LDN for Fibromyalgia Treatment Fort Lauderdale, FL

What is low dose naltrexone, or LDN?

Naltrexone is a prescription medication that blocks opioid receptors. Its label from the Food and Drug Administration, or FDA, approves it as a 50 mg tablet for the treatment of alcohol dependence and for blocking the effects of opioids.

Low dose naltrexone, or LDN, is the same drug at a small fraction of that dose. Compounding pharmacies prepare it in strengths from half a milligram to a few milligrams, and the strength for any one patient is worked out with the prescriber.

Every use of LDN is off-label. The FDA has never approved naltrexone for fibromyalgia or any pain condition, and a doctor who prescribes it relies on clinical judgment and thin evidence. So, why would anyone prescribe it at all?

How is LDN thought to work?

At the full dose, naltrexone sits on the opioid receptor around the clock. At a low dose, the blockade is brief, and one theory is that the body answers by making more of its own endorphins, its natural pain relievers.

A second theory is that LDN quiets the microglia, the immune cells of the nervous system that may keep chronic pain going after an injury has healed. Both ideas are plausible. Neither has been proven.

Can LDN help with fibromyalgia?

Fibromyalgia is chronic widespread pain in the muscles and soft tissues, usually with fatigue, unrefreshing sleep, and trouble with memory and concentration. It is not a tender-point disorder of the skin, as it was once described, and it is not imaginary.

Small studies of LDN for fibromyalgia have reported less pain and better daily function in some patients. Unfortunately, the studies are small and short, and some patients notice no change at all. Any patient should hear this plainly before the prescription is written.

Some patients who respond notice less pain and stiffness over the first weeks, and others feel nothing. Others feel nothing.

What about pain from autoimmune conditions?

LDN is also prescribed off-label for pain that comes with autoimmune and inflammatory conditions, for the same reasons. The evidence here is thinner still, mostly small studies and case reports.

While LDN may be worth trying as an addition, it does not replace what a rheumatologist or neurologist has already prescribed, and it is not a cure for anything. Dr. Leeds has written at more length about the uses of low dose naltrexone for pain and other conditions.

Why does LDN have to come from a compounding pharmacy?

Naltrexone is prescription-only in the United States, and the only manufactured oral form is the 50 mg tablet. Trying to get a 3 mg dose out of that tablet is like measuring a pinch of salt by hitting a salt block with a hammer. While this is not a perfect analogy, it explains why cutting tablets fails.

Fortunately, a compounding pharmacy can make capsules, or a liquid, to the exact strength on the prescription. Compounded medicines are not FDA-approved products, so the prescription should come from a doctor who knows the drug. Dr. Leeds works with compounding pharmacies that prepare LDN.

What are the side effects and risks of LDN?

Patients most often report vivid dreams or lighter sleep in the first weeks, sometimes a headache or nausea, and these usually fade. Naltrexone is not a controlled substance, it is not sedating, and its label states that it does not lead to physical or psychological dependence.

While the side effects are usually mild, there is one hard rule. If you take an opioid pain medication, you cannot take naltrexone at any dose. It blocks the pain relief, and it can set off withdrawal. The label also carries a warning about the liver, so liver history is part of the conversation before starting.

How does Dr. Leeds approach LDN?

Dr. Leeds is an osteopathic physician who sees patients throughout Florida by telemedicine, with an office in Fort Lauderdale. LDN is a small part of a concierge practice built around deprescribing, and it is offered in the same spirit, as a low-risk option for when standard treatments have fallen short, with the limits of the evidence stated up front.

The first step is a consultation: what has already been tried, every other medication the patient takes, and what a reasonable trial of LDN would look like. If LDN does nothing after that trial, it is stopped. Nobody should stay on a medication that is not helping.

To ask whether LDN is a reasonable option, contact the office to request a consultation.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.