Should we have 1, 2 or 4 daily doses of Low Dose Naltrexone (LDN)?
So, the dosing of Qid (4 times daily), Bid (twice daily), what's the rationale? I was taught by my colleague who introduced me to Low Dose Naltrexone that you can lower any side effects or problems with withdrawal because he was using it often to detox patients from high doses of opioids. If you use it with small aliquots over the day that you have better adherence to the use and less side effects. In addition, this refutes the concept that using a large dose in the evening suppresses opioid growth receptors and then getting rebound for the opiate growth receptor so that we get greater sensitivity to an opioid. It challenges that. If we have Qid dosing, we don't get that period where you are first blocking the opioid growth factor receptor and then freeing it. I think that I routinely use the Qid dosing, and then when I get to Qid dosing and find my maximally effective dose, I discuss it with the patient. I say it may be more useful for you or easier for you to do it twice a day instead of four times a day because four times a day is really, you know, quite a burden. So we try Bid, and sometimes patients say to me, "I actually feel better on Qid," Some patients say, "I like it better on Bid," and then we can try it once a day. They say, "I don't see any difference in taking it once a day or a divided dose." So we do it like that. It's trial and error.