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Use of Low Dose Naltrexone in Fibromyalgia

Dr. Jarred Younger
November 01, 2009
Interview with Dr. Jarred Younger, Associate Professor, University of Alabama at Birmingham, former Assistant Professor at Stanford University
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What gave you the initial idea that LDN might be effective in fibromyalgia?

Two different sources of information lead me to try LDN in a clinical trial for the treatment of fibromyalgia. First, a growing collection of basic science studies (by investigators such as Drs. Linda Watkins and Mark Hutchinson) suggested that Naltrexone can reduce the excitability of microglia in the brain, preventing the release of inflammatory and neurotoxic chemicals. Second, a small number of physicians have been using LDN for many years to treat conditions such as fibromyalgia. Bringing these two sources of information together, I hypothesized that LDN would show efficacy over placebo in a clinical trial.

How have you found patient satisfaction with LDN compared with other therapies?

The majority of the participants in our study were individuals who did not react favorably to more conventional treatment options. So, patient satisfaction with LDN has been very high. Advantages of the drug is that it is easily-dosed (once at bedtime), and relatively cheap (around $35 per month even if paying fully out-of-pocket). Also, most individuals we've seen report no side effects at all, which is a large part of the high patient satisfaction. The drug does not work for everyone - and we are trying to figure out how to predict who will receive benefit and who will not.

Is patient compliance with LDN better than with other therapies?

In our studies, compliance has been very high. While it is possible we may have a unique sample (those individuals highly interested in research), the high rate of compliance is probably also due to the lack of side-effects.

What side effects have your patients encountered?

The only side effect that we can consistently link with LDN is more vivid dreams. Most participants have made a point to say that the dreams are not nightmares, and may even be pleasurable. The number of individuals reporting changes in dreams may be around 10%. Other than dreams, a small number of individuals say that it is harder to get to sleep on the first few nights of treatment. On the rare cases where a side-effect is problematic, a reduction to 3.0 mg (instead of the normal 4.5 mg) has taken care of the problem. Given the small numbers of individuals that we have seen treated with the drug (around 50 individuals), there may be side-effects that we have not yet observed.

What are the main benefits of using LDN compared with other standard therapies for fibromyalgia?

I wouldn't say any compound has an overall benefit over other treatment options. The FDA-approved drugs currently on the market do work for a large number of people. Many physicians will likely want patients to try the three approved medications before trying LDN. Having said that, the main benefits of LDN are its low cost and high tolerability (i.e., low side-effects).

Do you believe LDN should be used widely in all patients with fibromyalgia?

It's still too early to tell. Our initial report was based on only 10 individuals. We will complete a larger trial of LDN by the end of 2009, and should have results available in 2010. If the new study shows similar results to the first study, then physicians can be more confident in prescribing the medication. Until more studies are done, it is difficult to make any broad recommendations, even though the preliminary data look promising

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