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Jeffrey Dach MD on Low Dose Naltrexone LDN
Fri Dec 10, 2010 10:04
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Low Dose Naltrexone(LDN)by Jeffrey Dach MD

A Drug to Reverse Narcotics Overdose

Imagine a drug addict slumped over from a lethal heroin overdose. He has shallow breathing and will die unless he receives prompt medical care in the emergency room. If he is lucky enough to make the trip to the ER, the doctors will give him an IV injection of Narcan (Naloxone), the drug of choice to reverse narcotics overdose, waking the victim and snatching him from the jaws of death.

Left Image: Duane Hanson's sculpture "Drug Addict" from 1974, Courtesy of wikipedia. The addict sitting the floor is a sculpture in a musem. The man standing is an anonymous museum visitor. (18)


A close cousin of Naloxone is Naltrexone, another opioid antagonist used as treatment for for narcotics and alcohol addiction.

Chemical Structures of Naloxone, Naltrexone and Morphine are similar (see below three diagrams).


Naloxone (Narcan) Naltrexone Morphine




Naltrexone: FDA approved since 1984

Narcan is available in the hospital operating room where anesthesiologists use it to wake up the patient after the operation. (image at left: first use of anesthesia). Opiate antagonists such as Narcan reverse the sedating effect of opiates by binding to the opioid receptors in the brain.

Left Image: First operation under ether anesthesia on October 16, 1846 (21) Courtesy Library of Congress.

Naltrexone was synthesized in 1963 and FDA approved since 1984. Naltrexone is a close chemical cousin to Narcan with very similar chemical structure, and is used to treat narcotics and alcohol addiction. (see chemical structure diagrams above). It was a surprise for me to find out that Naltrexone has other very important uses at a much lower dosage as an oral capsule. Medical scientists have been carefully studying its effect of Naltrexone on the immune system, and its clinical benefits for a host of disease states for the past 20 years.


Low Dose Naltrexone, (LDN), How Does it Work?

The beneficial effect of low dose naltrexone, LDN, was discovered by Bernard Bihari, MD (1)(1A), a physician in New York City who found that a small dose (3 mg) of naltrexone taken as a capsule at bedtime blocks the opiate receptors in the brain for a few hours during sleep, which then stimulates the brain to increase production of endorphins over the next 24 hours. These endorphins then stimulate the immune system. Although Bihari did much of the early clinical work, Zagon did much of the groundwork with animal research studies at Pennsylvania State University (3-17).


LDN Cures Crohn's Disease

A recent publication in the Jan 2007 Journal of Gasteroenterology on the use of LDN in Crohn's Disease, was the first breakthrough publication to appear entitled, Low-Dose Naltrexone Therapy Improves Active Crohn's Disease by Jill Smith MD.

Left Image: Typical appearance of Crohn's disease involving terminal ilem with ulcerations noted on barium small bowel examination (red arrows) . Courtesy of Jeffrey Dach MD, private collection.

Crohn's disease is a severe inflammatory condition of the small bowel which can be difficult to treat. Not difficult for LDN however. Jill Smith, M.D. reported that two-thirds of her 17 Crohn's patients went into remission, and 90% of the group had some benefit. Her article showed impressive colonoscopy photos before and after LDN treatment with complete clearing of the inflammatory changes in the bowel mucosa. Dr. Smith concluded that "LDN therapy appears effective and safe in subjects with active Crohn's disease."(2)


Other Conditions Which Benefit from LDN

The major therapeutic action of LDN is the restoration of normal endorphin production by the brain. This is beneficial for any condition in which there is a deficiency in endorphin production, such as autoimmune disease, cancer and HIV/AIDS. Bernard Bihari, MD, who discovered the LDN protocol has used it in hundred of patients in the following categories:


LDN for Cancer

LDN is useful for cancers of the Bladder, Breast, Colon & Rectal Cancer , Glioblastoma, Lung Cancer (Non-Small Cell), Lymphocytic Leukemia (chronic), Lymphoma Hodgkin's and Non-Hodgkin's) Malignant Melanoma, Multiple Myeloma , Ovarian Cancer, Pancreatic Cancer, Prostate Cancer (untreated), Renal Cell Carcinoma, Uterine Cancer,


LDN is useful for Autoimmune and other Diseases:

LDN treatment has benefited these diseases: ALS (Lou Gehrig's Disease), Autism Spectrum Disorders, Chronic Fatigue Syndrome, Crohn's Disease, Fibromyalgia, HIV/AIDS, Multiple Sclerosis (MS), Parkinson's Disease, Psoriasis, Rheumatoid Arthritis, Scleroderma, Systemic Lupus (SLE), Ulcerative Colitis, Wegener's Granulomatosis.

Left Image: Monthly MRI Scans of Multiple Sclerosis, small bright spots come and go, courtesy wikipedia.




LDN Has Virtually No Side Effects:

Occasionally, during the first week's use of LDN, patients may complain of some difficulty sleeping. This rarely persists after the first week. Should it do so, dosage can be reduced from 4.5mg to 3mg nightly.


Caution About Narcotics Withdrawal

Because LDN blocks opioid receptors throughout the body for three or four hours, people using narcotics pain pills such as Ultram (tramadol), morphine, Percocet, Duragesic, Oxycontin or codeine, should not take LDN until after complete withdrawal from their narcotic drugs. The use of LDN may induce narcotics withdrawal.

Although naltrexone is FDA approved, the LDN protocol is what is called "off-label use", and it is unlikely that any company will spend the millions needed to fund studies for FDA approval of the LDN protocol. However, off-label use of an FDA approved drug such as naltrexone is commonplace and widely accepted. The naltrexone capsules are inexpensive, about 20 dollars a month. The treatment is safe, with no adverse side effects.

Pharmacies that offer compounded LDN capsules:

The Compounder Pharmacy 340 Marshall Ave Unit 100, Aurora, IL 60506-2956 Phone: 630-859-0333 Fax: 630-859-0114. (22)

Skip's Pharmacy 21000 Boca Rio Rd Suite A-29 Boca Raton, Florida 33433, telephone 561-218-0111 800-553-7429 Fax: 561-218-8873 (24)

Thanks to Larry Frieders, the Compounder for bringing LDN to my attention, and for making low cost LDN capsules available to the public. (22)

Articles with related Content:

LDN Part Two (second part to this article)

Chron's Recovery with LDN Case Report



Jeffrey Dach, M.D.

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