Sunday, February 27, 2011

Multiple Sclerosis and Low Dose Naltrexone

Naltrexone is an old drug, now being used effectively in a very new and unique way.

This opiate blocker was the mainstay in drug overdose treatment 30 years ago.  When used for this purpose, Naltrexone is given in doses ranging from about 50 - 300 mgs per day, throughout the day.  Because the drug is old, the patent has long since expired.  The medication is cheap - about 50 cents per day -  so convincing pharmaceutical companies to study it for novel uses is... difficult.

Low Dose Naltrexone (LDN) is the term created by Dr Bernard Bihari - a New York neurologist who hypothesied that if high dose naltrexone (50mg - 300 mgs) would block opiate receptors throughout the body and deplete the immune system (a serious side effect of naltrexone treatment for drug addiction) as well as endorphin levels within the brain, then perhaps working with our body's natural circadian rhythm by giving a low dose of this common drug (1.5 - 4.5mgs) once at night might cause the body to rebound with an increased production of endorphins throughout the daytime. Fortunately for us, he was right.

We have known for some time that autoimmune patients typically show decreased endorphin levels, and since endorphins play a key role in the development and maintenance of the healthy immune system, perhaps if we could create that rebound effect, we might be able to heal the immune system itself.

Typically autoimmune diseases are treated by utilizing chemotherapy type agents which damage the immune system.  The hope is to damage it enough that it will not be causing excessive harm to organs and tissues of self as occurs in autoimmune disease, but not enough to leave the patient without enough immune system to survive.  This type of treatment often helps many of the symptoms of autoimmune disease, but it also hurts the immune system itself, leaving patients vulnerable to attack by other hostile invaders such as bacteria and viruses.  Sometimes, the autoimmune disease itself is so powerful, that even these toxic chemicals are not enough to keep the body from self-destruction.

Of course, then there are the side effects of the chemotherapy drugs themselves.  Even the most seriously ill autoimmune patients are sometimes seen to go off their therapy because - simply put - the treatment was worse than the disease that was already hurting or even killing them.  Unlike cancer patients who undergo cycles of treatment with breaks in the hopes of achieving remission and a cessation of treatment, autoimmune diseases don't function like cancer cells.  The treatment is ongoing and usually lasts the person's entire life.

The idea behind LDN is healing the immune system itself, not treating the symptoms as chemotherapy agents are designed.  While it was once feared that LDN might cause a boosting effect on an already errant immune system, we've found that is almost never the case.  As the immune system heals, it rebalances itself and produces the correct numbers of soldier and general cells that direct and fight invaders.  In the vast majority of cases, treatment results in an increased and BALANCED immune system.  Patients are left healthier and stronger with treatment.  Unfortunately, after treatment is discontinued, disease levels are seen to reappear, so like chemotherapy, LDN therapy is ongoing.  While this is a proven and under-used therapy for MS and other autoimmune diseases, it is not a cure.

In MS researchers think that naltrexone works to prevent the cell death of oligodendrocytes by reducing nitrous oxide activity, which prevents the inhibition of glutamate transporters in the brain.  Neurotoxicity of glutamate on neurons and oligodendrocytes is prevented.  LDN also prevents inflammation in neurons.  

LDN side effects are near zero.  Of course any medicine that has the potential to help you also has the potential to hurt you.  That said, unless a patient is allergic to the compound itself, side effects at such tiny doses are rare and are limited mostly to insomnia and bad dreams which tend to disappear as therapy continues.  Those with autoimmune thyroid disease are encouraged to get frequent testing while starting LDN as well as careful titration to a therapeutic dose, as correction of thyroid disease can be very fast, necessitating drastic and quick changes in medications.

One of the biggest problems with LDN is the inability to use opiate pain relievers or steroids.  I found this was the biggest problem for me as I started my own treatment, because I had to be sure I was healthy enough to NOT need these medicines for an extended period of time while the medicine did its work to make me better.  Many autoimmune patients are also chronic pain patients, and the thought of being without pain relief for days or weeks is scary at best.  Fortunately, the increase in endorphins often helps the chronic pain of autoimmunity.  An additional advantage some find is an elevation in mood.

LDN has been tested specifically on Multiple Sclerosis.  In fact, some of the earliest and most effective LDN tests were done on this disease.  Unfortunately, because of its status, no pharmaceutical companies are interested in testing a drug they'll never make any money on, so research has been University and patient driven thus far.  This creates a very slow process.  It also means that doctors who rely on pharmaceutical companies to educate them about new therapies will not be aware of this medicine.  In fact, most doctors who routinely prescribe LDN learned about it from their patients.  This patient driven movement began with the use of this therapy for MS. For details on the most recent research with links for your doctor:

Have you communities discussed LDN therapy?  Not every therapy is going to work for every patient, so I'm wondering if there are any members of your communities who are staunchly FOR LDN use or against it?  If you haven't heard of LDN before, will it be something you want to share in your communities by clicking the link below, or using this short url:
Comment by Tamara on February 28, 2011 at 7:01am
I don't have MS, but I take LDN for my lupus and fibromyalgia.  It has decreased my pain levels, increased my energy levels, helped with sleep and elevated my mood.  With it, I am able to exercise each day which further boosts endorphin levels.  Since beginning LDN about six months ago, I have not had one flare bad enough to need prednisone where before I was practically dependent on pred.  I couldn't be more pleased with the results of LDN and have experienced no side-effects from it.  It is also very cheap!  

Thanks for this post.  I hope more people give it a try.  I also hope that someday a way is found to get FDA approval for these other uses.  
Comment by Ellen S on March 2, 2011 at 11:58am
I'm okay with using it off-label myself.  I suppose I'm  used to that because I'm so used to it.  Migraine meds, autoimmune meds - nearly all of them were developed for use in other illnesses.  Most are not FDA approved for use in Migraine, but well, here we are using them anyway.  FD approval sure would be nice if for no other reason than to get the word out to patients and physicians that it is a potential alternative out there, as right now most people are completely unaware of its existence...


Kim said...

Thank you for your informative article. After about 3 months of research, I took the LDN plunge in hopes of finding much needed help with daily migraines. I am currently on my first month dosage of 1.5 mg of LDN (optimal dosage is 3-4.5 mg). At present, this is now the only medication I take for migraines. I am three weeks in and have seen positive results. One month prior to LDN, my daily migraines were severe and there had been no days without a migraine in over 200 days. I was taking Topamax at a dosage of 200 mg. Upon weaning off the Topamax, migraines became much worse and coincided with my first week of using LDN. Two weeks into using LDN, I experienced two days without a migraine at all! December 23 and 24th, 2013. What a wonderful Christmas present! In the following days, migraines were at bay until late in the evening. Since that time, migraines are still present but now instead of a "3" (rated 1, 2 and 3 for intensity), they have been mostly 1-2. The accompanying aura is not as frequent, however migraines are present earlier in the day over the past few days. Realizing the importance of patience in order to fully appreciate the potential benefit of LDN, I plan to give this medication a fair shot and use for at least 3 months. I have experienced a positive change in my sense if well being and hope to incorporate daily exercise back into my lifestyle in the next few days. This has always been important to me and a big part of my life but very difficult due to the pain and "sensory sensitivities" associated with daily migraines. Unfortunately, these migraines have managed to stop my life in its tracks. After being told by my headache specialist that the best I could hope for is to go from daily severe migraines to daily less severe migraines, I decided to try the LDN. This will cost me the relationship with my headache specialist who said he would not treat me if I chose to pursue LDN as treatment. He stated he was not familiar with this medication and would not advocate my use if it EVEN if I provided him with educational material. Given the grim odds he gave me for my future with his medicinal approaches, I figured I had little to lose. (; I am keeping a daily headache diary to better gauge my progress. I have also started taking supplements including Riboflavin, Magnesium Glycinate, and COQ10. If LDN doesn't work for me, I will keep looking for other treatments. My life is given only once and giving up is not one of my options at this time, My faith, perseverance and family are my greatest anchors. Thank you for allowing me to share. said...


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