Naltrexone is an FDA-approved medication used for opioid withdrawal at a dose of 50 mg per day.
However, low doses of this medication have been found to tweak the immune system and have shown promise in improving cases of autoimmune disease, including Crohn’s, MS and Hashimoto’s, as well as other immune system-related conditions such as cancer and HIV/AIDS.
Doses of 1.5–4.5 mg per day are usually recommended, and have been reported to enhance immune function through increasing our endogenous endorphin production, reducing inflammation, promoting DNA synthesis, and slowing down motility in the GI tract to facilitate healing.
Low Dose Naltrexone (LDN) balances the immune system by increasing the amount of T-regulatory cytokines IL-1 and TGF-B, leading to a reduction of Th-17, the promoter of autoimmunity. This means that it turns off the cells that cause autoimmunity!
This medication is available only as a prescription and can be compounded into lower doses by special professional compounding pharmacies. Luckily, even without insurance coverage, this medication is available in generic form and is very affordable, usually costing between $15-$40 per month.
The websites dedicated to sharing research on LDN, www.lowdosenaltrexone.org, and www.LDNresearchtrust.org are full of testimonials about ulcers, tumors, and lesions disappearing within months of initiating LDN.
The authors of the website even caution users with Hashimoto’s taking supplemental thyroid hormone to start low (1.5 mg per night) and watch for emerging signs of hyperthyroidism that may result from rapid improvement of the condition.
I decided to interview Dr. Mark Mandel, PharmD, compounding pharmacist, LDN expert and fellow Midwestern University Chicago College of Pharmacy Grad on the effects of LDN in people with Hashimoto’s and autoimmunity. Dr. Mandel recently hosted an LDN Conference in the Chicagoland area and was kind enough to share his knowledge with me.
IW: What types of people benefit from LDN?
MM: We have seen amazing results with people with autoimmune conditions, cancers and neuropathic pain.
IW: How is LDN thought to work for autoimmune conditions?
MM: The exact mechanism has not been determined, but the theory is that LDN increases endorphin activity two to three fold. Additionally, it may increase in the numbers of endorphin receptors and/or the sensitivity of the receptors. The increased endorphin activity results in better modulation of the immune system.
IW: How is LDN taken?
MM: The typical starting dose for people with Hashimoto’s, fibromyalgia and MS is 1.5 mg every night at bedtime but may be even lower depending on the individual. The target dose will come down to the individual patient and we often need to titrate it. At times, the condition may be dynamic and we may need to change the dose of LDN, just as you would with other medications such as thyroid drugs.
LDN can be taken in the form of a compounded tablet, capsule, liquid or transdermal formulation. We often find that the transdermal (skin) or sublingual formulations work best for those with liver issues; the transdermal for children with autism.
For people who are new to LDN or those with swallowing issues (dysphagia), I will usually recommend starting with a liquid formulation. That allows us to figure out the correct dose for each person.
IW: What are some of the more common adverse reactions that people have to LDN?
MM: Sleep disturbances nausea, and irritability are some of the issues that people report.
For those that have nausea, we have found that using a sublingual dose seems to help. In cases of sleep disturbances, we recommend adjusting the dose to morning time instead.
For those who have become irritable after taking LDN, I would recommend reducing the dose. While 1.5mg is a typical starting dose for Hashimoto’s, some may do better with a starting dose of 0.5 to 1mg. This is where the liquid LDN allows us to get a minute dose and gradually progress to a target dose. I like to use the old pharmacy adage that applies to most medications “Start low and go slow”.
Liver toxicity has been reported with the full dose naltrexone, none that I have encountered with the Low Dose (LDN), so we always recommend liver function tests while taking this medication.
IW: What types of benefits can be seen with LDN for thyroid disorders?
MM: Once you have been titrated to the correct dose, you will start feeling better. This will usually be followed by an improvement in labs, such as improved markers in TSH, T4, T3 & TPO levels. The time to start feeling better will of course vary per person. Once you start to feel better, maintain the dose for 2-3 months and follow up with your physician to see if your laboratory markers have improved. I recently had a patient with hyperthyroidism who struggled with trying to get pregnant for many years, and was finally able to get pregnant after starting LDN.
IW: Speaking of pregnancy, is LDN considered to be safe during pregnancy?
MM: Yes, all of the literature does seem to indicate that LDN is safe during pregnancy. (My note: I have found studies that have used full dose naltrexone during pregnancy for opiate addicted mothers).
IW: Is LDN a life-long drug?
MM: Not necessarily. We have experienced patients with chronic neuropathic pain who have used LDN for a limited time period and been able to stop it and if you are a young person with Hashimoto’s, you can go into remission though modulating your immune system with LDN. The medication will help you move towards an appropriate immune status, and once the immune system is in balance again you may be able to get off the LDN.
IW: What advice do you have for those considering the use of LDN?
MM: LDN should be used as part of an arsenal to help you overcome your autoimmune condition. Appropriate levels of Vitamin D, full spectrum light exposure, food sensitivities all play a role in autoimmunity and need to be considered as well. It’s also best to work with a compounding pharmacy that can help you titrate your dose correctly.
Dr. Mark Mandel, PharmD’s website is www.markdrug.com and he has two pharmacies in the Chicagoland area. The pharmacies provide compounding services (including LDN and thyroid hormones), hormone balancing solutions and a Mastectomy Boutique can be found at the Roselle location.
For best results…
As those of you that have read my book will know, the immune system can be thrown off balance by a variety of factors. Some of those factors include food sensitivities, infections, or an imbalance in gut bacteria, thus I always recommend using LDN as a part of a whole person approach, and not as a standalone therapy, for best results and for increasing your chances of remission.
LDN is not a commonly prescribed medication and it may not always be possible to convince your own doctor to prescribe it. On my quest to try LDN, I talked to my local compounding pharmacist to figure out which doctors in my area were knowledgeable about prescribing LDN.
LDN was one of the first interventions that I tried on my thyroid journey back in 2009. As a pharmacist, I was looking for the magic immune system pill, but I found that it made me somewhat irritable after a few nights of taking it, so I gave up on it and moved on to something else. Instead of working with a compounding pharmacist, I made the mistake of getting full strength naltrexone and compounding it myself.
I also used it before I started working on my diet, and had I worked with a knowledgeable professional, I would have learned that LDN working best when used in combination with a leaky gut diet as well as that I would have needed to titrate the dose for improved tolerability. It took me over three years to get myself in remission.
I hope that with the information I share in my book and on this blog, you will be able to get yourself in remission more quickly and efficiently.