We typically use 3 – 4.5mg per day for cancer recurrence prevention in adults. If 3mg is well-tolerated, we usually try 4.5mg. We initially prescribe Low Dose Naltrexone (LDN) at bedtime, but if there is pre-existing insomnia, then morning dosing is preferred (or natural sleep aid can be given along with LDN at bedtime). It makes sense to start lower and gradually increase the dose, for example, to start with 2mg and gradually increase to 4.5mg when LDN is given at bedtime. With morning dosing, LDN can be started at 3 or 4.5mg with no ramp up.