Figuring out dosing on Low Dose Naltrexone (LDN)

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Last Updated on August 28, 2023 by melissanreynolds

Figuring out the right dose on low dose Naltrexone (LDN) can be tricky. A lot of doctors are unsure on what dosing to use. Some seem to be aware that dosing in unique. So let’s talk about what LDN is, how it’s helped me, how to learn more about it and that all important dosing conversation.

figuring out dosing on low dose naltrexone (LDN)

What is low dose Naltrexone (LDN)?

As I summarised in my four year update article, Naltrexone is an opioid antagonist that works differently in the body when taken at a lower dose. Usually prescribed for alcohol and opioid addictions at doses of 50mg or more, low dose Naltrexone is usually anything from .25mg – 6mg.

It is being used for a wide range of conditions at this lower dose. From Multiple Sclerosis to fibromyalgia. There have been a few small studies on LDN specifically for fibromyalgia.

My experience, in short, is that it’s changed my life. It has helped me more than any other thing. In conjunction with working on sleep, calming the central nervous system, physically treating trigger points and gentle movement, it’s helped me to move from moderate to mild on the Fibromyalgia Impact Questionnaire Rating Scale.

To help you out, if you need it, I have an LDN eBook

This instantly downloadable printable eBook is an introduction to low dose naltrexone for Fibromyalgia with research and my experience – it is my hope that it will dramatically cut down the time you have to spend researching, I wasted so much time having to gather the information and research and I don’t want that for you.

low dose naltrexone for fibromyalgia

This 31-page eBook contains

*An introduction to what LDN is
*Some research about it and it’s use for Fibromyalgia
*LDN and Pregnancy
*LDN and my experience 
*LDN Reading and video List
*Research list for your information gathering
*Update for 2023 (exclusive)

Grab it here.

Dosing and low dose Naltrexone (LDN)

As someone who’s been on LDN for over six years, I have had to play with my dose for a while.

Studies tend to put patients on 4.5mg immediately and for around eight weeks.

But in real life the advice is low and slow. Doses of anywhere from 0.5mg – 8mg and more have been recommended. Some people dose twice per day. It’s personalised.

This compounding pharmacy says, “low dose naltrexone (LDN) therapy is usually prescribed as a capsule and dosed 0.25 mg to 6 mg per day. Our pharmacists can provide guidance for dosing condition-specific protocols. Each patient must find the “sweet spot” dose for them.”

This 2023 systematic review of existing studies of LDN for Fibromyalgia (PDF) says:
The efficacy of LDN in treatment of FM has been demonstrated, though there is no consensus on a specific dose, frequency, or duration. Among the included studies, LDN doses varied from 0.1mg to 9mg daily, with 4.5mg once daily as the most common option. Two studies used 4.5mg daily,17,19 and the other seven used varying titrating doses as needed.16,18,20–24 Six studies used once daily dosing,17–21,23 two studies used twice daily dosing,16,24 while the remaining study used once daily dosing first, followed by twice daily.” The Safety and Efficacy of Low-Dose Naltrexone in Patients with Fibromyalgia: A Systematic Review. Emphasis mine.

figuring out low dose naltrexone LDN dosing

My experience titrating up initially

As an example, I started with 0.5mg and titrated up to 2mg quick quickly (adding 0.5mg per night). It took me several months to reach 4mg. I never tolerated 4.5mg.

Once we achieve a dose that is too high then we tend to know. The side effects present. For me, I felt unwell, and had flares of viral issues such as ulcers and cold sores.

4mg gave me increased energy, less pain and better stamina. After a while, I dropped down to 3.5mg and that maintained my results.

When I needed to adjust dosing

In 2022, when my periods resumed after my fourth baby they were horrific. Much, much worse. Then I started quetiapine and began sleeping better. My health moved forward, except for during the 10 days per month of high pain around the period.

My health then began tracking down.

I did a heap of reading and decided to skip a few doses of LDN, and dropped my dose to 3mg. I thought perhaps I needed a lesser dose now that I was sleeping and as I had lost a decent amount (too much) of weight.

In November I ended up feeling like I did before I started LDN.

In December, I moved back to 4mg.

This helped. I felt clearer in my head, less pain and less sympathetic dominance.

In 2023 it’s been hard to ascertain anything as the period pain has progressed to the point where there aren’t many pain free days per month. On the days I don’t have as much period pain, I do feel more energy and better. I credit LDN with helping me maintain some of my gains during this difficult time.

For more about LDN for Fibromyalgia and chronic fatigue syndrome see this post
For more about LDN and Chronic Pain see this article

Conclusion on dosing of low dose Naltrexone (LDN)

It all goes to show two important things: one, we need more information out there about dosing and two, personalisation is important.

Have you struggled to find your correct dose? Has it changed?

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