Low-dose naltrexone (LDN)
What is it?
Naltrexone is licensed in the UK to help treat people who are addicted to opiates, such as heroin. Advocates of its use in MS suggest it should be given at a much lower dose (10-50 times lower) for the treatment of MS.
What does it do?
Some research suggests that when naltrexone is given at low doses, it triggers a prolonged up-regulation of endorphins. This increase may have an anti-inflammatory effect which could be beneficial in the treatment of MS.
It has also been hypothesised that LDN may be able to reduce injury to the nervous system by decreasing the harmful effects of two types of chemicals called ‘free radicals’ and ‘excitotoxins’ (Med Hypotheses 2005; 64(4):721-4).
Does it work?
In a small pilot clinical trial (Smith JP et al., American Journal of Gastroenterology; 2007 102(4): 820-8) LDN was shown to improve active Crohn’s disease, a condition which is caused by the immune system causing damage and inflammation to the intestinal tract.
At the 60th Annual Meeting of the American Academy of Neurology in Chicago in April 2008, two groups reported on the use of LDN. Dr. Gianvito Martino (San Raffaele Hospital, Milan, Italy) and colleagues assessed LDN in an open labeled trial of 40 people with primary progressive MS for six months, evaluating its safety and tolerability. They reported:
- five patients dropped out
- a significant reduction of spasticity was measured at the end of the trial
- the most common side effects included short-term increases in liver enzymes, urinary tract infections, mild agitation and sleep disturbance.
This study was published in the September issue of the journal Multiple Sclerosis (2008 Sep;14(8):1076-83)
Should I take it?
In autumn 2011, following a resolution at the AGM, the MS Society carried out a review of the evidence for LDN as a potential treatment for MS. Read a copy of the report.
Currently there is not enough evidence-based information to prove LDN is an effective treatment for MS. The results of the most recent clinical trials are an important step in determining if there is any benefit for people with MS and the MS Society welcomes this research.
LDN is not licensed for the treatment of MS in the UK. The MS Society supports an evidence-based approach to research and as such does not recommend that people take unproven treatments outside of a properly regulated clinical trial.
Some people with MS in the UK may have been prescribed LDN by their own GPs, but many are reluctant to prescribe LDN in the absence of phase III clinical trial evidence that the drug is clinically beneficial.
Source:
Med Hypotheses 2005; 64(4):721-4 Smith JP et. al. American Journal of Gastroenterology; 2007 102(4): 820-8 Multiple Sclerosis 2008 Sep;14(8):1076-83 Cree B et. al. Annals of Neurology; 2010 published ahead of print
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