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A to Z of MS Low dose naltrexone (LDN)

Naltrexone (Nalorex) is a drug that is licensed to treat people with addictions to opioid drugs such as morphine, codeine, methadone and heroin. Following anecdotal reports that low doses help the symptoms of people with a wide range of conditions, there have been a few initial studies of LDN in MS.

A study in Milan of 40 people with primary progressive MS showed LDN to be safe and well tolerated. It also found LDN reduced spasticity, but increased pain and had no effect on fatigue, depression or quality of life.

A study at the University of California in San Francisco in 80 people with MS showed LDN improved quality of life measures, but didn't find any effect on symptoms such as fatigue, bladder and bowel control, sexual satisfaction or visual function.

Although LDN is not currently licensed for use in MS, a doctor may prescribe it 'off label' if they feel that it is an appropriate treatment. When a drug is prescribed 'off label' this means that the medicines regulatory authority has not approved it for a particular condition and that there is limited safety or efficacy data relating to its use in that condition. Therefore, drugs prescribed 'off label' are at the discretion of the prescribing doctor and they must take full responsibility for the patient's progress on the drug. Although LDN is relatively inexpensive, funding for 'off label' prescriptions may or may not be accepted by the local primary care trust (PCT).

How LDN works

It is thought that LDN works by encouraging the body to produce endorphins and by stimulating the immune system - an approach that differs from most MS treatments, which attempt to reduce immune activity.

How LDN is given

LDN is taken orally, either as capsules or in a liquid form.

Side effects and contraindications

The full strength drug should not be used in conjunction with an opioid-containing medication, or by people with hepatitis or liver problems. 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.

Because LDN stimulates the immune system, it should not be taken by people also taking one of the beta interferon drugs, or other drugs that reduce the activity of the immune system such as steroids.