a young woman putting in eye drops, dry eye disase

Autoimmune diseases can be difficult to treat. In these conditions, the immune system that normally protects the body from invading pathogens gets disoriented and starts to attack bodily tissues. When the targets are tear ducts and salivary glands, the result is the symptoms of Sjogren’s syndrome. (It’s pronounced SHOW-grenz.) Treatments are often directed at these symptoms, primarily dry eyes and dry mouth. Sometimes people with Sjogren’s are treated with systemic medicines such as hydroxychloroquine (Plaquenil) or methotrexate (Rheumatrex, Trexall) to calm the immune system.

Looking for Treatments to Ease Symptoms of Sjogren’s Syndrome:

Q. My wife has Sjogren’s syndrome and some other autoimmune problems. She is currently taking Plaquenil, which worries us because it can cause serious vision problems.

I found a reference to using low-dose naltrexone as an alternative treatment with few side effects. Can you comment on the efficacy of this drug for autoimmune problems? I didn’t find any solid studies, just anecdotal information.

What Is Naltrexone?

A. Naltrexone is an oral form of the opioid antagonist naloxone. At the standard 50 mg dose, it is approved for treating alcoholism and other substance abuse disorders.

Off-label, low-dose naltrexone (1 to 4.5 mg) is being considered for use against chronic pain (Bostick et al, Senior Care Pharmacist, Jan 1, 2019), fibromyalgia (Metyas et al, Current Rheumatology Reviews, 2018) and certain autoimmune conditions (Li et al, International Immunopharmacology, Aug. 2018). It may work in part by binding to opioid receptors on immune system cells.

No Studies on Naltrexone for Symptoms of Sjogren’s:

We haven’t found any studies of low-dose naltrexone for symptoms of Sjogren’s syndrome, which causes dry mouth, dry eyes and complications affecting other organs. Researchers need to conduct well-controlled trials to determine if this drug would be helpful.

In the meantime, you and your wife should discuss your concerns with your wife’s doctor. There might be ways to mitigate the risk of side effects from Plaquenil. The doctor may also be willing to supervise a trial of low-dose naltrexone, since there appear to be few adverse effects.

Learn More:

We have written about using low-dose naltrexone for pain and naltrexone at regular doses to treat alcohol abuse disorder.

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  1. Cathy

    I am looking at the LDN as something to help reduce my very high inflammation number. I tried the Keto eating plan for 4 months and my CRP number almost tripled . Could LDN be a way to get this back in control ?

  2. Monica R.

    I was diagnosed with RA in 2009. I was put on Naprosyn, and after some time I didn’t feel any different, so I started on a Natural Rheumatoid Arthritis Formula treatment protocol from RICH HERBS FOUNDATION (ww w. richherbsfoundation. com). The treatment made a great difference for me. It effectively treated my Rheumatoid Arthritis and symptoms. The swellings, stiffness, fatigue and joint/muscle/body pains have subsided. I feel better overall than I have felt in years.

  3. Mary

    I have read that LDN (Low Dose Naltrexone) can work some miracles.
    Just try & get it, though. To the best of my knowledge, it needs to be formulated specially and is not readily available.

  4. Brenda
    New Mexico

    Erica, I take LDN for both fibromyalgia and arthritis, and it helps tremendously. Because of other medicines that I take I already have to take stool softeners for constipation so I have not noticed any problem with LDN. I did want to mention that you need to start taking a very low dose of LDN like 1/2 mg and work your way up otherwise most people are not successful starting it because of insomnia. They tell you to take it at bedtime but with my circadian rhythm I ended up taking it in the morning and it works great for me. LDN has been a miracle pain medicine for me. I used to be on Percocet and now I don’t have to! Good luck and God bless.

  5. Lynn

    Sjogren’s is the second most common autoimmune disease after rheumatoid arthritis. Rheumatologists are only recently becoming more aware of the disease and its symptoms and how to treat it. Pilocarpine is used to increase saliva and help secretion of moisture producing glands. Plaquenil is an immune suppressant often prescribed for systemic symptoms such as fatigue. It depends on your rheumatologists knowledge and treatment approach what medications, if any, you may be prescribed. Other physicians, such as ophthalmologists or dentists, may treat specific issues. Being proactive on your behalf and becoming knowledgeable, while not easy with this disease, is beneficial. If you have some knowledge of Sjogren’s when you visit your doctor, it can help with your discussion and treatment.

  6. Rm
    Butte County CA

    I’m surprised at Sharon from Florida’s comments about Low Dose Naltrexone since the only side-effect listed is “vivid dreaming”. I have been taking LDN for 8 years and have NEVER experienced a change in my bowels. Perhaps there was another reason her bowels were impacted? I know that in my experience, LDN has retarded the progress of Linear Scleroderma.

  7. Erika

    Sharon, how was your bowel impacted? What happened? Did you have pain or constipation, or diarrhea? I’m about to try LDN for Fibromyalgia and arthritis pain but I’m afraid of the side effects if there are any. Please respond with details of your experience. Thank you.

  8. BETTY

    I am taking pilocarpine for SJOGREN’S – have not been offered Plaquenil.

  9. Lynn

    I have Sjogren’s, the second most common autoimmune disease after rheumatoid arthritis. While Sjogren’s causes dry eyes and mouth, it is a systemic disease that commonly has fatigue and arthritis among its symptoms, which is why Plaquenil is frequently prescribed.
    I have been taking LDN for many years through an integrative physician to modulate my immune system. While LDN may not help specific symptoms of Sjogren’s, like dry eye and mouth, it helps modulate the immune system and reduce inflammation, which in turn helps the inflammatory symptoms of your autoimmune disease. Half of all Sjogren’s patients also have more than one autoimmune disease.

    In regard to the person whose wife uses Plaquenil, more frequent visits to the ophthalmologist are necessary to check for any damage. You do have to weigh the risks of this medication as with any other. There are other helpful lifestyle treatments for symptoms of Sjogren’s as well (see sjogrens.org). Lifestyle changes and complimentary medicine such as acupuncture can be helpful for fatigue, arthritis and other issues as well. More than one approach may be well be necessary for a good quality of life.

    If we were all the same, it would be much easier for physicians to prescribe and patents to be treated. We are each unique and we each react and tolerate treatments to varying degrees. While medicine is science it is an art as well.

  10. RSW

    In Julia Schopick’s best seller, “Honest Medicine,” she reports that Dr. Burt Berkson put his two aunts, both having Sjogren’s, on LDN, and they both had a complete improvement of symptoms. I also have Sjogren’s and take LDN everyday, but still have dry eyes and mouth, but my doctor and I both feel it may be helping me in other ways. It has no side effects and there isn’t really a downside to taking it. If it prevents sleep at night, just take it on an empty stomach in the morning. You can get more information by visiting the official site, http://www.ldninfo.org, and then joining the Yahoo Group mentioned at the top of that page, with over 14,000 people talk about and use LDN. They will answer your questions if you post. The LDN site is run by Dr. Gluck, a Harvard educated doctor and close childhood friend of Dr. Biheri, (also Harvrd educated, now deceased)who noticed in the 1980’s that Naltrexone, in very low doses, could modulate the immune system. Best wishes!

  11. Sharon

    I took Naltrexone low dose two days, and my bowels were impacted.

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