Low Dose Naltrexone for Multiple Sclerosis, What Happened?
Several years ago, a few studies reported promising results using low dose naltrexone for multiple sclerosis. Yet since that time, follow-up or new studies are virtually nonexistent, even though there have been some promising results and positive anecdotal reports from patients. What happened?
High doses of naltrexone are typically used to reverse the effects of heroin and other opiates. However, some research has shown that low doses of the drug—about 3.0 to 5.0 milligrams—can be helpful in various other situations, including multiple sclerosis, fibromyalgia, Crohns disease, pain, and even cancer.
Naltrexone, when taken at night before bedtime, is believed to work by blocking opioid receptors between 2 and 4 AM. This interference then results in an increase in the levels of the body’s natural pain relievers—endorphins and enkephalins.
Low dose naltrexone
According to David Gluck, MD, of the site LowDoseNaltrexone.org, “there is no longer any serious question remaining about the efficacy and safety of LDN.” He is referring not only to the use of low dose naltrexone for MS but for other conditions as well.
Gluck bases his statement on the results of numerous studies and trials in peer-reviewed medical journals and thousands of anecdotal reports. He also points fingers at the pharmaceutical industry and its profit-driven motives as a reason for the apparent lack of interest in this drug for multiple sclerosis and other purposes.
Specifically, he states that in his January 2014 article that “Big Pharma clearly uses the potential profitability of any individual candidate drug…to decide whether a new medication will or will not be tested.” He goes on to point out that “any off-patent generic drug [i.e., naltrexone] with a newly discovered usefulness…is for all intents and purposes, made unavailable by our system to the public because of its low profit potential for Big Pharma.”
Low dose naltrexone and multiple sclerosis
So, what studies of low dose naltrexone have been done regarding multiple sclerosis? Not a lot, but here are the highlights.
An often-referenced study is one conducted by scientists at the Multiple Sclerosis Center at the University of California, San Francisco. A total of 60 patients completed the double-masked, placebo-controlled, crossover trial that involved 8 weeks of treatment with 4.5 mg of naltrexone nightly and 8 weeks of placebo.
When taking naltrexone, the study participants reported a significant improvement in quality of life in the areas of pain, cognitive function, and mental health. In addition, they tolerated the drug well and no serious side effects were reported. Physical quality of life factors, such as bladder control, fatigue, and visual function, however, did not improve.
A small trial conducted in Italy followed 35 patients with primary progressive multiple sclerosis for six months. These participants took 5 mg of low dose naltrexone and experienced significant improvements in depression, fatigue, and spasticity. The price some paid for these results were sleep disturbances, urinary tract infection, or mild agitation. Only one patient experienced a worsening of neurological disability.
Another trial involved 96 patients with either relapsing-remitting or secondary progressive MS and was a double-blind, placebo-controlled, crossover design that lasted 17 weeks. Overall, the authors did not find low dose naltrexone to result in any significant difference in factors such as pain, energy levels, sexual function, emotional well-being, or brain functions. However, the authors also explained that the drug proved to be safe and that a longer trial was needed.
One of the most recently published reports on low dose naltrexone involved its use for inflammation and chronic pain. The reviewers noted that the drug appears to have anti-inflammatory activity in the central nervous system (CNS) through activity on microglial cells.
Microglial cells are the main immune system cells in the CNS and have inflammatory properties. Therefore, evidence that low dose naltrexone could fight inflammation in the CNS is significant.
Without naming multiple sclerosis in particular, the authors of the review pointed out that “LDN may represent one of the first glial cell modulators to be used for the management of chronic pain disorders.” Since about half of all people with multiple sclerosis experience chronic pain, low dose naltrexone appears to have a place in the treatment plan for some patients.
Low dose naltrexone has demonstrated an ability to help improve the quality of life of individuals who live with multiple sclerosis. Yet this off-patent, inexpensive drug has not garnered the attention of the big pharmaceutical companies. A search of ClinicalTrials.gov reveals no studies in the pipeline.
What has been your experience with low dose naltrexone? Have you ever talked to your healthcare provider about trying it?
Cree BA et al. Pilot trial of low-dose naltrexone and quality of life in multiple sclerosis. Annals of Neurology 2010 Aug; 68(2): 145-50
Gironi M et al. A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis. Multiple Sclerosis 2008 Sep; 14(8): 1076-83
Sharafaddinzadeh N et al. The effect of low-dose naltrexone on quality of life of patients with multiple sclerosis: a randomized placebo-controlled trial. Multiple Sclerosis 2010 Aug; 16(8): 964-69
Younger J et al. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clinical Rheumatology 2014 Apr; 33(4): 451-59
Khan A. Long-term remission of adenoid cystic tongue carcinoma with low dose naltrexone and vitamin D3—a case report. Oral Health and Dental Management 2014 Sep; 13(3): 721-24