Are there any recommendations for a patient who is experiencing severe nausea when taking LDN other than optimal dosage?
The recommendation would be to alter the dosage or to alternate the administration. So if someone is getting a capsule or a tablet and they're feeling very nauseous, try a sublingual form or a liquid form. Swapping to the sublingual form then removes the risk of fresh pass metabolism and it reduces the exposure of the gastrointestinal system.
The other thing you can do is to take antiemetics for the first period of time while you're doing the titration dose.
Or reduce the dose. You can, if you find that it doesn't work for you, go to very low dose or ultra low dose of LDN and gradually get up to low dose naltrexone range. Those are very very diluted forms of LDN, which you can gradually work up to to get to the low dose range.