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Low Dose Naltrexone
General Information
Low Dose Naltrexone (LDN) is a medication that involves using naltrexone (a medication used to treat opioid and alcohol dependence) in significantly lower doses. At these low doses, naltrexone exhibits unique pharmacological effects, such as adjusting how the brain’s support cells (glia) react to inflammation, promoting neuroprotection, and boosting the brain’s natural pain-relieving system. LDN shows promise in various conditions like autoimmune diseases, chronic pain disorders, and inflammatory conditions, offering potential benefits with minimal side effects.
Dosing Instructions
Please carefully follow your dosing instructions in your RTHM dashboard.
If side effects occur after any dose increase, reduce the dose by 1 capsule (1.5 mg) every night until the side effects resolve or your dose is zero capsules. If your dose reaches zero capsules, do not restart LDN - it is not a good fit for you at this dose. You may benefit from a lower dose than 1.5mg, but we currently do not offer lower doses through RTHM. Please check back in a few months as we may add additional dosages.
Please read this treatment guide in its entirety for additional important information.
Best Time to Take LDN
The best time to take LDN depends on your specific situation. In most cases, LDN is prescribed at bedtime because the middle of the night is when endorphin production is highest. However, LDN taken at night can disrupt sleep. Taking it in the morning may be better if this is the case. Whether you take it at night or in the morning, it is best taken at the same time every day.
Take With or Without Food
Taking LDN on an empty stomach helps with absorption, however, some people experience stomach upset when taken without food. If you experience stomach upset when taking LDN on an empty stomach, eat a small meal or snack before taking your LDN to see if symptoms resolve.
What to Do If I Miss a Dose
If you miss a dose, take it as soon as possible. If you are close to the time of your next dose, wait to take the next dose and then resume your normal dosing schedule. Do not “double-up” the dose.
Precautions When Starting LDN
  • Read the medication guide provided by your pharmacist before you start taking low-dose naltrexone. If you have any questions, log into the dashboard and message the RTHM Medical Team.
  • Take your low-dose naltrexone at the same time each day.
  • Do not increase or decrease your dosage or stop taking this medication without talking to your medical provider first.
  • Let your provider know if you have any liver conditions, or are pregnant or breastfeeding before starting low-dose naltrexone.
  • Avoid alcohol and opioid medications while taking low-dose naltrexone.
  • Low-dose naltrexone has the potential to cause false positive results in laboratory drug tests. Let your laboratory professional know you are taking this medication.
  • If you are an organ transplant recipient on immunosuppressive medications, low-dose naltrexone can counter the effect of these medications. Make sure your healthcare provider is aware of all medications you are taking. (2)
  • Have a patient safety card that notes that you’re taking this medication on you all the time.
Potential Side Effects
Side effects are common with most medications. Remember that your medical provider understands these side effects and has determined that the benefits of this medication are greater than the risk of any potential side effects.
In higher doses, naltrexone can cause damage to the liver, but this is rare with low-dose naltrexone.
Common symptoms seen with low-dose naltrexone include:
  • Nausea
  • Vomiting
  • Abdominal pain
  • Decreased appetite
  • Constipation
  • Headache
  • Fatigue
  • Insomnia or trouble sleeping
  • Vivid dreams
  • Dizziness
  • Depression
  • Anxiety
  • Allergic reaction: itching, hives, swelling in the face or hands, chest tightness, trouble breathing
This is not a complete list of potential side effects and if you experience any new symptoms after starting LDN, inform your healthcare provider immediately.
When to Seek Medical Attention
Serious side effects require immediate medical attention. If you experience these side effects, notify your healthcare provider immediately.
  • Confusion
  • Hallucinations
  • Blurred Vision
  • Severe vomiting or diarrhea
  • Thoughts of suicide
  • Dark urine or pale stools
  • Yellow skin or eyes
Interactions with LDN
  • Naltrexone blocks opioid receptors so you should avoid taking any opioid medications. This can include pain relievers, certain cough medications, and antidiarrheal medications. Let your healthcare provider know all medications and supplements you are taking.
  • Refrain from consuming alcoholic beverages when taking low-dose naltrexone.
  • Negative interaction with OTC Imodium, an antidiarrheal medication. Avoid taking Imodium while on LDN.
  • Negative interaction with OTC cough medicine containing dextromethorphan. Avoid taking these medications while on LDN.
  • Many herbal supplements can interact negatively with LDN. This can include kratom, St. John’s wort, Ginkgo biloba, and Echinacea. Make sure your provider and pharmacist are aware of all medications and supplements you are taking. (1)
  • You are recommended to maintain a list of all medications and supplements you take to best inform your healthcare provider and pharmacist to avoid potential drug interactions.
  • Do not start any new medications or supplements before checking with your healthcare provider and pharmacist.
Who Should Not Take LDN
Contraindications associated with the use of low-dose naltrexone include:
  • Individuals receiving opioid analgesics.
  • Individuals currently dependent on opioids or opiate agonists, such as methadone.
  • Individuals in acute opioid withdrawal.
  • Individuals with a sensitivity to naltrexone or components of naltrexone.
What If I Become Pregnant While Taking This Medication?
If you become pregnant while taking LDN, let your healthcare provider know right away. While LDN has a positive safety profile, it is still not recommended during pregnancy because of limited data. However, small studies show LDN is safe during pregnancy and can even help with infertility. (3,4) If you become pregnant, consult with your OB/GYN on your use of LDN.
Medication Storage
  • Keep this medication in the container provided by the pharmacy. Ensure it is properly closed and out of the reach of children. Store at room temperature and away from excess heat, direct light, and moisture (not in the bathroom).
  • Do not share this medication with anyone else.
  • Do not throw away unwanted or expired medications. Do not flush down the toilet or pour down the drain. Ask your local pharmacist about local drug take back programs to discard your medication.
In Case of Overdose
Take medication only as directed. In the event of an accidental overdose, contact emergency services immediately.
Symptoms of an overdose of low-dose naltrexone can include:
  • Nausea
  • Dizziness
  • Seizures
  • Stomach pain
  • Extreme fatigue
Questions?
If you have questions about this medication, please contact us by using our support form. We generally respond within 2 business days. If you have a more urgent issue, please seek care from your local primary care provider, urgent care or emergency services.
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