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Patient instructions

Low Dose Naltrexone (LDN) Patient Instructions

These instructions are for compounded low dose naltrexone capsules. LDN is prescribed at a small fraction of the regular naltrexone dose, usually taken nightly and stepped up gradually over the first weeks. Available by prescription only.

Bedtime dosing

LDN is usually taken at night. If bedtime dosing disturbs your sleep, ask your prescriber — timing can often be adjusted.

Start low, step up

LDN is titrated gradually — typically 1.5 mg, then 3 mg, then 4.5 mg. People with multiple sclerosis and muscle spasms are often kept at 3 mg.

Thyroid medication

If you take thyroid replacement for Hashimoto’s thyroiditis, LDN is usually started at 1.5 mg. Watch for symptoms of too much thyroid hormone — your replacement dose may need a prompt reduction.

How to Take It

  1. 1Take your capsule once daily, usually at bedtime. Follow the timing on your prescription label.
  2. 2Most prescribers use a step-up schedule: 1.5 mg nightly for 2 weeks, then 3 mg nightly for a month, then 4.5 mg nightly if more effect is needed.
  3. 3The usual therapeutic range is 1.5 mg to 4.5 mg each night. Doses below this range tend to do nothing; doses above it can block endorphins for too long and work against the therapy.
  4. 4Do not change your dose on your own — the step-up schedule on your label is part of the therapy.

If You Miss a Dose

  • If you miss a night, skip the missed dose and take your usual dose the next night.
  • Do not double up to catch up.
  • If you are unsure what to do, call the pharmacy.

Side Effects

LDN is generally well tolerated at the low doses used. You may notice:

  • Difficulty sleeping or vivid dreams during the first week or two. This usually settles; if it persists, the dose can often be reduced (for example from 4.5 mg to 3 mg).
  • Side effects beyond sleep changes are uncommon at low doses.

Cautionary Warnings

  • Opioid (narcotic) pain medications — including morphine, codeine, oxycodone, tramadol, and fentanyl patches — and dextromethorphan (in some cough syrups) must not be combined with LDN. LDN blocks opioid receptors for several hours, which can stop these medications from working and can trigger withdrawal. If you take opioids daily, they must be fully tapered off (with non-opioid pain control in place) before starting LDN.
  • If you have had an organ transplant and take immunosuppressive medication, LDN is generally not recommended — it may counteract those medications.
  • Full-strength naltrexone (50 mg) carries a liver-disease caution from much higher experimental doses. The low doses used in LDN have not shown liver impairment, but tell your prescriber about any liver condition.

Storage

Store the capsules at room temperature, away from heat and moisture, and out of reach of children. Check the beyond-use date on the pharmacy label — compounded capsules have shorter dating than commercial products.

When to Call the Pharmacy

  • You are prescribed, or about to be prescribed, any opioid pain medication, cough syrup, or new prescription — the interaction check matters with LDN.
  • Sleep disturbance is not settling after the first couple of weeks.
  • You take thyroid medication and notice palpitations, heat intolerance, anxiety, or weight loss.
  • You are running low — compounded LDN capsules are prepared to order, so plan refills a few days ahead.