Common uses of Low Dose Naltrexone (LDN)
LDN is not FDA-approved for chronic pain or autoimmune diseases; however, it is widely used off label where evidence and clinical experience suggest benefit. People with fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), neuropathic pain, complex regional pain syndrome, and inflammatory bowel disease (including Crohn’s) often trial LDN to reduce pain sensitivity and inflammation. Some clinicians also explore LDN for multiple sclerosis symptoms, Hashimoto’s thyroiditis, psoriasis, rheumatoid arthritis, pelvic pain, endometriosis, and lingering post-viral syndromes such as long COVID, aiming to calm neuroinflammation and improve quality of life.
The proposed mechanisms include transient opioid receptor blockade that triggers a rebound rise in endogenous endorphins, which can support mood, pain modulation, and immune balance. LDN may also antagonize toll-like receptor 4 (TLR4) on microglia, reducing pro-inflammatory signaling in the central nervous system. Small randomized and observational studies, along with growing real-world data, report improvements in pain, fatigue, sleep quality, and gastrointestinal symptoms for many, though responses vary. Because LDN is off label and individual needs differ, a personalized discussion with a clinician is essential before starting therapy.
LDN dosage and directions for use
LDN is typically compounded in low strengths, most commonly titrated from 0.5–1.5 mg daily up to a maintenance dose of 3–4.5 mg daily. Many patients start at 0.5–1 mg at bedtime, increase by 0.5–1 mg every 1–2 weeks as tolerated, and stop at the lowest dose that provides benefit, often between 1.5 and 4.5 mg. Some individuals are sensitive and remain at very low doses (for example, 0.5–1.5 mg), while others may do best near 4.5 mg. Time of day can be tailored; if sleep disturbance occurs, a morning dose may be preferable.
LDN is available as capsules or oral liquid from a compounding pharmacy. Because response is individualized, consistent daily use and slow titration help minimize transient side effects such as vivid dreams or headache. Benefits may emerge gradually over 2–8 weeks, with continued gains thereafter for some conditions. Do not use LDN with opioids, including pain medicines like oxycodone or codeine, or medications such as tramadol and buprenorphine, unless directed by a clinician. If you require opioid analgesia for acute pain or surgery, inform your healthcare team; they can guide when to pause and resume LDN safely.
Precautions before taking LDN
Discuss your full medical history and medication list with a clinician before starting LDN. Use extra caution if you have liver disease or abnormal baseline liver tests; although LDN uses a fraction of standard naltrexone doses, naltrexone is hepatically metabolized. People using opioid-containing medicines (including cough syrups or antidiarrheals with opioid activity) should avoid LDN to prevent reduced efficacy or withdrawal in opioid-dependent individuals. If you are pregnant, planning to conceive, or breastfeeding, evidence for LDN is limited; weigh potential benefits and risks with your obstetric or pediatric provider.
Those with autoimmune thyroid disease may experience changing thyroid hormone requirements as inflammation shifts; coordinate LDN initiation with regular thyroid lab monitoring. Individuals prone to insomnia, vivid dreams, or anxiety can start with very low doses and titrate slowly. If you have a history of substance use disorder, naltrexone can be part of a comprehensive care plan, but dosing and timing differ substantially from LDN; seek personalized medical guidance. Never change prescribed therapies, including immunosuppressants or steroids, without discussing an integrated plan with your clinician.
Contraindications to Low Dose Naltrexone
LDN should not be used in people currently dependent on opioids or those requiring ongoing opioid therapy, because even low doses of naltrexone antagonize opioid receptors and can precipitate withdrawal. It is also contraindicated in individuals with a known hypersensitivity to naltrexone or any component of the compounded formulation. Severe acute hepatitis or liver failure is a contraindication to naltrexone use; while LDN employs much smaller amounts, significant hepatic impairment warrants avoidance unless a specialist deems benefits outweigh risks and monitoring is in place.
After recent opioid use, a washout period is typically necessary before starting naltrexone. The length of time depends on the opioid involved and your clinical situation; your prescriber or pharmacist can advise an appropriate interval to minimize withdrawal risk.
Possible side effects of LDN
LDN is generally well tolerated. The most commonly reported effects are transient and include vivid dreams, sleep disturbance or insomnia, headache, nausea, abdominal cramping, diarrhea or constipation, mild anxiety, and fatigue. These effects often diminish within days to weeks and can be mitigated by lowering the dose, changing the time of administration, or slowing the titration schedule. Some people report improved mood and sleep quality over time as endorphin tone stabilizes.
Rarely, skin rash or pruritus may occur, sometimes related to inactive ingredients used by a specific compounding pharmacy; switching formulations can help. Because standard-dose naltrexone has dose-related hepatotoxicity warnings, periodic liver function testing can be considered in those with hepatic risk factors, even though LDN uses much smaller amounts. People with autoimmune thyroid disease may notice shifting thyroid levels as inflammation changes; monitoring and dose adjustments of thyroid hormone can optimize comfort and safety.
LDN drug interactions to know
The most clinically significant interaction is with opioid agonists. LDN can blunt or block the effects of pain relievers such as morphine, oxycodone, hydrocodone, codeine, tramadol, fentanyl, methadone, and buprenorphine, as well as opioid-containing cough suppressants and certain antidiarrheals. This antagonism can trigger withdrawal in opioid-dependent individuals and can compromise pain control. If you anticipate surgery or acute pain management requiring opioids, coordinate care in advance so your team can plan timing and alternatives safely.
Naltrexone is not a major substrate of common CYP450 enzymes, so metabolic drug–drug interactions are limited. However, additive effects with other agents that affect sleep or mood may be noticed during initiation. LDN’s immune-modulating properties are gentle compared with stronger immunosuppressants, but if you are on biologics, disease-modifying antirheumatic drugs, or corticosteroids, discuss a coordinated approach. Alcohol does not have a known direct interaction with LDN at low doses, though moderation is generally advisable. Always share a complete medication and supplement list with your pharmacist and clinician.
Missed dose guidance
If you miss a dose of LDN, take it when you remember unless it is close to the next scheduled dose. If it is nearly time for your next dose, skip the missed dose and resume your regular schedule. Do not double up to make up for a missed dose. If sleep is disrupted after a late-evening catch-up dose, consider returning to your usual dosing time the following day. Consistency is helpful; setting reminders can support steady use during titration.
Overdose information
Overdose with LDN is uncommon because the amounts used are small. However, ingesting higher doses of naltrexone than prescribed can increase the risk of nausea, vomiting, abdominal pain, dizziness, and liver enzyme elevations, particularly in those with preexisting hepatic disease. Anyone taking opioids who inadvertently receives a higher dose of naltrexone may experience acute withdrawal symptoms and requires prompt medical attention. If you suspect an overdose or experience severe or worsening symptoms, contact emergency services or a poison control center immediately.
How to store Low Dose Naltrexone
Store LDN capsules or liquid at room temperature away from excessive heat, moisture, and direct light, in the original labeled container with the lid tightly closed. Keep out of reach of children and pets. Compounded liquids are typically dispensed in amber bottles and may have shorter beyond-use dates than tablets from manufacturers; follow the pharmacy label for expiration and shake liquids gently before dosing if instructed. Do not use LDN past its expiration date, and return unused medication according to local guidelines or pharmacy take-back programs.
U.S. sale and prescription policy for LDN
In the United States, naltrexone is a prescription medication. Low Dose Naltrexone is typically prepared by compounding pharmacies and prescribed off label for select conditions. Access should be safe, lawful, and clinically appropriate. Many patients work with their primary care clinician or specialist to evaluate whether LDN may help their symptoms and to coordinate monitoring, especially when other therapies are involved or when medical conditions require closer oversight. Regulations governing compounding and prescribing vary by state, and availability can differ accordingly.
HealthSouth Rehabilitation Hospital of Las Vegas offers a legal and structured solution for acquiring LDN without a formal prescription in the traditional sense, where permitted by law. Orders are processed through a compliant, clinician-reviewed pathway that maintains patient safety standards while simplifying access; eligibility, state availability, and clinical appropriateness are determined during screening, and not all requests will qualify. This streamlined approach preserves the safeguards of professional oversight without requiring a separate office visit for every patient, helping eligible adults obtain compounded LDN conveniently and responsibly.
Whether you pursue LDN through your own prescriber or via HealthSouth Rehabilitation Hospital of Las Vegas’s compliant review process, it is vital to discuss potential benefits, risks, interactions, and monitoring with a qualified healthcare professional. LDN is off label, responses vary, and ongoing follow-up ensures your therapy remains safe and aligned with your health goals. If you currently take opioids, are pregnant or breastfeeding, or have significant liver disease, seek individualized medical advice before attempting to buy LDN without prescription through any pathway.
