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 than usual for the treatment of MS (10-50 times lower dose).  

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 has been 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 6 months, evaluating its safety and tolerability. 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)

Dr. Bruce Cree (University of California, San Francisco) and colleagues reported that eight weeks of treatment with LDN significantly improved quality of life (specifically, mental health, pain, and self-reported cognitive function) in 60 people with MS as measured by the MS Quality of Life Inventory. No impact was observed on physical quality of life (such as fatigue, bowel and bladder control, sexual satisfaction, and visual function). Vivid dreaming was reported during the first week of treatment, but no other adverse side effects were reported.

There is a study which began in early 2007 at the University of California which involving 80 people with MS looking at the effects of LDN on quality of life in people with MS.

In May 2007 the MindBrain Consortium and the department of psychiatry of Summa Hospital System of Akron in Ohio announced a new scientific study of the effects of treating 36 people with progressive or relapsing MS with LDN. The study aims to look at symptom severity as well as changes in quality of life and sleep patterns.
 

Should I take it?

Currently there is not enough evidence-based information to prove LDN is an effective treatment for MS. The results of these small pilot studies 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. Some people with MS in the UK may have been prescribed LDN by their own GPs, however many GP’s are reluctant to prescribe LDN in the absence of phase III clinical trial evidence that the drug is clinically beneficial.

The decision to take LDN is a matter for individual judgement, though people are advised to 'err on the side of caution' until the safety and effectiveness is fully established.