Are the Strengths of Oral and Topical Low Dose Naltrexone (LDN) Equal?

Are the Strengths of Oral and Topical Low Dose Naltrexone (LDN) Equal?

The question is, when you use oral and topical Low Dose Naltrexone (LDN) are they additive?  That is a good question.  The answer to that is yes.  We usually only use topical for a short period of time.  For example, let's take a look at lichen sclerosis.  It is not the easiest autoimmune disease to tackle but it certainly has a wide variety of symptoms that are troublesome and they can impact patients' lives, not just immediately but really for a good length of time.  That can happen on the inside of the mouth.  That can happen in other very soft tissues.  We use oral LDN because it has the greater impact because it can metabolize through the liver and get to the target tissues, and then we can use a little bit of topical LDN whether it's a half percent or one percent.  We use a little bit and we use that once, maybe twice a day to help reduce the inflammation.  We can also do that in other dermatological situations. We have to be careful about the dosage form.  Not all dosage forms are created equal and what I mean by that is some patients do better with a liquid that can be either swallowed or absorbed under the tongue.  Some will do better with capsules or tablets.  It just really depends because if they have a malabsorption issue, which most of us do, but if it's coupled with an autoimmune disease, then we need to take a look at other alternatives.  We can switch dosage forms around. If they start on an oral liquid and then four or five months later they're doing really well we can always switch them to a capsule.  Those dosage forms are one-to-one.  That means if somebody is on 3.5 milligrams in an oral liquid you can very easily use 3.5 milligrams in an oral capsule or tablet. They're equal, but the topicals we're usually using from one to three months, not necessarily routinely every day.  We use topicals to help control symptoms.