses, does not create dependence like medications that activate these receptors 1. The typical dosage range for LDN is 1.5-4.5 mg daily, significantly lower than the standard naltrexone dosing used for addiction treatment.
Some key points to consider when discontinuing LDN include:
- The plasma half-life of naltrexone is 4 hours, and the half-life of the active metabolite, 6-b-naltrexol, is 13 hours, which may persist for 2 to 3 days after stopping 1.
- If you've been taking LDN for an extended period and are concerned about discontinuation, you might consider a gradual reduction over 1-2 weeks as a precaution, though this is generally not medically necessary.
- The CDC clinical practice guideline for prescribing opioids for pain recommends careful consideration of the benefits and risks of continuing opioid therapy and tapering opioids, but this guidance is more relevant to opioid therapy rather than LDN 1.
- It's essential to consult with your healthcare provider if you experience any unusual symptoms after stopping LDN.
In general, the decision to taper or discontinue LDN should be based on individual patient circumstances and the clinical judgment of the healthcare provider, prioritizing the patient's morbidity, mortality, and quality of life.
From the Research
Tapering Off Low-Dose Naltrexone
- The provided studies do not directly address the question of whether low-dose naltrexone has to be tapered off 2, 3, 4, 5, 6.
- However, it is known that naltrexone is an opioid antagonist and abruptly stopping it may not lead to withdrawal symptoms like those seen with opioids, but it may lead to a return of the original symptoms it was treating 3, 6.
- In the study of extended-release naltrexone (XR-NTX), patients who discontinued treatment did so due to various reasons, including unfulfilled expectations and unexpected reactions, but the study does not mention tapering off as a requirement 5.
- The therapeutic uses and efficacy of low-dose naltrexone have been explored in various studies, but the specific question of tapering off remains unanswered 6.
- It is essential to consult with a healthcare professional for personalized advice on discontinuing low-dose naltrexone, as they can provide guidance based on individual circumstances and medical history.