What is the dosing of Low Dose Naltrexone (LDN) with amitriptyline and gabapentin?

LDN Specialist Pharmacist Michelle Moser
LDN Specicalist Pharmacist Michelle Moser

What is the dosing you use for amitriptyline, gabapentin, and LDN?   I'll just address it now.  So all right. We use in a suppository, and we're using about five milligrams of amitriptyline, and gabapentin is  50 milligrams, and Low Dose Naltrexone is five milligrams. Did you say it was a pessary or is it a suppository that is?  It's a very small suppository. 

What I said about the pessary is that sometimes the pessary can actually cause nerve impingement if it's not sitting properly. It just goes in a MBK, which is a medium-chain fatty acid.  It dissolves really nicely and then we'll kind of disperse around the vaginal vault.  It's not so big that it leaks out and causes, you know, just don't feel great.  You know it doesn't make a huge mess. Let's put it that way.  But, it needs to be in enough.  You could also put this in a muco adherent base if you wanted to.  It doesn't have to be a suppository.  Right.  It could be a muco adherent cream base.  So, we use either a lodge or muco lodge with versa base. That works really well, too. And the reason we use a muco adherent base is because then we can use less medication because then it sticks to where it needs to go, and it just stays there and and you just don't have to use as much and we just use it once at bedtime works.  You know everybody's going to respond a little bit differently, but great stuff.   I mean you could even throw Baclofen,  maybe 10 milligrams of Baclofen, in there if you wanted to if you think that there are some other muscle spasm issues.  I'm just thinking about MS patients. That would be a very good thing in my experience with MS patients.  

LDN is very good at two things specifically and one of them is this spasticity of the bladder during the night so I'm thinking Baclofen and LDN probably would be quite a good mixture to try..  Unfortunately, we don't have such a thing as compounding pharmacists over here so when you get a prescription, that is a specific prescription that a prescriber will have sent you or do you advise them on that?  Both. So usually what happens is I'll have a provider call or text or whatever and they'll just say, “Okay, I've got this patient.  Here's the laundry list of issues.  What do you recommend?”  There is a formula that we use a lot, and I will say I think the average age is usually a woman between 65 and 80. If she has autoimmune issues like fibromyalgia and MS., then a lot of times, she's even 30. But it is quite common that we, as pharmacists we can advise. We can suggest medications to be used in specific issues or disease states, so that's not a problem. I wish we could write, you know, we can't write forms. That'll probably come, I'm sure.  If you have the problem that we have of fewer doctors and more pharmacists you hope that will come eventually.  Good to know.  Otherwise, I might just be moving across the pond. You never know I'll come to visit. 

I'm just thinking about, sorry to prolong this conversation, but the interstitial UTIs, what would you recommend for that?  Would you ever use a pessary with LDN for that?  No,  I have seen small suppositories or a muco adherent base, cream base of LDN for IC, absolutely. Then you've also seen that I need to check progesterone levels and estrogen levels as well, too, because you know you have to be careful of where their hormone balance is, and you know I'm not ever going to forget anything about the gut.  I mean, we always, we just sound like broken records at the pharmacy. We always talk about the gut because it's just an extension of what's going on in the gastrointestinal tract.