Spotlight on Low Dose Naltrexone (LDN)
Dennis Bourdette, MD - Portland VA Medical Center
Naltrexone is a drug that is FDA approved to treat opiate and alcohol addiction. It is available in 50 mg tablets and, when it is used to treat addiction, it is given at that dose. Low-dose naltrexone (LDN) refers to taking not 50 mg but 1.5-4.5 mg a day of naltrexone. Many claims are being made about the ability of LDN to treat not just MS but a variety of diseases, including AIDS, lupus, Crohn’s disease and cancer.
The theory behind LDN is that it stimulates the body to produce endorphins (the body’s natural opiate-like peptides), which then help regulate the immune system, make people feel better, and reduce pain, spasticity, fatigue and a variety of other symptoms. There are many testimonials from people who have taken LDN and feel that it has helped them. There is even a pharmacist in Florida who claims he knows of over 10,000 people with MS who have taken LDN and almost all of them supposedly have been helped. However, there have been very few scientific studies done on LDN.
There have been several studies addressing LDN use for patients with MS. An Italian group published in the journal Multiple Sclerosis the results of treating 40 people with primary progressive MS for over six months. There was no control group as the purpose was to determine the safety of taking LDN. The people in the study did not experience any significant side-effects from the LDN. There was minor improvement in symptoms in some people, but no dramatic improvements were noted.
A group of scientists at the University of California at San Francisco (UCSF) completed an eight week double blind placebo controlled trial of LDN in 80 people with MS. (Double blind means that during the trial neither the subject nor the doctor knew whether the subject was receiving the LDN or a placebo look-alike pill without active drug.) Again there were no significant side-effects in the people taking LDN, aside from vivid dreaming in some people. The people taking LDN had some improvement in their sense of well-being but did not improve in how they physically functioned. Again no dramatic improvements occurred in any of the people taking LDN.
These two scientific studies are somewhat encouraging. LDN appears safe and some people experience some improvement in some of their symptoms. However, the results are not nearly as dramatic as one might have expected based on reading website testimonials. Much more research needs to be done on LDN before we understand what symptoms it might help and who might benefit from it. At this time it is premature to believe claims that it “stops MS” or that it is a “cure.” However, based upon the research so far, it appears that LDN is safe to use.
To obtain LDN, a prescription from a physician is needed, and the prescription has to be filled, not at a regular pharmacy, but at a “compounding pharmacy.” At the compounding pharmacy, a pharmacist prepares capsules with the low doses of naltrexone. The recommended dose is 1.5-4.5 mg at bedtime. It is relatively inexpensive; one website advertises 90 capsules, which would be enough for 30-90 days, for $38.
First, you should realize that it is an unproven treatment and, based on the first scientific reports, does not look like it is a “wonder drug.” Second, LDN should not be used in place of proven, FDA approved therapies. Some websites about LDN claim that interferons should not be taken with LDN and that the interferon should be stopped in order to take LDN; there is no basis for this claim and people with MS should continue to take the FDA approved MS therapies that they are already taking, whether or not they choose to go on LDN. Third, if you want to try LDN, you should discuss it with your physician. Finally, you should expect that you will have to pay for the LDN out-of-pocket because no insurance company or health care organization is currently covering LDN.
Whether LDN will be shown to be beneficial for MS or not remains to be determined. More research is being done and we should have a better understanding of where it fits in the treatment of MS within a few years.
External VA Links for LDN and MS
Last Updated: December 2009