MS and Low-Dose Naltrexone (LDN)

For the past several years there has been a bit of a cult following with a drug called LDN (low-dose naltrexone) . While writing at Suite101′s health site, I encountered several readers with MS who promoted the drug in comments sections, as well as a fellow health writer (with hyperthyroidism) who valued and wrote about its merits. There wasn’t much known about the drug then except that it wasn’t FDA-approved for multiple sclerosis patients and it wasn’t clear whether the drug could actually slow MS disease progress. Just recently I read an article from the National Multiple Sclerosis Society’s Momentum magazine with a current view about LDN. Here is what Dr. Allen C. Bowling, a neurologist and professor at the University of Colorado-Denver and Health Sciences Center, reports:

What is Low-Dose Naltrexone?

Dr. Bowling addresses the fact that LDN is getting a great deal of coverage on the internet, including various websites that are run by low-dose naltrexone organizations. Although LDN is reported to help patients with multiple sclerosis, it is considered a CAM or complementary and alternative medicine because it has not been extensively tested for effectiveness in patients with MS. Currently naltrexone is approved for opiate and alcohol addiction, with patients being treated with doses of roughly 50 milligrams/day. Patients who take LDN for MS use about 1.5 to 4.5 milligrams/daily, hence the name.

Naltrexone, which may increase endorphin productivity and increase the body’s sensitivity to it, could very well reduce pain and inflammation, as well as stabilize overall mood. It also may decrease the formation of free radicals (considered harmful) and thus protect nerve cells from injury.

LDN Studies, to Date

Not a great deal of low-dose naltrexone research has been done. Here are some recent studies and their results:

  • Two small, preliminary studies of LDN for EAE (experimental autoimmune encephalomyelitis which is an animal model of MS) found that LDN decreased nervous system inflammation, immune cell activation, and possible disease severity. These studies were presented at the annual meeting of the European Congress for Treatment and Research in MS (2008.)
  • A small clinical trial on humans with MS (reported at the same meeting this past year) was conducted at the University of California-San Francisco. 80 people were treated for 8 weeks with either LDN or a placebo. The LDN showed no effect on physical functioning, but it showed an improvement in some patients’ mental health and pain symptoms.
  • 40 primary-progressive MS patients in Italy were studied in 2008. LDN was administered for 6 months, although there was no placebo-treated control group for comparison. Patients noted an improvement in spasticity, but no effects on depression, fatigue, or overall quality of life. Some patients reported a worsening of pain. Only one patient showed a neurological worsening during the treatment.

What Does this Mean to MS Patients?

Dr. Bowling stresses that the preliminary studies still don’t show enough evidence that LDN effectively reduces multiple sclerosis inflammation/nerve attacks in humans and thereby slows MS’s progression in patients. The studies are a good start in the discovery of what low-dose naltrexone is capable of, although the studies on EAE were done on animals and not true MS patients, and the other studies were brief and the results were conflicting.

Questions Dr. Bowling—as well as other neurologists– still have:

  • Does LDN truly and consistently decrease the severity of MS symptoms?
  • Does LDN slow the progression of relapsing and/or progressive MS?
  • Is LDN safe to use on a long-term basis?
  • Does LDN interact with conventional MS medications?

In the meantime, low-dose naltrexone continues to be considered a complimentary and alternative medicine and is being further studied to determine its ability to slow disease progression (like other disease-modifying meds), its long-term safety, and its ability to effectively treat symptoms. At this point, many MS patients have been able to acquire it for “non-MS” use.

For further reference:

Bowling, Allen C, MD. “Low-Dose Naltrexone (LDN): The ’411′ on LDN.” Momentum, the Magazine of the National Multiple Sclerosis Society. Spring 2009, pp 44 – 46.

7 comments

  • Shane Jenkins Bernard

    I’m a 68 year old female who was diagnosed with r/r MS in 2003 but experienced initial symptoms 25 or more years ago. My neurologist has had me on Copaxone from the beginning and I continue with it, however, 13 months ago I was going down hill too fast. The body was close to being in a wheel chair, the mind couldn’t complete a thought or remember two digits at a time, the spirit had lost all energy and I had put myself on the DNR list. I had pretty much given up reading but some way, I have no idea how, I saw and read an article regading low dose naltrexone and its possible use for MS. I had retired from auditing pharmaceutical research protocols therefore was somewhat aware of the type information in front of me and it sparked a little of that lost hope. I was impressed with these facts: 1) the drug was FDA approved (for use with addictions), 2) possible MS doses were less than 5% of the FDA approved strength, 3) few if any adverse events or side effects were noted and 4)extremely low cost. I then collected and reviewed as much as I could and took it all to my neurologist. To make this long story shorter, he prescribed, I took, it helped. Within a week the fog began to lift and by the end of two, others were noticing major physical changes. I was taller, alert, alive and before long I gave up my walker, then my cane. I have been so good for so long that I have had a concern about being able to continue living in my assisted care facility. I took myself off of the DNR list…I’m involved in my community resident council…I’ve found my ‘creative’ side again, I’m active with my friends and I’m happy. Every now and then I find myself angry about something that I no longer have (my home and car, my cat) or can no longer do (work, travel, shop) …I hate MS but I have it and that probably will not change in my lifetime. I cannot report to you that the LDN has caused me to improve, but I believe it has…so I will continue my Copaxone with it and take my life one day at a time. One other observation I have regarding research and LDN…Since it is not on ‘patent’ and there are only 400.000 diagnosed cases of MS in the US I suspect it would not pay a pharmaceutical company to spend the multi-millions of dollars to gather the information required by the FDA for review and possible approval…only my thought. Thanks for your sounding board!

  • Jen

    Hi Shane—

    Thank you for commenting. I like to hear from people who have actually tried LDN for their multiple sclerosis. A fellow health writer, linked in the above article, swears by LDN and I use to run across followers in comments sections at that above site I once wrote for.

    I’ve heard a lot of good things about LDN (low cost, few side-effects, and improvements in conditions.) I really hope it becomes further investigated and maybe becomes a new medication for MS in the future. It’s good that your neurologist will write scripts for it, because many will not.

    Best of luck with the LDN and your MS journey. And thank you for presenting your side of the story.

    Sincerely,

    Jen

  • I have some recent successes with LDN in MS. I have used to it with other conditions with less impressive results. I feel this treatment is ahead of the research. Since the drug is off patent there is no money for larger more rigorous studies.

    At the end of the day the patient must be better. I recommend trying it.

  • vahid haghighi

    Hello dear. I have heard about LDN. And for some reason I can not get my doctor to write me a priscription. Would you please tel me what to do to be able to try this drug. I would appritiate the respond. I live in canada. Thanks again.

  • Jen

    Hi there—

    I believe you need to get a prescription from your primary physician or a neurologist (who agrees to you taking this) because the drug is not approved for MS. Many people use it for MS but they often run up against problems with getting doctors to prescribe it. I am not sure of the approval in Canada, however. I’m basing it from my knowledge in the U.S.

    Hope this helps. :)

    Jen

  • Julie Pattengell

    I was diagnosed with MS in 2007 and my neurologist started me on copaxone. Last week I began LDN at 4.5mg. So far I already feel better. I feel less pain and I seem to have more energy. I’m continuing with copaxone for now because my primary care doctor who prescribed LDN wanted to make sure before changing my medications that much. So far so good.

  • Kim Kacer

    The Q I saw that brought me here was: LDN has been used by MS patients for a number of years, but does it really treat multiple sclerosis or just the symptoms?

    From my research and personal experience, I would have to say a little bit of both.

    People w/ MS have low endorphin and enkephalin counts. Not most, ALL, at least all who have been tested. Since both are used by the immune system, mainly in communication… and since MS is an Auto-immune disease…. it stands to reason, correcting the low endorphin and enkephalin counts is fixing at least part of the underlying cause.

    It also helps w/ symptoms, though not all symptoms. What I have found personally if I maintain my D3 counts at >45 and my B12 counts at >800ng/l and take a daily dose of chia oil, rich in omega 3′s that handles everything else. Some may need magnesium, calcium and/or zinc and maybe a decent anti-oxidant (I like alpha-lipoic acid since water or oil can carry it into a cell, ymmv(

    But that’s my 2 cents and experience, hope it helps someone.

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