Low-Dose Naltrexone: A Potential ‘Wonder Drug’ Held Back by Costly Trials

Some research supports the use of anti-inflammatory low-dose naltrexone for chronic pain and autoimmune conditions.

Low-dose naltrexone (LDN) is generating buzz as a potential treatment for a range of conditions, from chronic pain to autoimmune disorders, offering new hope for patients with difficult-to-manage symptoms.

While hailed for its symptom relief, some health experts warn that LDN may not tackle the underlying causes of disease. The question remains: Is this affordable, underutilized drug a breakthrough or merely a temporary fix?

A Lifeline

Linda Elsgood felt unstoppable. A mother of two and full-time bank manager, she balanced work and family with ease.

“I was Wonder Woman. I could do anything,” she told The Epoch Times.

But when both her parents fell ill, the stress of caregiving began to take its toll.

Soon after, Elsgood began experiencing troubling symptoms: numbness in her leg and face, extreme fatigue, and vision issues. In 2000, she was diagnosed with relapsing-remitting multiple sclerosis (MS). By 2003, the disease had progressed to secondary progressive MS, and her doctors informed her that no further treatment options were available.

“I was devastated,” she said.

Facing limited options, Elsgood discovered LDN on an online forum, a drug commonly prescribed for addiction but now being explored for other conditions such as MS.

For three weeks, she saw no improvement.

“I thought it wasn’t going to work for me,” Elsgood said. “I honestly didn’t have another plan.”

Then, things changed.

“Amazingly, after three weeks, I could think again. I wasn’t talking rubbish anymore. I was coherent,” she said.

That renewed clarity felt like a gift, according to Elsgood.

“I was starting to feel like myself again,” she said.

Today, Elsgood leads the LDN Research Trust, a charity she founded to raise awareness and fund research into LDN’s potential benefits.

“I was deteriorating so quickly. Without it, I don’t think I would’ve lived much longer,” she said. “LDN gave me my life back.”

The nonprofit organization aims to fund clinical trials on low-dose naltrexone, particularly for autoimmune diseases and cancer. The trust has helped more than 100,000 people worldwide access LDN through private prescriptions and health care providers.

Now 68, Elsgood remains steadfast in her commitment to the treatment.

“There’s no way I’m ever going to stop taking it,” she said. “Today, I feel in a good place.”

Expanding Uses

Naltrexone, initially developed to treat opioid and alcohol addiction, is now drawing attention for its potential to manage a wide range of chronic conditions.

Approved by the Food and Drug Administration (FDA) at higher doses—typically 50 to 100 milligrams per day—to block opioid receptors, naltrexone functions differently in smaller doses, usually ranging from 0.1 to 6 milligrams. These lower amounts are believed to reduce inflammation and regulate the immune system.

Low-dose naltrexone is being studied for conditions such as multiple sclerosis, the illness Elsgood was diagnosed with in 2000. While large-scale studies are still lacking, smaller trials and patient testimonials indicate that LDN may help reduce symptoms and improve quality of life.

A 2023 study in Biomedicines looked at LDN’s use in chronic pain conditions such as fibromyalgia, with 65 percent of patients reporting pain relief. Side effects were minimal, with only 11 percent experiencing issues such as nausea, vomiting, anxiety, or headaches—these patients discontinued use of the drug.

LDN is also being studied for its potential to aid those struggling with long COVID, or post-acute sequelae of SARS-CoV-2 infection. A recent study in International Immunopharmacology found that patients treated with LDN experienced improvements in fatigue, brain fog, and sleep disturbances. The study suggests that LDN’s anti-inflammatory properties may help relieve lingering COVID-19 symptoms.

Board-certified gastroenterologist Dr. Leonard Weinstock referred to low-dose naltrexone as a “wonder drug” for its potential to treat irritable bowel syndrome (IBS) and other digestive disorders.

“LDN works. There’s no denying its effectiveness,” he wrote.

Weinstock told The Epoch Times in an email that LDN increases the body’s endorphin levels, which helps calm the immune system and reduce inflammation. By blocking toll-like receptors, LDN decreases the production of inflammatory substances, which can relieve symptoms in conditions such as IBS.

LDN is now being used to treat a growing list of conditions, including restless leg syndrome, mast cell activation syndrome (MCAS), and postural orthostatic tachycardia syndrome (POTS). In MCAS, the body overreacts to allergens. With POTS, the heart rate increases, and blood pressure can drop when standing, which can lead to lightheadedness, dizziness, and fainting.

According to Weinstock, low-dose naltrexone is remarkably safe and well-tolerated. He noted that side effects occur in about 15 percent of people but are usually mild and reversible. Common side effects include headaches, vivid dreams, and gastrointestinal issues such as diarrhea. Reducing the dose or gradually increasing it can help minimize headaches, while taking the medication in the morning may ease vivid dreams.

Overlooked Option

Despite its potential to address various conditions, low-dose naltrexone remains under-prescribed, according to Elsgood. One significant reason is that LDN is off-patent, she explained.

When a drug loses patent protection, its exclusive manufacturing rights expire, allowing generic versions to enter the market. While this lowers costs for patients, it also reduces the financial incentive for pharmaceutical companies to invest in costly large-scale clinical trials. Because they no longer monopolize production, it’s challenging to recoup their costs.

“Getting FDA approval for a specific indication takes a lot of money. Naltrexone, which was FDA-approved at high doses for prevention of narcotic and alcohol abuse in 1984, has a high bar to jump over,” Weinstock wrote. “It is hard to do expensive studies on a generic drug.”

Without the large-scale trials required for widespread FDA approval, LDN remains mostly overlooked by mainstream medicine. Its low cost—typically about $1 per day at U.S. compounding pharmacies—further reduces the motivation to pursue it, making it challenging to fund the research needed to secure its place in the medical community.

Low-dose naltrexone must be prescribed and monitored by a physician. While naltrexone is FDA-approved for addiction treatment, its use in low doses for other conditions such as autoimmune disorders is considered “off-label.”

Only compounding pharmacies can dispense LDN, typically in the form of tablets, sublingual tablets, capsules, or transdermal creams. This adds another layer of complexity, as many doctors may be hesitant to prescribe a treatment that hasn’t gone through rigorous regulatory approval for these off-label uses.

“Doctors are not taught about low-dose naltrexone in medical school or residency, and there is no drug rep that comes around to teach them either,” Weinstock wrote. “The open-minded integrative physicians and naturopaths know best.”

Right Dose

Determining the correct dosage of LDN is challenging. The drug’s effectiveness varies widely depending on the individual, and no single dose works for every patient.

Patients often respond to LDN in three to four weeks, Weinstock said, noting that the fastest improvements tend to occur in patients with conditions such as mast cell activation syndrome, psoriasis, restless leg syndrome, and Crohn’s disease. However, he emphasized the need for personalized dosing.

“For sensitive people, it is best to go low and slow,” he said.

The dosing range for LDN is wide, and finding the “sweet spot” often requires careful monitoring and adjustment. Many patients find relief between 3 and 4.5 milligrams per day.

“If they do have side effects,” Weinstock wrote, “it is always worth scaling back the dose quite a bit.”

A recent study in the Journal of Pain Research underscores the individualized nature of LDN dosing. The observational study, which examined 41 patients with chronic musculoskeletal pain, found that the maximally effective dose of LDN varied significantly among participants.

The study found that patients experienced pain relief with doses ranging from 0.1 mg to 6 mg per day, with some showing reduced effectiveness or worsened symptoms at higher doses due to a phenomenon called hormesis. Hormesis occurs when a drug that provides benefits at low doses can have the opposite effect at higher doses, leading to diminished results or negative side effects.

In an interview with The Epoch Times, study author Dr. Norman Marcus highlighted the limited research on optimal LDN dosing, noting that many current regimens, such as the standard 4.5-milligram nightly dose, are based on little scientific data.

“What works for one patient may not work for another,” Marcus said, highlighting the idiosyncratic nature of the drug’s dosing.

While LDN holds promise for treating various conditions, the study emphasizes that its dosing must be carefully tailored to each individual, with adjustments made according to the patient’s response and any side effects.

A Helpful Tool

Although LDN has attracted attention for its ability to alleviate symptoms of chronic conditions, it is not a cure-all. Experts warn that while it may reduce inflammation, LDN by itself does not address the underlying causes of autoimmune disorders or other chronic health issues.

“LDN can downregulate some of the inflammatory activity in the body, but it doesn’t fix the systems driving the immune-inflammatory process,” Ben Galyardt, a chiropractor and functional medicine expert, told The Epoch Times.

According to Galyardt, factors such as blood sugar imbalances, adrenal dysfunction, leaky gut, and liver issues are key contributors to autoimmune conditions—issues that LDN cannot resolve.

“Relying solely on LDN without addressing the root causes risks continued damage to the body, even if symptoms improve slightly,” he said.

LDN is most effective when integrated into a broader, holistic treatment plan.

“It’s a tool in the toolbox, but it’s not a miracle,” Elsgood said. “You still need to reduce stress, prioritize quality sleep, spend time outdoors, and eat nourishing foods.”

Galyardt agrees, noting that while LDN can aid in symptom relief, it should be paired with other anti-inflammatory supplements such as turmeric, resveratrol, and vitamin D to support the body’s overall healing.

“LDN can be useful for symptom relief, but it’s important that patients understand how it works and ensure they’re also tackling the root causes of their health issues,” Galyardt said.

Path to Hope

For many, low-dose naltrexone provides a renewed sense of possibility, especially for those battling chronic conditions who feel like they’ve exhausted all options.

“LDN offers hope,” said Elsgood, who credits the drug with turning her life around after her MS diagnosis.

Now, through the LDN Research Trust, she is committed to raising awareness about the drug’s potential benefits.

“So many severely ill people have been stripped of hope,” Elsgood said. “For me, LDN was life changing.”

Her larger mission is to advocate for more comprehensive research on LDN, which she believes is essential to unlocking its full potential. The LDN Research Trust funds studies to promote greater recognition and acceptance of LDN in mainstream medicine.

For Elsgood and many others who have found relief, LDN represents more than just managing symptoms—it provides a way forward for those who feel let down by conventional treatments.