The People's Perspective on Medicine

Low Dose Naltrexone for Fibromyalgia and Other Nasty Conditions

Chronic pain is challenging to treat. Standard therapies have drawbacks. That's why there is growing interest in low dose naltrexone for fibromyalgia.
Middle age hispanic woman standing over grey grunge wall suffering from headache desperate and stressed because pain and migraine. Hands on head.

Most health professionals are familiar with the drug naloxone (Narcan). They inject it when someone has overdosed on an opioid to reverse the effects. This medication has saved countless lives by homing in on opioid receptors in the brain like a guided missile. It kicks fentanyl, heroin, morphine and other opioids off those receptors. Within seconds, many overdose victims awaken and start breathing again. Most people are less familiar with naloxone’s chemical cousin, naltrexone. This oral medicine is also an opioid antagonist. It lasts longer and works to curb cravings from opioids and alcohol. Intriguing new data suggest that low dose naltrexone for fibromyalgia and other painful conditions may be worthy of consideration.

A Reader Inquires About Low Dose Naltrexone for Fibromyalgia:

Q. Why haven’t you written about naltrexone? It
has been used at low doses (LDN) to treat
fibromyalgia and myalgic encephalomyelitis. ME
is the new term for chronic fatigue syndrome.

A. Actually, we have written about low dose naltrexone for fibromyalgia and other hard-to-treat conditions such as complex regional pain syndrome, Crohn’s disease and multiple sclerosis. Here is a link:

Low Dose Naltrexone Worked for Pain
People with chronic pain from fibromyalgia, MS or complex regional pain syndrome have few options. Low dose naltrexone is a novel approach gaining converts.

Naltrexone has been available for decades. The FDA has approved this medication for helping people overcome alcohol dependence. It also has the FDA’s blessing to block the effects of opioids.

The FDA went out of its way to say:

“Naltrexone hydrochloride tablets USP 50 mg has not been shown to provide any therapeutic benefit except as part of an appropriate plan of management for the addictions.”

In other words, the FDA does not approve of naltrexone for any other uses. Please note that the dose the FDA is referring to is 50 mg. That is the amount that is used to curb alcohol cravings or overcome the impact of opioids. Low dose naltrexone for fibromyalgia or other conditions is way lower (1.5 to 4.5 mg). That’s less than one tenth of the “standard” FDA-approved dose.

Low Dose Naltrexone for Fibromyalgia and Nerve Pain:

Some physicians are prescribing low-dose naltrexone off label for a number of other conditions, including fibromyalgia, ME, multiple sclerosis, Crohn’s disease, inflammatory bowel disease and amyotrophic lateral sclerosis (ALS, aka Lou Gehrig’s disease) (NIPH Systematic Reviews, April 2015).

Although research shows that LDN may work by restoring the function of transient receptor potential (TRP) ion channels, we have not seen large clinical trials for these indications (Frontiers in Immunology, Oct. 31, 2019).

How Does Low Dose Naltrexone for Fibromyalgia Work?

Dr. Bruce Vrooman is an associate professor of anesthesiology at the Dartmouth Geisel School of Medicine.

He told Alex Smith, a health reporter for KCUR/NPR (Jan. 16, 2019) that:

“…when it comes to treating some patients with complex chronic pain, low-dose naltrexone appears to be more effective and well-tolerated than the big-name opioids that dominated pain management for decades.

“Those patients may report that this is indeed a game changer,” Vrooman says. “It may truly help them with their activities, help them feel better.”

Alex Smith goes on to note:

“So how does it work? Scientists think that for many chronic pain patients, the central nervous system gets overworked and agitated. Pain signals fire in an out-of-control feedback loop that drowns out the body’s natural pain-relieving systems.

“They suspect that low doses of naltrexone dampen that inflammation and kick-start the body’s production of pain-killing endorphins — all with relatively minor side effects.

“Despite the promise of low-dose naltrexone, its advocates say few doctors know about it.”

Dr. Vrooman and a colleague have reviewed the medical literature on low-dose naltrexone. They analyzed its clinical use for fibromyalgia, MS, Crohn’s disease, cancer and complex-regional pain syndrome.

Here is their analysis of one randomized controlled trial and their conclusions about low dose naltrexone for fibromyalgia (Medical Sciences, Sept. 21, 2018): 

“More than a half (57%), were considered responders per criteria used in the previous study. Patients’ satisfaction with life and mood was significantly better while taking LDN [low dose naltrexone]. Due to no reported side effects in the pilot study, it was interesting that vivid dreams and headaches appeared more commonly while taking LDN, even though the treatment was rated equally tolerable as placebo. These side effects were minimized once the LDN dose was lowered to 3 mg per day.

“Based on current reports of numerous benefits and an excellent safety profile, clinical use of LDN [low dose naltrexone] may be seen as a reasonable option in patients with fibromyalgia or IBD [inflammatory bowel disease].”

How Safe Is Low Dose Naltrexone for Fibromyalgia?

The FDA is surprisingly upbeat about the overall safety profile of naltrexone.

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Remember, the dose used in alcoholism trials is 50 mg, more than ten times the LDN dose.

“During two randomized, double-blind placebo-controlled 12 week trials to evaluate the efficacy of naltrexone hydrochloride as an adjunctive treatment of alcohol dependence, most patients tolerated naltrexone hydrochloride well. In these studies, a total of 93 patients received naltrexone hydrochloride at a dose of 50 mg once daily. Five of these patients discontinued naltrexone hydrochloride because of nausea. No serious adverse events were reported during these two trials.

“Among opioid free individuals, naltrexone hydrochloride administration at the recommended dose has not been associated with a predictable profile of serious adverse or untoward events. However, as mentioned above, among individuals using opioids, naltrexone hydrochloride may cause serious withdrawal reactions.”

What Readers Have to Say:

G.I.S. offers this perspective on low dose naltrexone for fibromyalgia:

“I have had fibromyalgia for over 20 years. This is a very hard disease to treat. I have taken everything for fibromyalgia but the following work the best for me: Magnesium two, 200 mg tablets a day; Vitamin D3; Omega 3 fatty acids; B Complex; Probiotic; Vitamin C; Melatonin 5 mg for sleep; Flexeril for muscle pain; extra strength Tylenol (ONLY AS NEEDED) and low dose of naltrexone, 1 mg, three times a day and Voltaren prescription pain cream. Eating a high protein and low sugar diet AND staying away from caffeine helps me the most, diet-wise.

“It’s important to keep moving as much as possible and keep your weight down. People truly do not understand both of these diseases if they do not have them. You have pain, soreness, stiffness, mental fog, trouble sleeping, severe fatigue and barometric pressure can flare up the pain.

“Long soaks in epsom salts helps along with heat packs, and a massage tends to help tremendously. No two people are alike that have fibromyalgia or Hashimoto’s – so it is not a one-size-fits-all treatment.”

Tom shares this experience:

“I’ve been on low dose naltrexone for fibromyalgia for 3-4 months. Nothing has helped calm/relieve my pain like naltrexone. I’ve taken gabapentin, cyclobenzaprine and even tramadol.”

Sissy also noticed improvement:

“I have had fibromyalgia for years. I tried most of the standard treatments—Lyrica, gabapentin, Cymbalta. I was still miserable with pain, fogginess, and other side effects.

“I finally started researching for myself. I found low dose naltrexone. I asked my rheumatologist about it. He told me he did not prescribe opioids (LDN is NOT an opioid).

“I then asked my primary care doctor. He actually said he had heard of it and wrote a prescription to a compounding pharmacy, starting at a low dose. I could tell I was improving within a month. Foggy days and pain levels were lessened.

“A few years later, I am much improved. Not cured, but it’s the difference between night and day, and I could not be more grateful. The ONLY side effect was insomnia for the first few weeks, which now I understand could have been alleviated by taking LDN in the morning, instead of at night. I will never stop taking my LDN.”

Share your own story about low dose naltrexone for fibromyalgia or any other condition in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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  • Ringerike T et al, "The use of naltrexone in low doses beyond the approved indication [Internet]." Frontiers in Immunology, Oct. 31, 2019.
  • Tolian K & Vrooman B, "Low-dose naltrexone (LDN)-Review of therapeutic utilization." Medical Sciences, Sept. 21, 2018. DOI: 10.3390/medsci6040082
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I was diagnosed with fibromyalgia about 5 years ago. I was first put on Plaquenil. After one year, my rheumatologist had been to a seminar where they discussed the use of LDN. He suggested I go on it. I took the Rx to a local compounding pharmacy and had it filled. It took a couple of months, but nothing else has helped me like LDN.

I recently began exercising on a regular basis, watching my diet (less gluten), and I’ve lost about 15 pounds. Since changing my lifestyle, I feel more like my old self again. I still have some pain, however, I feel like I have my life back.

I am still taking LDN, and Plaquenil. My Rhuematologist wants to put me on methotrexate, but I am fighting against that for as long as I can. I am the type that doesn’t like to take ANY medicine.

LDN has been very helpful for my primary Sjogren’s pain, fatigue and fogginess. My pharmacy compounds a liquid for me which makes it easy to titrate to get an optimal dose and it’s less expensive than pills. My downside from LDN is hot flashes. Anybody have suggestions on how to minimize or alleviate those?

There is a great Facebook Group call Low dose Naltrexone (LDN) for chronic illness & infections. I have learned a lot from that group. Just a couple of things, it is important to start at a lower dose and work your way up to the standard dose of 4.5mg (some people end up going above 4.5). Also, it can work quickly for some and can take months or even a year to be helpful to others.

This scares me. A pill to sleep, a pill to get up,a pill to relate, a pill to stay calm, a pill to have sex, a pill for energy, a pill, a pill, any kind of pill.

Pharma’s investments look pretty good for the future.

I have autoimmune thyroiditis. I started taking LDN a year and a half ago, but then stopped when my antibody levels climbed. Thought the LDN was responsible. Gave up plastic and aluminium and tried again. Antibody levels have fallen by 1000 points every 6 weeks. I’m happy!!!

I have had severe Fibromyalgia for over 24 years and have tried EVERYTHING – diets, full range alternative, prescriptions, prescriptions, prescriptions(!) and have never gotten the relief that I have from Low Dose Naltrexone. I feel like I can live again. It has been a true Godsend! Each morning I literally kiss the pill and give thanks as I take it.

Naltrexone is not approved by the FDA for Fibromyalgia, and Lyrica has been removed a a medication for Fibro. I hope that MDs will stop using dangerous drugs off-label, thinking the medication will work. It doesn’t.

ME is not the new word for Chronic Fatigue Syndrome. The new name is S.E.I.D, Systemic Exertion Intolerance DISEASE, and is no longer considered a syndrome. The name is recognized by the NIH, WHO, and other hospitals and research facilities world-wider who study S.E.I.D, an article in the July 9, 2017 The New Yorker as well.

It’s time for pharma to create a medication that truly works on both illnesses. I have S.E.I.D. and am pleased that the name has been changed to reflect the fact that it’s a disease.

I can’t take NSAIDs for my arthritis, so when I read about Naltrexone as a possible treatment for pain, I discussed it with my doctor. He wasn’t opposed, wrote the prescription, and I took it to our local compounding pharmacy.

A month later, I was a hundred dollars thinner in the wallet, had never experienced any pain relief, and was tired of the “vivid dreams,” otherwise known as nightmares. I stopped taking the Naltrexone.

Another fleeting hope dashed. Ah, well.

I asked my Rheumatologist about prescribing low dose naltrexone for fibromyalgia and RA pain. He researched it and determined I could not take it because of elevated liver enzymes. Have studies been done on this aspect of treatment? I am limited to what I can take for pain, no Tylenol or Aleve. I can take Tramadol but with caution and am limited to the amount I can fill in a prescription. Massage and acupuncture are not covered by insurance and are way too expensive to do weekly. Heat, ice, and gentle stretches and exercise are what I do most, and they are not enough. Grape juice, certo, gin and raisins, turmeric etc. offer little to no relief. I have been on 4 different biologics. I got relief at first but all lost their effectiveness. Treatment or lack of treatment is very frustrating. I keep hoping for something that will bring relief from pain and stiffness.

I take savella 50 mgs twice a day, and it helps my fibromyalgia. I was on fentanyl for years before this. My husband was Rx low dose naltrexone for neuropathy, and it made him so sick. He could barely eat anything due to nausea. Needless to say, after his experience I am leery about trying it.

I found LDN from a compounding pharmacy to be quite expensive. Instead, I use a glass cylinder and measure 50 ml of filtered water. I place a 50-mg tablet of Naltrexone in a small, brown glass bottle and add the filtered water.
After the tablet dissolves, I use a plastic syringe to take the dosage I need (from 2 to 4 mg). I keep the solution in the refrigerator. Much more affordable.

LDN for psoriasis and psoriatric arthritis. Had recurring psoriasis over about 50% of body (age 80). 2 weeks on LDN,and it’s gone, never to return. Also, cured 93 yr-old mother-in-law of psoriasis, who had all the conventional treatments including UV, without much success.

After 1 1/2 years on LDN, my wife and I just don’t have colds anymore, even after extensive air travel. Maybe because we just believe in it. But who cares? Something works for us.

I make our own from 50mg pills. Buying LDN online ready-made is quite expensive.

It’s terrible that we should need a prescription for this stuff. Easy to do more harm with ordinary aspirin.

I used LDN to get off methotrexate for rheumatoid arthritis. Diagnosed in late 2012 I wanted to treat the cause (leaky gut) of my RA instead of just the symptoms. I’m so grateful I found a doctor who was willing to follow my suggestion and try LDN. I’ve been symptom free since 2013.

Any possibility of trying this for severe RLS?

Is there is any evidence for LDN to help psoriasis?

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