Naltrexone is an opiate receptor antagonist used in high doses (50 mg or more) on a daily basis for alcohol or narcotic dependence. Smaller doses (usually 3-5 mg) at bedtime, called low dose naltrexone (LDN), have been advocated by different groups for years to treat a number of conditions including HIV, fibromyalgia, cancer, inflammatory bowel disease and MS, to name just a few. The general hypothesis, for which there is little direct clinical evidence, is that a low bedtime dose of naltrexone helps modulate the immune system in beneficial ways. What is known is that low doses of naltrexone at bedtime paradoxically increase your own endogenous opiate levels; these are substances called endorphins and enkephalins. This makes everything feel a little better. Studies in MS are virtually non existent; a small study by Bruce Cree and colleagues at UCSF suggested that low dose naltrexone may improve well being and pain and daytime fatigue over the short term but there is no evidence that LDN effects the course of the disease. We also do not know if it is safe in long term use. I find that patients often feel better on LDN, particularly those with sleep disorders and discomfort at night; so I will use it for this purpose with attempts at weaning the medication over time. As of now, there is no evidence of any abuse or additive potential to this drug. The drug is not available in this dose formulation so it must be obtained through a compounding pharmacy.
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