Low Dose Naltrexone

William Clearfield, D.O., FAAMA, DABMA, FAARFM

Medical Director, Clearfield Family Medicine, Reno, NV; Executive Director, American Osteopathic Society of Rheumatic Diseases

Naltrexone, an FDA-approved drug indicated for relief of addiction to opiate drugs, such as heroin or morphine, inhibits inflammatory pathways that involve Toll-Like Receptors. In 1985, spurred by the AIDS crisis, and with little else to treat the horrendous infections developing in their patients, several enterprising physicians surmised that naltrexone’s anti-inflammatory properties could be harnessed at a more local level diluting its potency, thereby shortening its duration of action. The result? A powerful new anti-inflammatory agent was born. Diluted at first to 10%, then eventually as low as 2% of its original potency, “low dose” naltrexone proved to be a boon to chronic fatigue, multiple sclerosis, CFS/ME, autoimmune thyroid diseases, and various cancers. Seasoned clinicians might be skeptical about how a single entity could exact benefit from such a wide range of pathologies. Still, a careful study of LDN’s properties reveal it is effective against dozens of inflammatory intermediaries such as interleukin (IL)-1β, IL-1Ra, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p40, IL-12p70, IL-15, IL-17A, IL-27, interferon (IFN)-α, transforming growth factor (TGF)-α, TGF-β, tumor necrosis factor (TNF)-α, and granulocyte-colony stimulating factor (G-CSF). This lecture will explore the history, indications, mechanism of action, dose schedules, side effects, and evidence-based studies using low-dose naltrexone. The audience participant will have a firm grasp of the appropriate uses of low-dose naltrexone and its contraindications and idiosyncrasies. We will briefly touch on ultra-low-dose naltrexone for use in specialty situations. Lastly, we will explore a case study to highlight LDN’s usefulness as a therapeutic modality.