If You Take Oral Low Dose Naltrexone (LDN), Can You Also Apply Topical? 

Clinical Pharmacist Nat Jones
Answered by Nat Jones, R.Ph. FAPC

If You Take Oral Low Dose Naltrexone (LDN), Can You Also Apply Topical? 

If you take 4.5 to 5.5 milligrams oral LDN can you also apply topical LDN creams for rashes, itching and rosacea? Will there be additional benefits?  If it's an autoimmune disease I think you should stick to oral wherever possible.  If you want to start, if you've got local symptoms and you want to start that way you can but in terms of the long term for a autoimmune disease I think oral is the way to go by far rather than topical because you see the immunomodulatory effects from the oral that you don't see as well or nearly as well with topical.  There's some autoimmune activity from topical but it's not as good in my opinion.  

What are your thoughts on using oral and topical LDN for some of these diseases like psoriasis?  If you do what dose will you use?  For oral I would just titrate.  The oral disease is pretty much the way you would any other Low Dose Naltrexone patient.  .  Typically I titrate up in half milligram increments.  The Baha'i protocol was 1.5 and go up by 1.5 after a week and go up 1.5 after another week assuming the patient tolerated it because to me I think if you go a little slower it may attenuate some of the adverse events.  You can find at what point the patient tolerates it and what point they don't.  You can back up a little bit, maybe wait a while attempt going up again later.  

There's not one way to do it right or wrong.  If you're going to use topical, like I said, I generally look at the amount of percentage of Naltrexone that I recommend based on surface area. If  you’re covering an area about the size of your hand then one percent is probably fine.  If you’re covering one the size of your hand or smaller then one percent is probably fine.  If you get into treating the entire forearm or the entire arm then you want to go with the half percent.  If you're treating the trunk you probably want to go down to 0.1 percent because it's a lot of surface area.  Just going to kind of be cognizant of how much Naltrexone that's getting through the skin during the course of the day.  I have patients apply it twice daily. If you're using it topically and like I said if you want to use it topically in the beginning if the patient's got severe pruritus or it's an inflamed skin condition you're going to take weeks to titrate the patient up to their maintenance dose.  

Could you start with topical and oral titration at the same time?  I think yes but certainly after two or three weeks of topical and the dose on the oral has already progressed up above three milligrams you should probably discontinue it in the case of autoimmune Durham conditions because to me the topical is not as efficacious for the autoimmune component as the topical is, not as effective as the oral so I would certainly go with oral in that case.