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Pharmacist Michelle Moser, LDN Key to Success (LDN, low dose naltrexone)
Review: Michelle Moser has 35 years experience as a Pharmacist and is very experienced with the utilization of LDN (Low one Naltrexone). She volunteers her knowledge as an a LDN specialist with the LDNresearchtrust.org. Her 21 minute presentation covers how they supply a thorough service to their customers, with advice and council on dosing and related help for a variety of conditions. She explains how LDN can be used along with most other drugs, even opioids if the LDN is micro dosed and immediate release. All autoimmune conditions can benefit from LDN.
Review by Ken Bruce
Linda Elsegood: Welcome to the LDN Radio Show brought to you by the LDN Research Trust. I'm your host Linda Elsegood. I have an exciting lineup of guest speakers who are LDN experts in their field. We will be discussing low dose naltrexone and its many uses in autoimmune diseases, cancers, etc. Thank you for joining us.
Linda Elsegood: Today I'd like to welcome back our guest pharmacist, Michelle Moser who's also one of our LDN Specialists. Thank you for joining us today, Michelle.
Michelle Moser: Oh, thank you so much for having me. It's certainly my pleasure.
Linda Elsegood: So we're all keen and eager, and as people can see, you've put “Keys To Success” up there, so take it away.
Michelle Moser: Thank you, thank you very much. I appreciate the opportunity to share some information with everybody today that really goes over not only how patients can find their success, but how providers can also enhance patient outcomes. So here we go. The first thing I want wanted to address is that low dose naltrexone plays really well with other therapies. It's not necessarily medication that is used all by itself all the time, and that is a question that comes up from not only patients, but from providers as well, wanting to know, well, the patient is taking this this and this. Can I use LDN? And the answer almost always is yes, and the main reason is that even if we are using or prescribing opiates for patients with chronic pain, depending on how those opiates are being utilized throughout the day, LDN might still be an option. Very few times is it that LDN is not something you can start. It doesn't have very many drug interactions, so LDN is brilliant for a wide variety of indications. And as we know, as so many more autoimmune diagnoses are being found every year, I think now there's something like 100, 120 some, maybe even 140 autoimmune disorders, low dose naltrexone is a wonderful fit for most of those patients.
But we also have other dosing, such as very-low-dose, which is 50 to maybe 250 micrograms. And then we have ultra-low dosing, which stems from the oxytrial study where we were using only microgram dosing, one, two, three, four micrograms, alongside short-acting opiate medications to help reduce the need for those opiates and replace it with low dose naltrexone. Because we know that low dose naltrexone not only helps to intermittently block those pain receptors, but also helps to reduce not only inflammation and those pro-inflammatory cytokines, but we can also see that low dose naltrexone helps to modulate the immune system. And there's a wide variety of studies that have been published to emphasize exactly those parameters. So if you're needing those, either reach out to the LDN Research Trust or your local compounding pharmacist. Sometimes we have those available, as well some of the other things that we use in our compounding lab and compound on literally a daily basis, because low dose naltrexone is used for a lot of inflammation issues, autoimmune, chronic pain.
We can also use low dose naltrexone for some of those other nuanced areas such as traumatic brain injury PTSD, depression, and anxiety; and we've heard from a wide variety of wonderful practitioners during the LDN Research Trust conferences on those specific areas. But when we're able to use other medications in combination with LDN; I don't mean like in the same capsule or in the same liquid, I just mean side-by-side dosing; we can see that oxytocin, especially in a nasal spray, is incredibly helpful to help build that sense of connection, to help alleviate depression and grief, as well as go after some of those imposed pain areas. And oxytocin is one of those medications that is very easy to administer in a nasal spray, even in sublingual drops. But it is very sensitive to heat, so we have to be very careful about what dosage forms we're using. We don't use oral capsules with oxytocin. The stomach acid kind of wipes out its activity. So we need to find alternative forms for that.
But also if you're needing low dose naltrexone for dermatology issues then we can combine it with mast cell stabilizers like ketotin or either other anti-inflammatories, even tranexamic acid, to help decrease some of the redness, in that dermatology issue. And even the autoimmune dermatology products, we're very careful about the bases that we put low dose naltrexone in so that we can control exactly how deep we want that therapy to go. So not every base is going to work, because we really need to individualize that therapy for that condition.
Of course we use low dose naltrexone in a situation with ketamine, which is a non-opiate pain medication as well. And because ketamine works on different receptors than low dose naltrexone we don't see the withdrawal. We actually see the enhancement of that pain control. So there's a a lot of options here.
And lastly, I wanted to address synapsin, which is this wonderful combination of medications. It's a ginseng derivative along with an NAD that again helps to reduce the central inflammation in the brain. And when we use it in a nasal spray, of course that helps with the neural transmission directly to the brain.
As a pharmacist, when a patient is new to low dose naltrexone, or even comes to us because a provider would prefer to use our pharmacy, we emphasize that low dose naltrexone is not a cure-all drug. It actually doesn't really cure anything, but what it does do is it helps to trick the body to work on its own pathways, and much more effectively, and much more efficiently.
So when we set up the expectations, we want patients to know that this isn't like taking something like an aspirin or a Tylenol. It's going to take a little while for this medication to provide full benefit. And we also know that low dose naltrexone isn't for everybody. But when we start low with the dosing and slowly increase, that we can actually see patient outcomes in greater than 50, actually approaching 80 to 90 percent of the time, which as a pharmacist, I've been a pharmacist for over 35 years, I don't recall any other medication providing that high of patient outcome, and that high patient benefit. So we also let patients know that this is a therapy that we're going to start with a low dose, slowly increase over time, and when we find their happy dose, which may be 4.5 milligrams, might be less than that; in some situations we might actually split the dose and take some in the morning and some at night; again completely individualized therapies. We let them know that most respond in about 60 days, so you got to give it some time. And with that I try to emphasize that most of the time, by the time patients are finding low dose naltrexone either through their provider or through the suggestion of their pharmacists or other chat groups, that they have been years into their therapy without great outcomes, without great success. They've used maybe even a wide variety of providers, a wide variety of alternative therapies, and now they're going to give low dose naltrexone a shot. So don't expect everything to just magically go away in a week. That's not going to happen. And in some situations, even when we're dealing with the same disease state - so let's say we're talking about fibromyalgia patients - some respond very quickly, others do take about four to six months to respond. Even with Crohn's disease, we've heard from Dr Leonard Weinstock during the LDN Research Trust conferences, that most of his patients really respond somewhere around the four-month mark. So that is very important, so that we make sure that patients are compliant on their therapies, and that they understand that the pharmacy and the provider will be checking in with them to make sure that they're still doing well, and then if there are any questions, that come up, we can answer those right then and there rather than answering them after they've stopped their therapy.
One thing we've also learned over the years with low dose naltrexone is that often less is more. So increasing the dose frequency beyond twice a day is not necessarily very helpful, and certainly going above maybe even six milligrams isn't usually as effective as lower doses, especially when we're dealing with autoimmune conditions. Now if we're dealing with weight loss, then we then we move into a little bit different realm. But again that therapy is taken once or twice a day, so again it's about treating that individual and making sure that that individual is heard, is listened to, and is able to express their goals so that we can effectively meet those.
And I wanted to throw this in there too, that we had a gal who slowly increased her dose, and when she was at 3 milligrams she felt great. She got up to 3.5, she wasn't feeling as good, and she went up to 4 and she still wasn't feeling very good. So we bumped her back down to 3 and then we slowly increased with 0.1 milligram dosing, which is itty-bitty, but sometimes even that 0.1 milligram makes all the difference in the world. And her happy dose was 3.1 milligrams. So it was great, and that's where she stayed, and she's been at that dose now for a couple of years. We also let patients know that yes, the pharmacy will check in with you periodically, usually around week 3 or 4, but don't wait for us. If something comes up, please get a hold of us, please let us know how we can help you, because we'd much rather answer those questions sooner than later, or have them stop therapy altogether, and really have to start all back at square one. So when we're slowly increasing these doses, we try to make it as easy as possible for the patient to understand. So whether we're dealing with capsules or liquids, we've built these great handouts so that patients understand how to slowly increase their dose without taking literally a handful of capsules at a time. That isn't necessarily the best way to go about it, because then they have to wash it down with a lot of water, and if dosing is at bedtime, that could very much disrupt their sleep because they've got to get up in the middle of the night to use the restroom. So we provide these handouts, and we color code them, because we provide two different strengths in two different colored bottles, and we emphasize that as we are reading from left to right rather than using the columns top to bottom. Then we're going to be able to use a little bit of out of one bottle or the other bottle concurrently as we slowly increase that dose. But we also have liquids that we use, and this liquid starter kit includes a lot more color, mainly because we slowly associate the color with the gradation, and this is actually a twice a day dosing starter kit that we use with a liquid base, because liquids are a lot easier to manipulate and find those doses that are going to be specific to them. Not everybody uses doses that are the same in the morning or at night. Sometimes one end is higher than the other.
Also, using an oil suspension is going to give a longer dating for the patient. Their bottle is going to last longer than 30 days, and that's also very pleasing to the patient, because they're very cost conscious, as they should be, because the majority of the time these medications are out of pocket expenditures. We offer an almond oil base, an olive oil base, or an MCT oil base which is derived from coconut oil. We can splash it with a natural flavor like tangerine, lemon, mint, cinnamon; and then in some situations we might actually add a little natural sweetener like a Stevia. W at this pharmacy really steer away from artificial sweeteners because we find that sometimes that actually increases inflammation, and we're also really careful about the oils that we are using. These are not cosmetic or traditional food-grade, these are bases that are backed by the United States Pharmacopoeia with a national monograph behind those.
We also are really careful about the fillers that we put in our capsules, and we work again with that individual to ensure that we're using a filler that is going to best meet their needs. All of the capsules are immediately released. We do not use any extended-release product, because that does slow down the absorption. A lot of times there's absorption issues to begin with, and certainly if we do extend the release of the naltrexone, we are actually bypassing and negating the science behind how naltrexone actually works at that receptor site. Most of the time we're using a microcrystalline cellulose, but we do have other fillers as well, so again we let them know we try to make this as easy as possible. But if it is at all confusing when the patient goes over their medication, we ask that they call the pharmacy. Let's go over those questions right away to make sure that they are getting the best information for the greatest success possible
So with our patient follow-up programs, we identify those individuals who have recently received their medications, and we kind of look at where they're at in their in their dosing schedule. We give them a call or we send them a text, “Hey we'd like to check in with you. We want to make sure everything is going well”. And we also realize that not all patients are available 9 to 5 when the pharmacy is open. Sometimes we need to schedule conversations outside of business hours, and so we make sure that that is available to a patient so that all of their needs are being met. We check in with them at least once during their first month, but we always reiterate to the patient if something comes up, get a hold of us, and this is how. We have an email option, we have a texting option, and we have a phone call option as well.
We also let them know that as dosing adjustments are being made. sometimes side effects might crop up. and so we let them know exactly what those are. Sometimes it is vivid dreams, but often when we have vivid dreams we know LDN is working, because it's helping us get into that REM sleep cycle. But if those vivid dreams become disturbing or change our sleep patterns, then we want to move the dosing schedule. We also let them know that if there's a little bit of a headache, how to alleviate that, and how long that those side effects might persist, and when they should expect those to go away. And if they're having issues with perhaps constipation, we explain that as well, because sometimes even these very small side effects can allow a patient or cause a patient to back off of their therapy and abruptly stop.
Answering the questions as they come up again are keys to success. This is how we allow our patients to communicate so that we are acknowledging what is going on with them, and they feel heard and understood. Anytime that we can alleviate side effects only allows for a better health program and for greater success, and this is when really their prescriber or their provider becomes the hero in all of this, because they suggested a therapy that is finally working for them, maybe even after years or decades of them searching for a really good way to feel better, perhaps even feel normal.
When we enhance compliance, of course we see better outcomes. When a patient is heard, when they are allowed the time to explain what's going on with them, they take ownership of their own care, and in our experience at our pharmacy, we find that when a patient takes ownership over their care, they're more likely to then be fully engaged and follow other processes or programs that may be in place by the provider. Often that leads to less phone calls to the provider office, less insignificant or issues that could be dealt with over a simple phone call, maybe even less visits to the emergency room mental health, which is always a concern, and especially in the last couple of years with stress and anxiety and depression, we see that even using low dose naltrexone can be beneficial in helping some of those areas where patients may not have been using low dose naltrexone as a primary concern, but they realize that oh my gosh, these other symptoms have disappeared too. And that's always a great benefit. We see increased patient compliance, and always better patient outcomes.
But truly, because low dose naltrexone is such a low-risk, low-side-effect, it's a low dose and honestly, it's a very low cost medication. That safety margin is much better than most commercially available prescription medications. The minimal drug interactions make it a prime candidate for the use of low dose naltrexone in the majority of health concerns and diagnoses, and quite honestly, we have over 30 years of research behind low dose naltrexone. So if you're looking for great science in using a medication that is beneficial for many many people not just in the short term but over decades. This is where we really say, “Why not try low dose naltrexone. It's a fabulous way to really get after some of those chronic issues that maybe will enhance a lifestyle, and be able to allow somebody to cross things off of their bucket list.
So here we are. I want to thank Linda for the opportunity to chat with everyone today and certainly, if there's any questions that I can help with, please let me know. This is my personal email, and these are questions, and my cell, as well as my store phone number. So I'm happy to help. Thanks so much Linda.
Linda Elsegood: Thank you! Any questions or comments you may have, please email me, Linda, at linda@ldnrt.org I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.