Pharmacist Stephen Dickson
Can you talk through the starting dose and titration of Low Dose Naltrexone (LDN)? And are there any contraindications?
Pharmacist Stephen Dickson, LDN Specialist
You really shouldn't be starting LDN until you have had a consultation with someone who knows how to use LDN properly and can guide you through taking LDN.
There are a number of contraindications, not only from medicines, but from general disease states and issues, but the general blanket contraindications are long-acting potent opiates.
If you're taking a long-acting opiate regularly or you're taking, for example, Co-codamol four times a day, then you need to look at changing that before you can start LDN. There are a number of other contraindications available on the prescribing pack and the patient pack on the LPN Research Trust website.
The starting dose and titration dose is pretty standard for everyone. We tend to start almost everyone on a liquid or a sublingual preparation because you have this flexibility in dosing. For most autoimmune conditions or most pain-related conditions, we'll start on 1mg and increase by 1 mg weekly, until by week five you're able to go up to 4.5 milligrams. For the vast majority of people, that will work absolutely fine. For patients who have Chronic Fatigue Syndrome, ME or long COVID it's very central, it's potentially going on for a long time, and they tend to be quite chemosensitive or sensitive to medications in a way that other people are not. We would start at 0.5 milligrams and increase by 0.5 milligrams every two weeks until they get to the maximum tolerated dose.
If people start to get to the dose where they're feeling terrible side effects that don't subside after a few days, then we suggest halving the dose and gradually going back up again as you did before. Generally, you can burst through that ceiling and you can get to the 3 or 4.5 mg doses.