Low-Dose Naltrexone for Fibromyalgia

[Reprinted with permission from the book From Fatigued to Fantastic by Jacob Teitelbaum MD (Avery/Penguin 2021)]

Low-dose naltrexone (LDN) is a remarkable compounded medication that can be very helpful for anybody with fibromyalgia, autoimmune illness, or chronic pain.

Put simply, virtually anybody with severe chronic pain should be put on LDN if they are not already taking narcotics. Interestingly, narcotics block the effect of low-dose naltrexone, whereas high-dose naltrexone blocks the effect of the narcotics.

Highly Effective and Inexpensive

There is a very large body of research and clinical experience showing this low-cost medication to be profoundly beneficial for chronic pain and autoimmune illness. Two studies have shown this for fibromyalgia alone.

The problem? The medication is off patent and relatively inexpensive, so it is nearly impossible to put through our regulatory process, regardless of the available research showing its efficacy. But your physician can prescribe it through compounding pharmacies such as Skip’s Pharmacy (the team at Skip's is very knowledgeable about LDN).

If LDN was patentable, it would have sailed through the FDA approval process (God knows the pharmaceutical industry has tried, despite it being generic). But then the treatment would probably cost $25,000 per person per year instead of $250 as it does now. And the pharmaceutical industry would have every physician convinced that they should prescribe it to everyone.

The bottom line? Your physician likely doesn't know anything about LDN beyond its blocking effect on narcotics. However, you might be able to talk your doctor into writing you a prescription for 50-milligram LDN pills to avoid your asking for narcotics instead

What to Know About LDN Treatment

There are several key points to know about this treatment:

1. It won’t work if you are taking narcotics.
2. Doses over 4.5 milligrams at night usually lose effectiveness (although we do see exceptions). A recent study of veterans with chronic pain found the 3-millgram dose to be more effective than 4.5 milligrams. The standard dose used by most physicians (to block the effect of narcotics in drug addicts) is 200 milligrams a day, and they come in 50-milligram pills from a standard pharmacy.
3. LDN can disrupt sleep in some at the beginning of treatment and may also trigger vivid dreams. For most people, this side effect goes away with time. Because of this concern, many compounding pharmacies offer an LDN “starting pack” so that you can begin treatment at a very low dose and gradually increase to the normal recommended amount. Overall, that’s a good idea. But better yet, I like to have the compounding pharmacy make a liquid LDN, which allows you to start with a dose as low as a hundredth of a milligram. I advise those I treat to find the dosage that is most comfortable for them—even to the extent of just carrying the bottle in their pocket for a week to help their psyche/body get used to it. Then, after the “Uh-oh, what’s this gonna do to me?” feeling has passed, even sensitive people can usually start with a really tiny dose and comfortably work up slowly. It's OK is one can’t take the full dose. Those who are sensitive often find that 1 mg or even less often works. Again, you need to be on your "comfortable" dose for a couple of months to see the effects.
4. To restate, it takes two full months to start working. When I first began using the treatment about twenty-five years ago, I only gave it three to four weeks to work, so I didn’t see the effectiveness and I abandoned it prematurely. You have to give it time.
5. I recommend people under 150 pounds take 3 milligrams at bedtime. Those over 150 pounds should take 4.5 milligrams.
6. After two months on the full dose, if finances are tight, there is the option of getting naltrexone in 50-milligram tablets (by prescription)  from their regular pharmacy so that it can be covered by insurance. You can grind the tablet up very finely with a mortar and pestle, mix it with about 3 ounces of water (83 milliliters to be exact), and shake it well to make a very inexpensive liquid supply. Taking 1 teaspoon (5 milliliters) a night will supply the 3-milligram dose. For the 4.5-milligram dose, mix the ground 50-milligram tablet in with 55 milliliters (just under 2 ounces) of water and take 1 teaspoon a night. This recipe will yield eleven doses.

After two months, this treatment can not only significantly reduce pain but also enhance overall well-being, including increased energy, improved cognitive function, and relief from various other symptoms.