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Naltrexone, a drug originally approved for treating alcoholism and opiate addiction, can be used in lower than standard doses (e.g., 4.5mg orally at bedtime) to provide pain relief and anti-inflammatory benefit by inhibiting cellular proliferation of T- and B- cells and blocking Toll-like receptor 4 (TLR4). Low Dose Naltrexone (LDN) appears to reduce production of multiple cytokines including IL-6 and is available as an oral preparation. As such it is ideal to use to attempt to modify progression of disease, and it can easily be given to both hospitalized patients and patients in the community.
Ketamine, a drug approved as an anesthetic, may be able to interrupt the inflammation that causes the worst COVID-19 symptoms. A new study will investigate the potential benefit in a randomized, blinded trial.
A clinical trial involving both medications and sponsored by Beaumont Health of Michigan began April 29, 2020 and plans to enroll 500 participants. The trial will measure the ability of LDN (Low Dose Naltrexone) to reduce the progression of disease in participants with COVID-19. In this study, naltrexone or placebo will be given to participants in early stages of COVID-19 infection in a randomized, double blinded manner, whereas the use of ketamine will be unblinded and given as a rescue agent should a participant’s progress. Additionally, should a participant be ineligible for the randomized portion of the study due to already being in a more advanced stage of the disease, they will be given the opportunity to enter the trial to receive ketamine without being randomized to receive a placebo.