Low Dose Naltrexone
 

Anyone here had success with Low Dose Naltrexone?

I am trying it for all over body neuropathic pain. So far after 6 days, not working. But I'm not up to optimal dose yet.

I take it for MS. 4.5 mg. daily taken at about 3 AM. I don't take it for pain mgmt. I take it for MS symptom mgmt. It works well for me but one of the side effects are vivid dreams. I believe it has prevented me from progressing with MS. I really won't know how much it's helping me unless I stop taking it and I'm not willing to risk throwing myself into an exacerbation to find out. ;)

I've heard of it used in conjunction with an opioid, but not by itself. Last I heard, this was an off-label use, but that may have changed as well. There's been a lot of chatter about it being used for neuropathic pain, but all I find seems to be several years old, and is either talking about studies being done or people asking questions similar to yours.

I think I would see it through, anyway, if that's bearable. I sincerely hope it works for you; from everything I've read it seems to hold great promise.

Best Wishes,

Doc

Quote: "I've heard of it used in conjunction with an opioid, but not by itself."

I used low dose naltrexone with an opioid, like Dr. Smith said. It was during a clinical trial. Johnson & Johnson was trying to make fentanyl patches with naltrexone in it, supposedly to make the fentanyl more effective. That was what the clinical trial doctors told me, but it did not make sense to me. This medication sent me to the Emergency Room twice: I was sooo sick and throwing up sooo much bile because I could not stand food, let alone a drop of water. The Emergency Room doctors told me the clinical trial doctors were not telling the truth when they claimed the naltrexone was supposed to make the fentanyl more effective. They discovered it was to prevent thr drug addicts from tampering with the patches to get high with the fentanyl. Grrr! These drug addicts are seriously starting to get on my nerves! It is because of them that we, chronic pain patients, have trouble getting access to narcotic painkillers when needed.

You don't have to answer this, but were you on any kind of opioid medication within 7 days of them giving you the patch with the naltrexone in it? If so, the naltrexone can induce immediate withdrawal symptoms. My understanding is that it's supposed to be given only with first-time opioid use, or with a carefully monitored switching procedure to avoid such a reaction.

IIRC, the idea of adding LD neltrexone to opioids is that it eliminates the euphoric effects and retards/prevents tolerance to the opioids.
Google: low dose naltrexone

Doc

Hi, Dr. Smith:

Quote: "Were you on any kind of opioid medication within 7 days of them giving you the patch with the naltrexone in it?" Before I was given the fentanyl patches with naltrexone in them, I was using the Janssen Duragesic fentanyl patches. The clinical trial was reserved for people who were using fentanyl patches (at that time, there were no generic fentanyl patches). Johnson & Johnson wanted to compare the fentanyl patches without naltrexone to the fentanyl patches with naltrexone.

Quote: "If so, the naltrexone can induce immediate withdrawal symptoms." The doctors who were taking care of the clinical trial told the Emergency Room doctors that the naltrexone was not supposed to get in the blood. In this case, replied one of the ER doctors, how could the naltrexone make the fentanyl more effective (this is what the clinical trial doctors claimed the naltrexone was supposed to do). The ER doctors thought that what the clinical trial doctors were claiming (the naltrexone supposedly making the fentanyl more effective) did not make any sense. The ER doctors thought the same thing as you, that is, that the naltrexone caused immediate withdrawal symptoms, which made me feel very, very sick.

Quote: "My understanding is that it's supposed to be given only with first-time opioid use, or with a carefully monitored switching procedure to avoid such a reaction." I did not know this. Did the clinical trial doctors and did Johnson & Johnson know this? They should have! Many people know that paramedics often use the naltrexone to reverse the overdose of heroin addicts. Of course, that must cause withdrawal symptoms in these addicts.

Quote: "The idea of adding LD neltrexone to opioids is that it eliminates the euphoric effects and retards/prevents tolerance to the opioids." The ER doctors thought they added the naltrexone to the fentanyl patches (at that time, these patches had a reservoir with the fentanyl in it) so that if a drug addict tampers with the patches to try to get high, the naltrexone would somehow get in the blood, mix with the fentanyl, and make it ineffective to protect the drug addicts from death by overdose from getting the fentanyl all at once. This is a bit confusing to me, but I think what the clinical trial doctors said is not clear. There is a lie or hiding the truth somewhere.

I just googled this medication and I don't understand why it is used together with opioids. Here is what it said," Naltrexone is in a class of medications called opiate antagonists. It works by decreasing the craving for alcohol and blocking the effects of opioid medications and opioid street drugs."

This states it blocks the effects, does that mean that is also blocks the active agents that help with the pain? I'm totally confused! It also said it is used for off label use and such just like other medications are. But this is scary.

Gabbycakes

Hi kittycapucine1974,

Is it possible that in this case you may be confusing naltrexone with naloxone? AFAIK, naloxone is used to counter the effects of heroin or morphine overdose, while naltrexone is used for dependence treatment rather than emergency overdose treatment.

I agree with this and pretty much everything else you said. There is some acknowledged controversy about all of this, and this is why studies are being done (and it's important that they are being done) to find out.

As I understand it, they should have brought your opioid levels down considerably before trying this, and even then there is a specific protocol that must be adhered to and carefully monitored. Somebody (and possibly more than one) messed up.

Doc

Ok, I'm not a doctor, or even a chemist, so I don't understand some of the technical stuff either. Maybe someone else here does(?) The information I get is from reading this same stuff (and some discussions from patients who've been involved).

As I understand the material, the addition of LDN supposedly blocks the euphoric effects (those that cause addiction) but not the therapeutic effects (those that alleviate pain) and also supposedly reduces/eliminates tolerance (needing more opioid for the same effect over time).

This sounds great, and will be if it turns out to be true, but it's (as we know) off-label, controversial (not universally believed/accepted) and under study.

A lot of drugs are used off-label routinely nowadays. That's how (just one example) viagra was discovered. Gabapentin, which many people are using to control the pain of Peripheral Neuropathy (PN) was originally an anti-siezure medication, and initially, use for PN was "off label". Topamax is an anti-convulsant, but is showing some promise off-label as a migraine prophylactic.

Undoubtedly, there are some bad off-label medication stories too. Like anything else, each has to be examined and validated on its own merits, which can take time and risk, depending on how desperate we are, how effective the drugs are for these off-label uses, and what risks we are willing to take for relief.

I'm as hopeful as we all are.

Doc

Hi, gabbycakes:

Quote: "I just googled this medication and I don't understand why it is used together with opioids." I personally think that naltrexone should not be used with opioids like fentanyl because these opioids will become ineffective because of naltrexone. The fentanyl patch withdrawal symptoms caused by naltrexone are pure hell. I felt so sick I could not swallow anything without vomiting bile and I thought I was going to die. I was not depressed at that time, so these thoughts of impending death were not caused by depression.

I think that when naltrexone blocks the effects of a certain family of opioids, called opioid agonists, it blocks their bad effects (respiratory depression on those who abused opioid agonists by taking too much of them, voluntarily or not) and it blocks their good effects (pain killing effects).

As long as you do not mix this type of medication (opioid agonists, such as fentanyl, oxymorphone, hydromorphone, morphine, hydrocodone, and codeine) with medications such as naltrexone, you have nothing to fear. You will still benefit from the pain killing effects of the opioids. Your doctor can reassure you.