In this article

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Decades ago, researchers began to explore the benefits of low doses of the drug naltrexone (LDN) as a potential treatment for autoimmune conditions and chronic pain. Today, LDN has become one of the few prescription medications that may help reduce autoimmune reactions -- or even help patients achieve remission. In this article, we take a look at LDN treatment for an autoimmune disease like Hashimoto's, and factors to keep in mind when following this treatment. 

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Naltrexone is a drug that, at high doses, is used as part of treatment programs for alcoholism and opioid addiction. But as was discussed in a Paloma Speaker Series presentation on the topic, in the 1980s, LDN pioneer Dr. Bernard Bihari found that lower doses of naltrexone helped patients with AIDS. LDN treatment typically uses a dosage of from 1.5 to 4.5mg of naltrexone per day, a dose that's much lower than the 50mg+ usually prescribed as part of addiction treatment.

Dr. Bihari's theory was that low-dose naltrexone treatment (LDN) provided immune-modulating benefits. He then studied the use of the drug and concluded that LDN may have beneficial effects for those with autoimmune disorders and certain cancers, as well as other medical conditions. 

Since then, the interest in using off-label LDN in clinical practice has increased, due to evidence that very low doses of naltrexone also have the ability to block some of the receptors that cause inflammation and reduce autoantibodies characteristic of autoimmune disease. Because of this, LDN may benefit those with inflammatory autoimmune disorders such as Crohn’s disease, multiple sclerosis, and Hashimoto's thyroiditis.

Unlike naltrexone, LDN is not FDA-approved, meaning those taking LDN are doing so “off-label.” There aren’t enough standardized, large-scale clinical studies showing the benefits of using LDN for specific indications, including Hashimoto’s disease.

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While there are no large clinical studies looking at the benefits of using LDN in those with Hashimoto’s, studies of LDN use for other autoimmune disorders have shown that LDN may benefit autoimmune patients by:

• Acting as an immune modulator. LDN changes the function of your immune system by binding to opioid growth factor and non-opioid receptors on your immune cells. Because of this action, your immune cells can’t grow and divide. Because it's an opioid antagonist, LDN may “calm” your immune system down, resulting in a decrease in inflammation.
• Affecting cytokine production. Cytokines are part of the immune system that manages inflammation. LDN may decrease cytokine levels, resulting in reduced inflammation.
• Increasing endorphins. Endorphins are a type of hormone that, when released, trigger positive feelings. LDN increases the production of two of them, which may positively affect your mood and quality of life.

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Some individuals with Hashimoto’s have great success taking LDN to help manage their symptoms. Specifically, some of the benefits Hashimoto's patients may experience on LDN treatment include the following:

• Reduced inflammation associated with Hashimoto’s
• Reduced thyroid antibodies
• Improved energy levels
• Better sleep quality
• Reduced depression and anxiety associated with autoimmune conditions
• Reduced muscle and joint pain

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At the low doses used in LDN therapy, naltrexone is considered extremely safe and is generally well tolerated.  Clinical studies suggest that those starting on LDN may experience the most common side effects, which include vivid dreams or insomnia. Because of this, try to avoid taking it right before bed. The good news is these side effects usually go away with continued use of LDN.
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Other possible side effects include the following:

• Abdominal pain
• Feelings of anxiety or nervousness
• Headache
• Nausea
• Vomiting

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Even though LDN is well tolerated, there are interactions that you should be aware of while taking LDN. These include:

Alcohol use

Since LDN blocks opioid receptors, it decreases the euphoric feeling many achieve through drinking alcohol. Because of this, individuals may drink more alcohol than usual to achieve the desired euphoric feeling. This may result in symptoms of an alcohol overdose, including:

• Mental confusion
• Seizures
• Slow heartbeat
• Trouble breathing
• Unconsciousness
• Vomiting

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An overdose of alcohol can lead to serious injuries such as brain damage and, in some cases, death. Therefore, individuals taking LDN should avoid drinking alcohol.

Opioid medications

Similar to alcohol use, LDN blocks the pain relief and other effects of taking opioid drugs. Because of this, opioids like oxycodone, morphine, and fentanyl should be avoided while taking LDN. This is also true for heroin which has a similar structure to morphine.

Taking opioids or heroin while taking LDN may lead to an unintentional overdose. Individuals may take higher amounts to achieve the desired euphoria resulting in a coma or death.

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Opioid containing medications

Some medications are available in combination with opioids. These combinations typically help manage:

• Cough and cold symptoms
• Pain
• Diarrhea

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As mentioned, LDN blocks opioid receptors, so opioid-containing medications may not relieve your symptoms. Thus, these medications should be avoided when taking LDN.

While most of these products need a prescription, some are available over the counter (OTC). Be sure to check with your healthcare provider or pharmacist before taking OTC medications to ensure there are no interactions with LDN.

Cough and cold medications

Two types of opioids -- codeine and hydrocodone -- are commonly found in combination with antihistamines or decongestants to help treat cough and cold symptoms. Some examples of these medications include the following:

• Codeine and promethazine
• Codeine and chlorpheniramine
• Hydrocodone and guaifenesin
• Hydrocodone and chlorpheniramine (Tussionex)

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Most states require a prescription for codeine-based cough syrups. But, In some states, you can buy codeine-based cough syrups without one.

Opioid analgesics

Opioid analgesics provide pain relief and are available with other pain relievers. Examples of prescription combination opioid analgesics include:

• Percocet, Endocet (oxycodone and acetaminophen)
• Percodan, Endodan (oxycodone and aspirin)
• Norco, Lortab, Lorcet (hydrocodone and acetaminophen)
• Reprexain (hydrocodone and ibuprofen)

Anti-diarrheal medications

Loperamide (Imodium) is an OTC medication used to manage diarrhea. Its structure is similar to an opioid. Because of this, you may get minimal or no relief from taking loperamide.

Other prescription anti-diarrheal medications to be aware of include diphenoxylate/atropine (Lomotil) and opium tincture.

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If you're taking LDN and are having a scheduled surgery, make sure that your doctor is aware that you're taking LDN. Typically, surgeons will ask you to stop taking the LDN before and after surgery to ensure that anesthesia and pain medications are effective. 

If you need emergent or acute pain management, tell your healthcare provider you are on LDN. This may change the way they manage your pain or administer anesthesia.

LDN is not a stand-alone treatment and is best integrated into a comprehensive plan for managing and treating your Hashimoto’s. This plan may include thyroid hormone replacement medication and lifestyle modifications such as diet and exercise.

Our Paloma Health thyroid specialists can help you understand the different treatment options for managing your Hashimoto’s, including LDN. And Paloma Health’s nutritionist can help fine-tune your diet to eliminate foods contributing to your Hashimoto's symptoms or flare-ups. Learn more about how to get started with a Paloma doctor for a virtual appointment.