The Use of Low-Dose Naltrexone
for Lupus and Other Overlap Conditions
WHAT IS LDN?
Low-dose naltrexone or LDN is a medication that is getting more attention because of preliminary research showing promise for use with diseases like multiple sclerosis, some cancers, HIV/AIDS and other chronic pain conditions. Over the last several months, we, at Molly’s Fund, have received numerous inquires about this drug and it’s effectiveness on treating the pain associated with lupus, rheumatoid arthritis and fibromyalgia.
We felt because of the rise in curiosity, the controversy among doctor opinions, and the limited information on the use of this drug for the lupus community, that it is important to delve into what this medication is, what it does, and what the potential side effects may be. Our hope is that you can, in turn, take this information back to your healthcare provider(s) and have an open conversation about this experimental option and if it is of benefit to you and your current health situation.
HOW DOES IT WORK?
Naltrexone works by binding to the opioid receptors in the cells. These opioid receptors are designed to respond to your body’s “feel good” chemicals – endorphins. The drug (typically taken before bedtime) temporarily blocks both the endorphin and opioid receptors. This tricks the body into thinking it needs to make more endorphins, so it makes more endorphins. Claims have been made that this sequence improves immune function, pain relief, and sleep.
Naltrexone or it’s sister medication Naloxone (Narcan), has been used in higher doses since the 1980’s to help with opioid dependence, alcohol dependence, drug detoxification and overdose. It works by preventing patients from experiencing the opioid “high” and effectively stopping overdoses in their tracts. It can also help people with addiction relapse.
- There is no known abuse potential
- It is inexpensive
- It is well tolerated
IS IT SAFE?
Currently, LDN is not approved by the FDA for treatment for lupus. Naltrexone, however, is approved for the treatment of chronic opioid dependence and drug detoxification.
Here are some important things to know before starting low-dose naltrexone:
- Make sure to tell your doctor if you have acute hepatitis or ANY liver issues.
- You should not take it if you are currently taking opioids for pain relief.
- Avoid slow-release (SR) or timed-release naltrexone.
- Avoid LDN capsules that contain calcium carbonate fillers.
- Find a reliable compounding pharmacy.
THE SIDE EFFECTS
Another benefit with LDN is that the side effects seem to be mild. The most common side effects reported are gastrointestinal issues and vivid dreams. Frequency of headaches seems to be reported slightly higher than with placebo.
LDN AND AUTOIMMUNE DISORDERS
Recent information published on chriskresser.com discusses how LDN can affect (and ultimately help) certain autoimmune disorders due to idea that LDN can promote T regulatory cell function. T regulatory cells or Tregs, keep the immune system in balance, turn off and on inflammation and prevent autoimmune disease. Everything from allergies, to asthma, to lupus – are under this umbrella.
People who suffer from autoimmune disorders often have lower levels of endorphins and white blood cells. LDN, in theory, may help the immune system by temporarily blocking the certain receptors in the brain, and tricking the body into thinking more endorphins should be made. By the time more are made, the LDN is out of the system, and the receptors are unblocked.
LDN AND FIBROMYALGIA
LDN has been tested in a few chronic pain conditions including the lupus overlap disease fibromyalgia. Fibromyalgia syndrome (also known as FMS or ‘fibro’) is a disorder that affects the muscles and soft tissues of the body. It is believed that fibromyalgia intensifies painful sensations by affecting the way that the brain processes pain signals. It is often characterized by widespread and chronic muscle pain and stiffness, extreme fatigue, problems with sleep, painful or tender spots on the body, to name just a few of the troubling symptoms.
In two small separate trials, research published by NCBI found that LDN might be an effective treatment for Fibromyalgia syndrome. The first trial in 2009 showed a significant pain reduction in patients. A second study was conducted with 30 women which showed a 57% reduction in pain after starting LDN. At the end of the double-blind study, half of the participants described feeling “much improved” or “very much improved” from taking LDN. The two studies were promising in proving that LDN was superior to placebo in the pain and discomfort associated with fibromyalgia syndrome.
WHAT DOCTORS THINK?
LDN is prescribed often by Naturopaths. Why you ask? Well, since LDN is not backed by major pharmaceutical companies, many doctors are not familiar with it. Additionally, some doctors feel the research is unsupported and pseudoscientific. Steven Novella of the Yale University School of Medicine further argues that the claims of LDN as an effective treatment for autoimmune diseases and immune dysfunction is contradictory and that improving the immune response could make an autoimmune condition worse.
However, there seem to be differing opinions in the complementary medicine field. Functional Medicine Practitioner, Suzy Cohen, believes that LDN has “undeniable applications for autoimmune conditions, chronic infections and pain syndromes.” You can read more about her opinion here.
Naltrexone has shown a substantial history of being safely used in other capacities, however, very little is known about the long-term safety of it being used for other conditions. That is why, it is so important to discuss all your questions with your rheumatologist and any other healthcare provider.
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