A to Z of MS
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A to Z of MS Low dose naltrexone (LDN)
Naltrexone (Nalorex) is a drug used to treat people with addictions. Following anecdotal reports that low doses help the symptoms of people with a wide range of conditions, there have been a few pilot studies of low dose naltrexone (LDN) in multiple sclerosis.
Research into LDN and multiple sclerosis
A study in Milan involved 40 people with primary progressive MS taking 4mg/day LDN for six months. The results and showed LDN was safe and well tolerated. There was a significant reduction of spasticity during the trial, but half the participants reported an increase in pain. There were no significant changes to measures of fatigue, depression or quality of life.
A study at the University of California looked at the effects of LDN on quality of life in 80 people with MS. Results showed LDN significantly improved quality of life (specifically mental health, pain, and self-reported cognitive function). However, no impact was observed on symptoms such as fatigue, bowel and bladder control, sexual satisfaction, and visual function. Vivid dreaming was reported during the first week of treatment, but no other adverse effects were reported.
A second study of quality of life in 96 people with relapsing and secondary progressive MS found that there were no significant differences on a wide range of quality of life measures betwen those taking placebo and those taking LDN for 17 weeks.
How LDN works
It is thought that LDN works by encouraging the body to produce endorphins which alters the action of the immune system.
How LDN is given
LDN is taken orally, either as capsules or in a liquid form.
Side effects and contraindications
The low dose used in MS is less than a tenth of the dose used to treat addictions, and the trials that have taken place report that LDN is not associated with any significant side effects. The full strength drug should not be used in conjunction with an opioid-containing medication, or by people with hepatitis or liver problems.
Treatment with LDN
As naltrexone is a licensed drug in the UK, it can be prescribed for conditions other than that for which it is licensed if a doctor feels that it is an appropriate treatment. Drugs prescribed 'off licence' are the direct responsibility of the prescribing doctor, who will need to be convinced that the treatment is safe and potentially effective. Although LDN is relatively inexpensive, funding for off licence prescriptions may not be available via the NHS.
Gironi M, et al.
A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis.
Multiple Sclerosis 2008;14(8):1076-1083.
Cree B, et al.
Pilot trial of low dose naltrexone and quality of life in MS.
Annals Of Neurology 2010;68(2):145-150.
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;16(8):964-9.
LDN Aware is a portal website giving links to LDN groups around the world.