Low-Dose Naltrexone

Also known by these names

  • LDN
  • Revia
  • Depade
  • Vivitrol

Key Points

  • LDN must be prescribed by a physician.
  • LDN is used “off-label” for a number of diseases, including cancer.
  • LDN must be compounded by a pharmacist. Experienced clinicians urge that best results come from compounding which is exact and of the highest possible quality and consistency.
  • Numerous studies in animals and humans show an immunomodulation effect.
  • BCCT’s interest in LDN derives from human cancer case studies showing increased disease-free survival and quality of life.
  • No published human clinical trials in cancer have been completed to date.
  • No major safety issues have been reported, though there are cautions and contraindications.
  • LDN is inexpensive.
  • Resources are available for finding compounding pharmacists and licensed prescribers.

LDN (low-dose naltrexone) is a drug that shows promise in integrative cancer care. Clinical observation,  hundreds of case studies, and lab, animal and human studies suggest that LDN may have significant potential to increase disease-free survival and quality of life in people with certain cancers. LDN seems to exert its effect, in part, by modulating the immune system, particularly helpful to people with conditions of immune system dysfunction and cancer. Studies suggest that when taken at night, LDN increases endorphin production, which then orchestrates the activity of stem cells, macrophages, natural killer cells, T and B cells and other immune cells—all of which benefit wellness and health.

Although no clinical trials of LDN in cancer have been conducted to date, lab studies, as well as human studies in other diseases such as Crohn's, have helped to define its action as well as its safety profile.

LDN is inexpensive. It must be compounded, preferably by a pharmacist skilled in compounding this drug. LDN is generally well tolerated.

Description

Naltrexone is an opioid antagonist used in conventional medicine to treat opioid and alcohol addiction, using doses of 50 mg or higher. When used in very low dosages (4.5 mg or less), naltrexone seems to modulate (control or influence) the immune system.1

LDN is used off-label to treat a number of diseases and disorders. Off-label use is a drug’s application for a disease or condition that has not yet received FDA approval. Every US state allows for drugs to be used off-label as long as there is enough evidence to support its use. According to Dr. Linda Elsegood, enough small studies and case-study evidence supports off-label use of LDN.2

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Modes of Action

According to Tom Gilhooly, MD, the exact modes of LDN’s effects are not yet known in cancer treatment, and even the mode of action of the drug itself is not entirely established. Dr. Gilhooly says some evidence suggests LDN works to reduce inflammation by influencing the immune response, and this may well be one of the ways LDN modifies the course of cancer.3

Read more

While no published prospective, controlled clinical trials on LDN in cancer treatment have been published, clinical observation, case studies, and lab, animal and human studies have shown LDN’s significant potential to increase disease-free status as well as overall survival and quality of life in people with certain cancers.

Clinical Evidence

Case studies and anecdotal evidence are promising but far from conclusive.

Tumor Shrinkage or Remission

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Improved Survival

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Animal Evidence

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The Low Dose Naltrexone website lists LDN as useful for the following cancers:

  • Bladder cancer
  • Breast cancer
  • Carcinoid
  • Colon and rectal cancer
  • Glioblastoma
  • Liver cancer
  • Lung cancer (non-small cell)
  • Lymphocytic leukemia (chronic)
  • Lymphoma (Hodgkin's and non-Hodgkin's)
  • Malignant melanoma
  • Multiple myeloma
  • Neuroblastoma
  • Ovarian cancer
  • Pancreatic cancer
  • Prostate cancer (untreated with hormonal therapy)
  • Renal cell carcinoma
  • Throat cancer
  • Uterine cancer

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Clinical Evidence

Read more

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

In their review article, Brown and Panksepp suggest that LDN is a safe and promising approach to prevention and/or treatment of many cancers and other diseases and conditions worsened by compromised immunity.30

Access

Compounding Pharmacies

For listings of reputable compounding pharmacies in the US and abroad who prepare LDN, see the following sources:

LDN requires a physician prescription but is not overly expensive. For example in 2017, a one-month supply from “The Compounder” was $36 US dollars (60 capsules for $64; 90 for $97), plus a $10 shipping fee. Multiple orders can sometimes be shipped in the same package, reducing costs further.

Naltrexone is not manufactured in low-dose form, needing to be specially compounded by a pharmacy. Preparation by a reliable compounding pharmacy yields the best quality and results. Beware that naltrexone is often created illegally and manufactured to substandard quality and sold via the Internet. No reputable pharmacy will sell LDN without a prescription.

Read more

Cautions

In the animal and human studies and case reports in cancer and other diseases, LDN is generally well tolerated and without significant side effects. Dr. Berkson and others also note that patients are easily able to comply with treatment.31

Adverse Events / Side Effects

Most side effects reported by patients can often be prevented by starting at a low dosage and increasing by 1 mg per week until reaching 4.5 mg.32

Read more

Contraindications / Do Not Use If

These situations may cause clinicians to decide against LDN use:34

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Interactions

People who have received organ transplants and who therefore are taking immunosuppressive medication on a permanent basis are cautioned against the use of LDN because it may act to counter the effect of those medications.36

Dosing

Guidelines are available from these sources:

The LDN Research Trust website lists physicians in the US and abroad who prescribe LDN, as well as compounding pharmacies.

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.
  • Programs and protocols
    • Bastyr University Integrative Oncology Research Center protocol for stage IV breast cancer37
    • Block program38
    • Elsegood LDN guidelines39
      • Dosing guidelines for LDN alone: p. 21
      • Dosing guidelines for combined protocols for cancer: p. 23
        • LDN plus alpha-lipoic acid (ALA-N) twice daily
        • LDN plus omega-3 fatty acids
        • LDN plus cannabinoids
    • McKinney protocols40
      • Bladder cancer
      • Brain/nerve cancer
      • Breast cancer
      • Cervical cancer
      • Esophageal cancer
      • Gallbladder cancer
      • Head and neck cancer
      • Kidney cancer
      • Leukemia
      • Liver cancer
      • Lung cancer
      • Lymphoma
      • Melanoma
      • Multiple myeloma
      • Myelodysplastic syndrome
      • Ovarian cancer
      • Pancreatic cancer
      • Prostate cancer
      • Sarcoma
      • Skin cancer
      • Stomach cancer
      • Thyroid cancer
      • Uterine cancer
      • Vulva cancer
      • Relief from myalgia due to drugs such as  aromatase inhibitors
    • Schachter LDN protocol41

Non-cancer Uses of LDN

Originally, LDN was used in treating AIDS. In addition to cancer, LDN is also used in treating these diseases and conditions:42

  • Multiple sclerosis
  • Lupus
  • Inflammatory bowel disease
  • Chronic fatigue syndrome and fibromyalgia
  • Thyroid disorders
  • Testless legs syndrome
  • Depression
  • Autism spectrum disorders

For a complete listing of diseases and disorders LDN may be useful in treating, see the Low Dose Naltrexone website.

Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update April 18, 2019.

View All References

More Information

  • National Cancer Institute Office of Cancer Complementary and Alternative Medicine: Alpha-Lipoic Acid Plus Low-Dose Naltrexone Reviewed for Cancer Treatment
  • Low Dose Naltrexone website: The site is kept current, listing the most recent studies, with links to the following information:
    • General information about LDN: What it is, how it works, diseases for which it is effective, including a link to information about LDN and Cancer
    • How to obtain it and cost
    • How to find a compounding pharmacy to prepare it
    • Prescribing information
    • Cautionary Warnings Existing research
    • Editor’s Blog
    • LDN Conferences
    • FAQ’s
  • The LDN Research Trust as well as LDN Radio: The LDN Research Trust was founded by a group of patients with multiple sclerosis, for whom LDN worked very well after all other treatments had failed. The primary aim of the Trust is to initiate clinical trials of low dose naltrexone. The site provides information on how LDN works, its use in treating pain and medical conditions and types of LDN. The LDN Radio Station provides presentations by LDN prescribers, researchers and pharmacists. It also lists pharmacists and medical subscribers by country and state/province. It is a sponsored publication of The LDN Book, which is a comprehensive resource for patients and clinicians on LDN.
  • The LDN Book: Edited by Linda Elsegood, this book explains the drug’s origins, its primary mechanism, and the latest research (as of 2016) from practicing physicians and pharmacists as compiled by Linda Elsegood of The LDN Research Trust, the world’s largest LDN charity organization. The book features ten chapters contributed by medical professionals on LDN’s efficacy and two patient-friendly appendices. There are helpful tables on dosing, usage, side effects, combination protocols. It includes guidance to patients who wish to converse with their physicians about using LDN for their conditions.
  • Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
  • Podcast: Use of Low-Dose Naltrexone and Cancer:  Dr. Lise Alschuler of Five to Thrive Live Radio interviews Akbar Khan, MD  about the unique mechanisms of action and  health-promoting effects of low-dose naltrexone, particularly in cancer. Dr. Khan is a graduate of the University of Toronto, Faculty of Medicine (1992). He completed his certification in Family Medicine in 1994. Dr. Khan co-founded Medicor Cancer Centres with his wife in 2006. Medicor is the first integrated private cancer clinic of its kind in Canada. The goal of opening this clinic was to provide better therapies for cancer patients, without the limitations of the government-funded Canadian health system. Since 2007, Dr. Khan has gained international recognition for his work with non-toxic off-label drugs, and has published groundbreaking cancer papers in various peer-reviewed medical journals. He is regularly invited to present lectures on complementary cancer therapy.
  • Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
  • Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
  • Barbara MacDonald, ND, LAc: The Breast Cancer Companion: A Complementary Care Manual: Third Edition

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