Low-Dose Naltrexone Drug Interactions

Low Dose Naltrexone Drug Interactions

Naltrexone has been linked to over 350 different drug interactions. [1] These interactions can occur when taking naltrexone at low doses for the treatment of certain medical conditions like fibromyalgia or Crohn’s disease.

Perhaps the most important type of medication to avoid when taking low-dose naltrexone is opioid drugs. Opioids are frequently abused, but they are also prescribed as pain relievers and are ingredients in some cough and cold medicines as well as anti-diarrheal medications. Ask your doctor about alternative medications to take when using naltrexone to avoid adverse effects.

What Is Low-Dose Naltrexone (LDN)?

Naltrexone is known as an antidote for certain types of substance use disorder. This medication is a member of a class of drugs known as opioid antagonists. It may be recognized by its brand name Vivitrol. [2] Specifically, naltrexone is well-known as an effective treatment for opioid use disorder (OUD). It’s also FDA-approved to treat alcohol use disorder.

In recent years, doctors have started prescribing low doses of naltrexone off-label to treat a number of different health conditions. Low-dose naltrexone refers to dosages around 4 to 5 milligrams, which is about a tenth of the dose generally prescribed to treat opioid addiction. [3]

What Does Low-Dose Naltrexone Treat?

There are a number of medical conditions that may benefit from a regimen of low-dose naltrexone, including: [4]

• Crohn’s disease
• Chronic pain
• Autoimmune diseases
• Multiple sclerosis
• Cancer
• Gulf War syndrome
• Myalgic encephalomyelitis
• Fibromyalgia
• Chronic fatigue syndrome
• Thyroid disorders

If you have any of these conditions, consult your doctor to determine if you may be a suitable candidate for low-dose naltrexone treatment. While there may be advantages to this medication, it’s not for everyone.

How Naltrexone Works

Low-dose naltrexone temporarily binds to opioid receptors in the brain, causing it to produce more of the natural opioids called endogenous opioids. [5] The effect is short-term pain relief and a feeling of general well-being.

Low-dose naltrexone also blocks the TLR-4 receptor in the brain, preventing microglial cells from being activated. This can have an anti-inflammatory effect that may be beneficial for various health conditions.

Naltrexone Side Effects

Naltrexone can cause various side effects in some people, even at low doses. Some commonly reported side effects of naltrexone include: [6]

• Headache
• Fatigue
• Joint pain
• Muscle pain
• Stomach cramps
• Nausea
• Vomiting
• Anxiety or nervousness
• Insomnia

If any of these side effects become bothersome or persist for more than a few days, tell your doctor.

Long-Term Effects of Low-Dose Naltrexone

When considering low-dose naltrexone for the treatment of an autoimmune disease or other health condition, it could be important to know that naltrexone is only FDA-approved to treat substance use disorder, particularly opioid use disorder and alcohol use disorder. When doctors prescribe this medication for other medical conditions, it’s considered an off-label use.

Moreover, there have been few studies probing the long-term effects of taking low-dose naltrexone. Studies show naltrexone is safe to use long-term, we know that this drug doesn’t behave the same way when used in lower doses. [7]

Naltrexone Drug Interactions

If you’re taking naltrexone, even at a low dose, it’s important to be aware of any possible drug interactions. Learning about the medications to avoid while on naltrexone can help prevent adverse effects.

Types of Medications to Avoid

There are over 350 different medications that may interact with naltrexone, so it may be impossible to remember them all. [8] One good strategy is to avoid certain groups of medications, or check for possible interactions before taking them: [9]

• Cough and cold medications containing opioids (including recreational drug cocktails such as Lean)
• Antidiarrheal medications containing opioids
• Opioid analgesics
• Any opioid medications
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Specific Medications to Avoid

Some medications may be riskier than others when it comes to possible naltrexone interactions. Specific drugs to avoid include: [10]

• Hydrocodone
• Oxycodone
• Tramadol
• Buprenorphine
• Methadone
• Morphine
• Codeine
• Diphenoxylate/atropine
• Thioridazine

This isn’t a complete list of drugs known to interact with naltrexone. If your healthcare provider recommends this medication, even at a low dose, it’s important to tell them about any other medications you’re taking, including prescription medications, recreational drugs, over-the-counter medicines, vitamins, and supplements.

Potential Effects of Drug Interactions

If you do take a medication that interacts with naltrexone, whether intentionally or by accident, you could experience one or more adverse effects. These effects will depend on the type of medication you take, but could include: [11]

• Decreased benefit of one or both medications
• Increased lethargy or sleepiness
• increased anxiety
• Increased heart rate
• increased blood pressure
• Liver damage

If you accidentally take a drug that interacts with naltrexone while on low-dose naltrexone treatment and are experiencing one or more of the above effects, contact your healthcare provider right away.

What Else Should I Avoid on Low-Dose Naltrexone?

When taking low-dose naltrexone for a medical condition, it could be essential to avoid other substances. There could also be medical conditions that may pose a problem when taking LDN. Here are some things to know before beginning a regimen of low-dose naltrexone:

• Don’t take low-dose naltrexone if you’re currently withdrawing from opioid drugs.
• Avoid LDN if you have opioid use disorder.
• Tell your doctor if you have acute hepatitis.
• Don’t take this medication if you’re allergic to naltrexone or any of its ingredients.
• Don’t drink alcohol while taking naltrexone in any dose.

Risk of Opioid Withdrawal Syndrome

People who combine low-dose naltrexone with other opioid medications are at risk for experiencing severe opioid withdrawal symptoms. This adverse effect could be immediate and may require medical attention. Symptoms of opioid withdrawal include: [12]

• Intense opioid cravings
• Nausea
• Vomiting
• Anxiety
• Chills
• Fever
• Muscle aches
• Dilated pupils
• Increased heart rate
• Increased blood pressure
• Crying
• Excessive sweating
• Insomnia

Seek Professional Addiction Treatment and Recovery Support

In higher doses, naltrexone is sometimes used in substance use treatment. If you or a loved one has opioid use disorder or alcohol use disorder, you may benefit from this treatment. A compassionate and knowledgeable substance use and rehabilitation counselor can provide more information about this treatment option and help you explore other treatment approaches.

In some cases, medication-assisted detoxification services may be a good fit. You don’t have to face substance abuse and addiction alone. Reach out for help today.

Frequently Asked Questions About Low-Dose Naltrexone