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Q & A: Taking LDN and Other Substances/Treatments

The most frequent questions we receive at LDNscience are whether LDN can be safely combined with other medications. Currently, the only type of medication that is considered incompatible with LDN is opioid/opioid-like medication. If you are unsure whether a medication you are taking is opioid-based, ask your pharmacist or LDN prescriber.
We are not aware of any contraindication between the two. There is some scientific literature about interactions between opioid and cannabinoid systems (read one article on our website here (http://ldnscience.org/research/pmid21415049). There is also some literature about naltrexone in other dosage levels (ultra-low, very-low, or what others call 'low dose' but we would not consider as such) and cannabinoids- those topics are beyond the scope of this website (solely LDN).
There are some clinical studies which show effectiveness of LDN in opioid withdrawal, however, we recommend consulting with an addiction specialist so the proper dosage and protocol are utilized based on your personal medical history. Locate an LDN prescriber here.
LDN should not be combined (taken together at the same time) with opiates, opioids, or opioid-like painkillers, as it could block/cancel their pain-killing effect for several hours, and cause unwanted symptoms and withdrawal problems. There is no known reason, however, why LDN cannot be combined with other types of painkillers, such as the class of medicines called non-steroidal anti-inflammatories (NSAIDs)/nonsteroidal anti-inflammatory agents/analgesics (NSAIAs)/nonsteroidal anti- inflammatory medicines (NSAIMs). These medicines include aspirin, ibuprofen, and naproxen sodium. Acetaminophen/paracetamol is also not known to cause any problem when taken together with LDN.
LDN is metabolized by the body within a few hours (meaning that the body has processed it and gotten rid of it) so after that time is no longer as “available” to interact with other substances. Therefore, as long as LDN and an opioid or opiod-like painkiller are kept apart (staggered) by at least several hours, LDN should not interfere with the pain-relieving effects of the opioid-based medication. However, each person’s metabolism is different, so the assessment of how long to wait after taking LDN should be done in consultation with a physician knowledgeable in LDN and one’s personal medical condition. Locate an LDN prescriber here.
Once several hours have passed since taking LDN, you may find that opiate and opiate-like painkillers actually work better, as the Naltrexone increases the sensitivity of the cell’s receptors to the opiates.
LDN is not compatible to be combined with any opiate-type drugs such as Imodium (loperamide) or Lomotil (lomanate, lonox). The reason for this is that the effect of the opiate-type drug may be neutralized or cause undesirable symptoms, so they should not be combined with LDN (taken together at the same time). If needed in the same day, the medications should be spaced apart by at least several hours; you may wish to discuss this with your physician as metabolization rates vary. Locate an LDN prescriber here.
At LDNscience, we are not aware of reports of any adverse effects from combining LDN with immunosuppressive drugs such as steroids. To learn more about a study that showed that taking LDN long-term is associated with reduced use of immunosuppressive, see Dr. Guttorm Raknes’ interview.
There is no known problem with combining LDN with chemotherapy. However, if any opiate pain killers are being taken with the chemotherapy, LDN would neutralize the effect of the painkillers for several hours and may cause other unwanted symptoms or withdrawal problems.
Since LDN raises OGF levels that slow down cell division and reduce cancer cell growth, it should potentially enable chemotherapy to be more effective. While previously recognized for its anti-cancer effects, the first study to examine a synergistic effect between LDN and chemotherapy was published in 2016. In this laboratory study by researchers at St. George’s University of London, they found that treatment with LDN before a standard cancer treatment drug improved the effect of the chemotherapy, especially when given at certain times. (More information on this article can be found at here). It is hoped that future clinical trials will continue to confirm the synergy between LDN and chemotherapy.
A filler is a substance that is mixed with an active ingredient in order to enable tabletting or encapsulation of consistent quantities of active ingredient. Certain fillers may interfere with rapid absorption of LDN. Additionally, some patients are intolerant of certain fillers. It has been reported that microcrystalline cellulose and dextrose are both compatible with LDN. However individual tolerance to these may vary in very sensitive individuals.
At the moment there is no published list of supplements that could interfere with LDN absorption. Some patients have reported their LDN does not work as well when calcium carbonate is used as a filler in their LDN capsules, or when taking LDN together with supplements containing calcium carbonate. The reason to avoid taking calcium carbonate in close proximity with LDN is because it binds to the Naltrexone, turning it into a “slow-release” formulation that prevents the necessary rebound effect that makes LDN effective.
We are not aware of any contraindication for taking LDN with beta interferons.
We are aware that some doctors are combining the two. We are not aware of any reason to avoid the combination. We do not know if the benefit seen is cumulative or synergistic, as no studies have been done to determine how the benefit is achieved. Read more about Dr. Berkson’s experiences here.
LDN does not interact with alcohol in any negative way. Whilst high dose Naltrexone is used to treat alcohol craving, there is no problem taking LDN after alcohol.
Food is not known to affect the absorption of LDN. It can therefore be taken with or without food.
This question must be discussed with the anesthetist who can advise you how much time before the surgery LDN should be stopped. Make sure to inform the anesthetist that you are using a low dose and the exact dose being used.
Research at present does not support taking the two simultaneously, since LDN neutralizes the effect of OGF. However there are physicians who prescribe the two together, whilst advising a few hour break between the two. Whether the results are better than taking OGF on its own has not yet been clarified in a trial.
Although we are aware of no published research examining this question, some patients have reported needing less thyroid medication or being able to cease it. It may be that LDN helps regulate thyroid function, although this has not been proven. Therefore, before beginning LDN, one should consult a physician well-experienced with LDN for personalized medical advice about combining the two medications, monitoring blood levels, and adjusting dosages. Locate an LDN prescriber here.
As opiate-based medications are commonly given to patients during various medical procedures, it is important to discuss the fact that you take LDN with the medical team who will be caring for you, in order to allow them to advise you how much time before the procedure LDN should be stopped. Make sure to inform them that you are using a low dose and the exact dose being used. If you need to consult with an LDN knowledgeable prescriber about this issue, you can search for one here.
In some studies, LDN has been used safely in combination with buprenorphine, however, naltrexone can block the effects of buprenorphine and make it less effective in treating your condition. Also, if you have been taking buprenorphine for longer than a week, naltrexone can precipitate withdrawal symptoms.

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