What Is Low-Dose Naltrexone, and Can It Reduce Alcohol Consumption?
Many people ask us whether very low doses of naltrexone can be used to treat alcohol use disorder (AUD). And it’s a good question. Early research has shown low-dose naltrexone (LDN) to be a promising treatment for multiple chronic disorders. Studies also suggest it could be effective for other substance dependencies. Still, the answer isn’t cut-and-dried.
In this post, we’ll discuss what LDN is, and whether it’s as effective as a full dose of naltrexone for AUD.
Read more about the standard use of Naltrexone for Alcohol Use Disorder
That’s a good question. The verdict is still out on that. Because for some people yes, some people no. It all goes back to—as I always say—medicine is called a “practice” for a reason: “Let’s try this and see if it works.” And it’s not a good feeling to be on the receiving end of that, feeling like a guinea pig. But at the same time, that’s the best we have.
For some people—and it depends on how a person metabolizes naltrexone (some people are fast metabolizers)—they need a high dose in order to get proper blood levels in their system. Other people are slower metabolizers.
For some people, we have had to send low-dose prescriptions to compounding pharmacies for low-dose naltrexone, because that’s all they can tolerate, or that’s all they need. We always say the lowest effective dose is what we want. If 10 milligrams does it, there’s no reason to go higher, especially if it’s just going to increase your risk for side effects.
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If low-dose naltrexone works for you, great. We encourage taking the lowest effective dose. Oftentimes people do need higher doses, and that is backed up with medical studies.
The receptor we’re trying to target in addictions regarding naltrexone is the kappa receptor.
Naltrexone is used for opiate addiction in that it’s targeting the mu receptor, which is an antagonist that blocks it completely. That’s why naltrexone blocks all opiates. But for alcohol—alcohol’s not an opiate, nor are we trying to hit that receptor—we’re trying to hit the other one, the kappa receptor.
A research study says that at 50 milligrams, which is a standard dose of naltrexone, the kappa receptor is about 60% full. For a lot of people, that works for them. At 100 milligrams of naltrexone, that kappa receptor is between 90% and 95%. Some people need that little extra difference.
And there are cases where we have gone higher—150 milligrams—and at that point, does the benefit really outweigh the risk? Because you’re really only getting that extra 5% or 10% of capture on that kappa receptor, but you’re also increasing your risk for side effects. Once you get above 100 milligrams, I recommend getting a liver function test often and your doctor will monitor that.
Dosage is something to consider. Some people can get the good effect at 12 milligrams—a quarter tablet of naltrexone—and they’re fine. Other people need 100 milligrams. So it all depends on how your body metabolizes it.
Naltrexone is an opiate antagonist used to treat a variety of conditions, including problem drinking. Doctors typically prescribe 50 mg tablets of naltrexone for AUD patients. But there are also tablets that contain only a few milligrams of naltrexone. That’s “low-dose naltrexone,” and it’s used to treat a different set of conditions.
Although not specifically approved by the FDA for these purposes, low-dose naltrexone benefits include being used off-label to treat chronic pain from fibromyalgia, arthritis, and other inflammatory diseases. It may also benefit people with immune disorders and even cancer.
Although further research is needed to pinpoint exactly why patients experience relief, it’s believed that LDN works by increasing endorphins.
LDN is typically prescribed in starting doses of 0.5 mg to 1.5 mg, increasing to 4.5 mg or higher over the course of several weeks. Compare that to the typical starting dose of 25 mg for alcohol use disorder, ultimately increasing to 50 mg. That’s the dose we typically prescribe Ria Health members. It’s also what the Sinclair Method recommends to treat problem drinking.
A Brief History of Low-Dose Naltrexone
According to the LDN Research Trust, in the 1980s, Dr. Ian Zagon and Dr. Patricia McLaughlin (at Penn State) began investigating LDN. Around that time a New York-based neurologist, Dr. Bernard Bihari, was using LDN to treat patients infected with HIV. Some of these patients had concurrent issues with opioids. Bihari noticed that naltrexone appeared to have positive effects on other symptoms.
In 2007, Dr. Jill Smith, now professor at Georgetown University in Washington, DC, was the first physician to do human clinical trials of LDN to treat Crohn’s disease. Since that time, other researchers have built on these studies, and now LDN is showing promise for many conditions outside of the addiction universe.
What Is LDN Used For?
From Crohn’s disease to multiple sclerosis, from chronic fatigue syndrome to fibromyalgia—dozens of conditions appear to be candidates for LDN treatment. This diversity, and LDN’s low cost, make it a prime candidate to be widely prescribed.
An NIH study also noted LDN’s effectiveness against chronic pain, noting its anti-inflammatory properties. These effects have been confirmed by the Kaiser Health News, an arm of the Kaiser Family Foundation. Weill Cornell Medicine in New York has also been using the medication for chronic pain relief.
Further, LDN is showing promise in treating Type 2 diabetes. A study cited in September shows that LDN may calm inflammation and aid in insulin resistance. Some researchers are also testing it for use against methamphetamine addiction.
What’s the Difference Between LDN and Naltrexone for AUD?
Can low-dose naltrexone work to treat alcohol dependence, even though it’s more than 10 times less than a typical dose?
Since most studies on naltrexone and AUD evaluate 50 mg doses, there isn’t enough research to conclusively determine whether LDN can also treat AUD. The research that has been done has focused on low doses of naltrexone combined with other drugs or other substance dependencies, like this 2017 study on LDN and the antidepressant bupropion.
A 2011 study investigated the effects of very low-dose naltrexone on opioid detox patients who were also problem drinkers—as heavy drinking can make opioid withdrawal worse. Researchers found that those who took very low doses of naltrexone showed fewer withdrawal symptoms. They were also more likely to continue treatment, and drank less in the days after leaving treatment.
Another study by researchers at the University of Maryland showed that LDN combined with the dopamine antagonist 1-THP may improve relapse behavior more than naltrexone alone—at least in cocaine-addicted rodents.
Normal Dosage of Naltrexone vs. LDN
So, what is the best way to take low-dose naltrexone? For most people, 50mg of naltrexone (taken orally) is the recommended dose for use against alcohol cravings. At Ria Health, like many medical professionals, we prefer to use the least amount of medication to get the job done. With that in mind, we may start members with 25mg, and increase that amount to 50mg. (Physiology, body weight, other medications and health considerations all play a role.)
LDN, on the other hand, is usually prescribed at a fraction of that amount—usually 0.5mg to 1.5mg, or if needed, as high as 4.5mg. These small amounts make their use potentially even safer.
Can Low-Dose Naltrexone Treat Alcohol Use Disorder?
The jury’s still out. There simply hasn’t been enough research to determine whether low-dose naltrexone can help with AUD. And since 50 mg doses have already been proven extremely effective, most doctors will recommend a full dose of naltrexone instead. Side effects are relatively rare, mild, and tend to go away after your body has adjusted to the medication. If you’re worried about potential side effects, ask your doctor about starting at a 25 mg dose and slowly increasing it.
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Side Effects of Low-Dose Naltrexone
One of the advantages of naltrexone over other medications is that, for most people, side effects are generally mild. These effects usually disappear after the body gets used to the medication. Some common effects are nausea and chills, among others. With LDN, these effects are even more unlikely to appear in the first place.
The LDN Research Trust (in Norwich, UK) has explored the use of the medication, primarily for immune system disorders. The Trust cites side effects such as increased fatigue, flu-like symptoms, or insomnia. (Some of these depend not only on the amount of the medication, but the condition for which treatment is being used.)
Some potential patients may worry that LDN worsens their symptoms, i.e., “the cure is worse than the disease.” According to Dr. Julia Piper of the Trust, “the die-off effect of organisms with underlying infections can trigger a healing reaction called a Jarisch-Herxheimer reaction.” This occurs when the body reacts to harmful microorganisms dying, and produces fever, chills, and in some cases, more serious symptoms. But in her experience, these incidents are relatively rare.
What to Avoid When Taking Low-Dose Naltrexone
On its own, naltrexone is one of the safest medication options available for treatment of alcohol use disorder. And low-dose naltrexone (LDN) has an even lower rate of side effects. The FDA has approved LDN for patients 18 years or older.
That said, like most medications, LDN doesn’t always mix well with other things, especially opioids, which are commonly found in analgesics such as hydrocodone, oxycodone, and codeine. But any prescription opioids (or illegal ones, such as heroin) should not be used while taking LDN. Also to be avoided: medications for diarrhea, and antihistamines for colds, such as promethazine (brand name: Phenergan).
Further, people with liver or kidney problems should not use LDN, as the medication is processed by the liver. As always, even though LDN is generally quite safe, patients should get advice from their doctor.
What Does the Future Hold for LDN?
At Ria Health, naltrexone is an integral part of our innovative treatment plan. We use it—in normal, 50mg doses—to help make the craving for alcohol gradually fade away over time. If you think lower dosages of the medication might help you with another condition, we advise you to check with your doctor first.
As the institutions above have noted, LDN is inexpensive. Given its apparent effectiveness—and with such a wide array of treatment options—it is likely to increase in popularity. We share the cautious optimism of many researchers, scientists, and medical professionals.
As Dr. Bruce Vrooman, professor at Dartmouth’s Geisel School of Medicine notes, “Patients may report that this is indeed a game changer. It may truly help them with their activities, and help them feel better.”
Other Resources on LDN
Another advocacy organization, also based in the UK, is LDN Now (LDNNow.com), which encourages wider acceptance of LDN in contemporary medicine, and is dedicated to exploring myriad uses that may benefit. LDN Now cites studies by the Penn State team of Dr. Ian Zagon and Dr. Patricia McLaughlin, who specialize in next-generation therapies.
Located in Virginia, the Barr Center for Innovative Pain and Regenerative Therapies—founded by Dr. Lisa Barr—maintains a page on LDN. The Center has also found that LDN is effective for reducing chronic pain, and like other research outlets, confirms the safety, effectiveness, and low cost.
And finally, www.lowdosenaltrexone.org, founded by Dr. David Gluck, is devoted to the use of LDN for all of the conditions mentioned above. In a recent editorial, Dr. Gluck suggests that LDN may also boost the immune system, to help ward off COVID-19.
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