for managing severe pain, they are unlikely to see any withdrawal effects.
LDN can be taken with other medications or supplements as long as they do not contain opiates or synthetic narcotics, examples of which include fentanyl, meperidine (Demerol, Pethidine), tramadol, morphine, oxycodone and hydrocodone. Naltrexone blocks the opioid receptors. Therefore pain medications will be blocked from working and could lead to withdrawal problems. Check with your doctor and pharmacist to make sure that none of your medications are contraindicated. They can also advise you on stopping pain medications that might interfere with LDN and offer advice and amount of time to allow between stopping opiates and starting LDN.
After starting LDN, if you have surgery scheduled or a procedure that may require pain medications, consult with your doctor to determine the amount of time needed to clear again from your system so that it does not interfere with anesthesia or pain medications. LDN must also be stopped if your doctor plans to prescribe opiate-based medications for postoperative use. The time required to clear naltrexone for the body may vary, based on dosage and body weight. After a procedure under anesthesia or requiring pain medications allow adequate time for the opiates to clear from your system before restarting LDN.
Considering that the naltrexone is such a low dose, it is uncommon to cause any side effects; potential side effects diminish as the body adjusts to LDN and increased endorphin levels. Side effects are less likely to occur when a small starting dose is used and gradually increased over time. It is better to start LDN at the lowest dose possible and increase slowly to allow for any side effects that may occur. If side effects occur, the dose can be reduced. Some of the more common side effects are: sleep disturbance, insomnia, vivid dreams.
If sleep disturbances do occur, LDN can be taken in the morning. Sleep disturbances diminish after taking LDN for some time.
Naltrexone is manufactured as 50mg pills. Compounding pharmacies can prepare Low Dose Naltrexone to any dose specified. Because of differences in compounding pharmacies and the fillers, it's suggested that patients use a compounding pharmacy that has experience with LDN. The pharmacy must produce LDN in an instant release formulation and not as timed release or slow release. The LDN must not be released in to the body slowly. Compounding pharmacies can prepare the drug as capsules, tablets, liquid or topical cream. In preparing LDN, pharmacies can change the inactive ingredients (fillers) especially if a reaction is suspected. They can also make it in a gluten-free filler. For ultra low doses of naltrexone, it is prepared as a liquid suspension.
The dose recommended by Dr. Bihari was 1.5mg to 4.5 mg taken at bedtime. However studies show that taking LDN at night is not necessary. If side effects occur then lowering the dose is recommended, or taking it in the morning in case of insomnia.
This article is not intended to provide advice on personal medical matters or to substitute for consultation with a physician. The material in this article is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. The use of Low Dose Naltrexone is an off label use by the FDA.
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