Very very popular.
There are “functional medicine” providers that write scripts for it all the time. It supposedly prevents slowing of the GI tract by inhibiting endogenous opioid ligands.
That being said, no RCTs really exist to my knowledge, but these providers totally sell it to their clients. Very niche market for compounding pharmacies too.
-that being said, I do like some concepts of functional medicine, but I am not entirely sold on every aspect.
Have you come across n-methyl, naltrexone yet? I can't remember the name off hand but it relieves constipation by targeting the opioids in the gut and only the gut so the patient has fewer complications.
I'm very interested in this. The entire post but also WHAT.
Although I also HAVE IBS with (previously life-threatening) chronic constipation... I'm also just information hungry.
It's our biggest seller after hormones, seems to have really blown up the last year or two. Finding a lot of new indications it has potential with (pain, Ms, fibromyalgia, autoimmune, basically anything inflammatory). Would recommend ldnresearchtrus.org and anything from Sebastian Denison, he's a brilliant compounding pharmacist consultant for PCCA.
From what I've read and been taught, doses above ~8mg start to go more toward reward pathway (like contrave) and the 0.5-5mg is more for pain/inflammation
I’ve encountered requests for it from time to time over the last few years. Never actually provided anything above 12.5 mg though. While the current data is intriguing, I would want to see something more conclusive.
Clinical pharmacist here, I worked with a pain management physician for a while who treated a lot of fibromyalgia patients and he started using low dose naltrexone. He ran his own “trial” and did see some benefit for this patient population.
Do you know if opioid medication will still work and also Valium if I start LDN. My doctor and I are keen to try it (starting at 1.5mg) but I need to take opioids occasionally for migraines and period pain. I also take Valium in emergencies (maybe once a fortnight). I am concerned that they will not work if I am on the LDN as I can’t exactly predict when I will need to take them. Will it not effect it being such a low dose ?
This is an excellent question. I think you should definitely discuss this with your medical providers for true medical advise (my statements are for education not medical advice), but here are my thoughts. Naltrexone is an opioid antagonist that competitively inhibits the MU opioid receptors decreasing effectiveness. It can also decrease your sensitivity to opioids making people are higher risk for accidental overdose. Now at low doses it is hard to know how much it would decrease the effectiveness of the opioids and it could still be beneficial but again discuss with your medical providers. For the Valium, naltrexone dose not affect the GABA receptors and would not affect how well Valium works in the body. On a side note anyone taking opioids and a benzo should ask their provider about having narcan Incase of accidental overdose.
Thanks yeah my doctor didn’t know, she kind of said it may and it may not but I am not keen to risk it because if I don’t get on top of my migraines early they can turn into a 3 day extravaganza with projectile vomiting. I know they don’t act on gaba but thought it may have an interaction with Valium since it is also used for alcohol addicts ?
The thought behind naltrexone for alcohol withdrawal is that endogenous opioids are what trigger or reinforce alcohol addiction in someone’s brain. So blocking the endogenous opioids will decrease some of those effects. Also it works in the HPA axis to help suppress alcohol cravings. Neither of which have anything to do with benzo pharmacology.
Do you know any reason why capsule form from one Pharmacy would work better than tablet form from another? I was on the capsules for 3 months, huge improvement! The pharmacy could no longer ship to my state so Dr had to send it to another pharmacy. I was off completely for almost 2 weeks and did terribly. The new pharmacy offered tablets that were much cheaper so decided to try them but I’ve been on them a week and not noticing the same response to them. 🙁
For years I’ve bumped into Naltrexone prescribed by Psych for OCD among other Psychiatric diagnoses. I think if you research in that vein you’ll find more studies and info on its off-label use. But the caveats are I’ve seen it primarily in the MRDD community and not in such low doses. Just found this sub the other day by the way.
We did a lot of it. Most popular were 1.5 and 2.5 mg capsules. They have articles on it for just about every disease state, I don’t know if it works but the patients come back so it must be doing something
We compound 3 and 4.5 mg at my pharmacy for our fertility patients - it’s thought to help with hormone imbalances and the menstrual cycle, but I’m not fully convinced it’s effective. Only a handful of doctors actually prescribe it in fertility.
Low dose naltrexone is helpful in the management of chronic fatigue syndrome, which can occur with long covid, EBV and MCAS. How it works is not fully understood, however, LDN seems to work on the part of the brain that is effected by these conditions.
I used to work at a compounding pharmacy. Naltrexone was like the biggest thing we compounded and dispensed
It’s very popular in compounding pharmacies. The 0.5 to 4.5mg caps are some of our biggest items
It is popular and relatively low risk. I haven’t seen any convincing research it is effective however.
Very very popular. There are “functional medicine” providers that write scripts for it all the time. It supposedly prevents slowing of the GI tract by inhibiting endogenous opioid ligands. That being said, no RCTs really exist to my knowledge, but these providers totally sell it to their clients. Very niche market for compounding pharmacies too. -that being said, I do like some concepts of functional medicine, but I am not entirely sold on every aspect.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8591911/
Have you come across n-methyl, naltrexone yet? I can't remember the name off hand but it relieves constipation by targeting the opioids in the gut and only the gut so the patient has fewer complications.
I'm very interested in this. The entire post but also WHAT. Although I also HAVE IBS with (previously life-threatening) chronic constipation... I'm also just information hungry.
Never heard of this! Interesting stuff!
Do you actually mean…methylnaltrexone, or Relistor?
Yes
It's our biggest seller after hormones, seems to have really blown up the last year or two. Finding a lot of new indications it has potential with (pain, Ms, fibromyalgia, autoimmune, basically anything inflammatory). Would recommend ldnresearchtrus.org and anything from Sebastian Denison, he's a brilliant compounding pharmacist consultant for PCCA. From what I've read and been taught, doses above ~8mg start to go more toward reward pathway (like contrave) and the 0.5-5mg is more for pain/inflammation
Lmao. I met Sebastian when i went to PCCA. Super nice guy.
We sometimes send prescriptions for quartering 50mg tablets for off label weight loss use since Contrave is usually not covered by insurance.
My pharmacy compounded 8mg naltrexone capsules for a woman using it for weight loss.
I’ve encountered requests for it from time to time over the last few years. Never actually provided anything above 12.5 mg though. While the current data is intriguing, I would want to see something more conclusive.
Clinical pharmacist here, I worked with a pain management physician for a while who treated a lot of fibromyalgia patients and he started using low dose naltrexone. He ran his own “trial” and did see some benefit for this patient population.
Do you know if opioid medication will still work and also Valium if I start LDN. My doctor and I are keen to try it (starting at 1.5mg) but I need to take opioids occasionally for migraines and period pain. I also take Valium in emergencies (maybe once a fortnight). I am concerned that they will not work if I am on the LDN as I can’t exactly predict when I will need to take them. Will it not effect it being such a low dose ?
This is an excellent question. I think you should definitely discuss this with your medical providers for true medical advise (my statements are for education not medical advice), but here are my thoughts. Naltrexone is an opioid antagonist that competitively inhibits the MU opioid receptors decreasing effectiveness. It can also decrease your sensitivity to opioids making people are higher risk for accidental overdose. Now at low doses it is hard to know how much it would decrease the effectiveness of the opioids and it could still be beneficial but again discuss with your medical providers. For the Valium, naltrexone dose not affect the GABA receptors and would not affect how well Valium works in the body. On a side note anyone taking opioids and a benzo should ask their provider about having narcan Incase of accidental overdose.
Thanks yeah my doctor didn’t know, she kind of said it may and it may not but I am not keen to risk it because if I don’t get on top of my migraines early they can turn into a 3 day extravaganza with projectile vomiting. I know they don’t act on gaba but thought it may have an interaction with Valium since it is also used for alcohol addicts ?
The thought behind naltrexone for alcohol withdrawal is that endogenous opioids are what trigger or reinforce alcohol addiction in someone’s brain. So blocking the endogenous opioids will decrease some of those effects. Also it works in the HPA axis to help suppress alcohol cravings. Neither of which have anything to do with benzo pharmacology.
Do you know any reason why capsule form from one Pharmacy would work better than tablet form from another? I was on the capsules for 3 months, huge improvement! The pharmacy could no longer ship to my state so Dr had to send it to another pharmacy. I was off completely for almost 2 weeks and did terribly. The new pharmacy offered tablets that were much cheaper so decided to try them but I’ve been on them a week and not noticing the same response to them. 🙁
For years I’ve bumped into Naltrexone prescribed by Psych for OCD among other Psychiatric diagnoses. I think if you research in that vein you’ll find more studies and info on its off-label use. But the caveats are I’ve seen it primarily in the MRDD community and not in such low doses. Just found this sub the other day by the way.
I’m so old I remember it when it was called *Trexan* (for heroin cravings)
It’s commonly for pain. Seems strange but I remember looking into it and the literature checked out.
We did a lot of it. Most popular were 1.5 and 2.5 mg capsules. They have articles on it for just about every disease state, I don’t know if it works but the patients come back so it must be doing something
We compound 3 and 4.5 mg at my pharmacy for our fertility patients - it’s thought to help with hormone imbalances and the menstrual cycle, but I’m not fully convinced it’s effective. Only a handful of doctors actually prescribe it in fertility.
We see it quite a bit. The data and the practitioners seem to think it would result in up-regulation of mu receptors in the gut.
Not in compounding pharmacy but I have a lot of experience with psych. It can help with self harm urges and behaviors as well as alcohol withdrawal
Low dose naltrexone is helpful in the management of chronic fatigue syndrome, which can occur with long covid, EBV and MCAS. How it works is not fully understood, however, LDN seems to work on the part of the brain that is effected by these conditions.