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Opioids Low dose or ultra low dose naltrexone for post acute withdrawal syndrome?

I think the reason there is such a wide range of doses reported has to do with how each individual metabolizes Naltrexone orally. The main reason I would recommend starting with very small amounts like 1-2 mcg and then titrate up is because you want to use the smallest amount of NLTX that will work since the active metabolite of NLTX with a long half life will cause build up and eventually block the brain's endorphins long term instead of the desired couple hours.

Yep, I was just pointing out that 10 mcg was not the maximum for concurrent administration with opioids. Definitely best to start with an extremely low dose if taking it with opioids IMO :)



So, unfortunately my pharmacy has said that they can't guarantee the stability of naltrexone in water beyond 2 weeks, so that adds to the cost substantially if I decide to keep taking it in liquid form, since I'd have to go in every 2 weeks. In reality I think that it can be kept longer than 2 weeks in a sealed dark container in the fridge, people preparing it themselves will make like a month's worth (or more) at a time, but I thought I would bring this up because stability is a legit concern for people wanting to make their own solution or for *whom cost is a consideration in getting a solution from a pharmacy. I was thinking IF I end up thinking it works and want to keep taking it and I find a suitable dose for me, then I could get capsules instead in the future to save money and not have to go to the pharmacy so often. But I don't really know how well extremely low doses like 0.5-10mcg could be accurately measured in capsules (as opposed to liquid) for people currently taking opioids and wanting to take doses in that low a range.
 
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Yep, I was just pointing out that 10 mcg was not the maximum for concurrent administration with opioids. Definitely best to start with an extremely low dose if taking it with opioids IMO :)



So, unfortunately my pharmacy has said that they can't guarantee the stability of naltrexone in water beyond 2 weeks, so that adds to the cost substantially if I decide to keep taking it in liquid form, since I'd have to go in every 2 weeks. In reality I think that it can be kept longer than 2 weeks in a sealed dark container in the fridge, people preparing it themselves will make like a month's worth (or more) at a time, but I thought I would bring this up because stability is a legit concern for people wanting to make their own solution or for home cost is a consideration in getting a solution from a pharmacy. I was thinking IF I end up thinking it works and want to keep taking it and I find a suitable dose for me, then I could get capsules instead in the future to save money and not have to go to the pharmacy so often. But I don't really know how well extremely low doses like 0.5-10mcg could be accurately measured in capsules (as opposed to liquid) for people currently taking opioids and wanting to take doses in that low a range.

It would be next to impossible to get capsules containing 10mcg of active ingredient without them compounding in substantial inactive ingredients. Which I guess isn't a problem, but if they contain some sort of sugar based inactive like dextrose, I don't think I would want to expose that to time. Naltrexone may be able to be stored in liquid form made from tablets, however if it contained an inactive ingredient that is known for spoiling in contact with water over time, it might not be as worth it as just getting the liquid naltrexone every 2 weeks.

Just my $0.02, I'm extremely interested in this subject as a whole, I just need to figure out my source of naltrexone. Everyone I know who takes naltrexone has a court-mandated implant hahaha =\
 
for some reason I feel like 1 mcg really wouldn't do much. that's such a low dose I have my doubts it would make a difference.
 
^fair point. I haven't done enough research to deny or confirm.
 
It would be next to impossible to get capsules containing 10mcg of active ingredient without them compounding in substantial inactive ingredients. Which I guess isn't a problem, but if they contain some sort of sugar based inactive like dextrose, I don't think I would want to expose that to time.
Seems like the popular filler for capsules now is microcrystalline cellulose. I had assumed that might slow absorption but it's apparently an acceptable filler according to pharmacists and LDN websites.

for some reason I feel like 1 mcg really wouldn't do much. that's such a low dose I have my doubts it would make a difference.
It actually can, if used with opioids, there are studies using as little as 0.5mcg or 1mcg that found it effective for preventing tolerance and reducing dependence (see my post above - with links - under "Dosages"). It depends on what opioid you're using and in what doses etc though. Personally I am not using it with opioids so I'm going to take more than that.
 
Seems like the popular filler for capsules now is microcrystalline cellulose. I had assumed that might slow absorption but it's apparently an acceptable filler according to pharmacists and LDN websites.


It actually can, if used with opioids, there are studies using as little as 0.5mcg or 1mcg that found it effective for preventing tolerance and reducing dependence (see my post above - with links - under "Dosages"). It depends on what opioid you're using and in what doses etc though. Personally I am not using it with opioids so I'm going to take more than that.

Very interesting SD, as always.
 
So I've got my naltrexone and I'm starting it tomorrow. I put a ton of background info on my blog here if anyone is interested. I will post on my blog about what happens once I start it. I'm trying not to have any expectations either way but wish me luck :)
 
So I've got my naltrexone and I'm starting it tomorrow. I put a ton of background info on my blog here if anyone is interested. I will post on my blog about what happens once I start it. I'm trying not to have any expectations either way but wish me luck :)


I tried it, it doesn't work.. It will do something for few hours the next day, but then your in a fog, stops working and you build tolerance in a matter of few days, after that your in even worst depression...Tried it for PAWS, doesn't work.. Also DO NOT take it with any opiates because you will feel bad the next day granted i.e sweats and typical withdrawals, even WORSE depression, this is why people dont post more about ULDN or LDN because it does not work as you expect..
 
I tried it, it doesn't work.. It will do something for few hours the next day, but then your in a fog, stops working and you build tolerance in a matter of few days, after that your in even worst depression...Tried it for PAWS, doesn't work.. Also DO NOT take it with any opiates because you will feel bad the next day granted i.e sweats and typical withdrawals, even WORSE depression, this is why people dont post more about ULDN or LDN because it does not work as you expect..

What dose did you try?
 
It varied, and was very low, from 1mg to 0.5..It doesn't matter which low dose or ultra-low dose, the fact it does not work as you want is factor, and not worth it at all.
 
It varied, and was very low, from 1mg to 0.5..It doesn't matter which low dose or ultra-low dose, the fact it does not work as you want is factor, and not worth it at all.
Just because it didn't work for you doesn't mean it can't work for anyone. There is plenty of evidence that it can be effective for some at least.

I am taking 4.5 mg ldn for suboxone PAWS and it is working like a charm.
Details please! :) When did you stop Suboxone, when did you start the LDN and how long have you been taking it?
 
I know tons of people who tried this method and claim it did not work at all, if it do anything it was for a day or 2 then found themselves in worse situation i.e brain fog, ULDN stops working, worst depression etc...If it really was successful generally then it would be known by now and many people would be trying it. None of us are that different when it comes to PAWS where something like LDN works for some and for others it does not... For most in my experience it does not work how we want it to work.
 
Don't believe ya.

4.5mg is not really LDN and if your using it for PAWS that dose definitely does not have any benefits.

Suboxone PAWS are just too strong for LDN to do anything at all, same with methadone PAWS.
 
I came off 9 years on suboxone (went from 32 mg per day to 8 durung the last year and then tapered to .5 mg before I jumped on 1/1/2013. Probably should have tapered a little lower and a little longer. I had pretty horrible withdrawal for an extended period of time. Didn't get out of the acute withdrawal phase for 3 months. My doctor helped ease this alot with klonopin and clonidine. This made it bearable and allowed me to stay clean. After I was through the acute phase I still had significant problems with PAWS (post acute withdrawal syndrome). I was depressed, lethargic, and very uninspired. My doc prescribed Toradol for the symptoms but this drug only made me feel more depressed, and it affected my libido which depressed me even further. After researching low dose naltrexone I became convinced that this might help me. My doc was convinced and prescribed it off label at 4.5 mg once a day before bed. I felt good the first morning and have improved every day. I believe that this dosage is "upregulating" my endorphin system. I have to admit that I feel pretty normal after a month on LDN (4.5 mg once a day.) Seems like a miracle drug. (at least it is for me) Good luck to all.
 
I would not be so naive, what about when you build it up in your system and become foggy? (many ex-sub users report this) what about when or if it stops working? what about if you feel worse later on? the general notion is that LDN helps for a day or 2 but after that it stops giving those feelings and you become depressed even more.

I do not believe it jumps starts or down regulate endorphins because 3 people I know who tried the LDN claimed they felt ever worse a week later and were in a worst fog for 2 more weeks, and then back to PAWS...Perhaps it may helps some and not others but that only proves that it's not proven to help PAWS in the long term..

I remember I tried the LDN and it put me back in withdrawal, it made me feel good for 1 day or 2 days but then stopped working and felt worse..
 
I stopped taking suboxone after 9 years this past January 1, 2013. The acute withdrawal lasted for 2-3 months. (No I am not kidding) I still had no energy and just generally felt bad. (I lost 25 pounds during that time) I got my doctor to prescribe LDN 4.5 mg at bedtime and it made an almost immediate drastic improvement in my life.
 
I stopped taking suboxone on 01/01/2013 after 9 years on the drug for maintenance. I feel like I was in acute withdrawal for at least 2 months. During that time my doctor prescribed ativan, clonidine, and klonopin to help me make it through. These helped but I was pretty zombie like. Lost 25 pounds during this period. After that I complained of being in a fog, lethargy etc... and my doc put me on toradol. Stayed on that for a month and got off because of depression. I then just sucked it up for another month thinking I would get better "any day". I didn't. I then got my doc to prescribe 4.5 mg. of ldn and I have been better everyday since then. This stuff works.
 
Although this thread is old, I thought I'd chime in with my 0.2 and also, see if there are any updates on how you went after day 6, Swimmingdancer?

I used ultra low dose naltrexone extensively in the past, with what seem like good effects. It's hard, though, to know what to attribute to the uld naltrexone, given I don't have a 'control'. I've also spent long periods without taking it, then restarting, and so on.

I began taking around 10mcg a day when I first started using codeine daily. I found I was able to stay on the same dose of codeine for about a year and a half, with only small-moderate reductions in the codeine's effects. I was able to stop this daily use cold turkey with only very mild wd symptoms - though, I wouldn't expect bad wd's from codeine anyway. Since then I have begun using stronger opioids daily. I do feel that my tolerance has risen during the periods when I wasn't taking uld naltrexone - but again, it's hard to say for sure. My feeling from my experience is that uld naltrexone is most effective in preventing tolerance rise whilst being taken concomitantly with agonist opioids. IME, it seems to have had limited effect in reducing my tolerance, once it's already there (and perhaps, then, limited effects in addressing PAWS? I don't know).

My tolerance has risen to an unmanageable level lately (perhaps interestly, I haven't been using uld naltrexone for the past year or so), so I have again made up a batch of uld naltrexone to take alongside a sub taper, in the hopes it'll help. I've been taking 10-30mcg a day. No conclusions to be drawn yet, as I'm yet to take a full opioid agonist to see where my tolly is at, though I haven't found dropping my sub dose particularly easy.

I do use the 50mg revia tablets to make up my ultra low doses. I crush up half a 50mg pill (25mg), and mix that into 25mls of water, so I should have 1mg per 1ml. I then take 1ml of that and put it into 200mls vodka, ending up with 5mcg per ml. I find the vodka necessary as a mixture in water seems to go funky very quickly. I once put a naltrexone/water mix inside a syringe to give to a friend, and within a couple days it was looking very off, with large white, flaky chunks floating around - far more than just the solids settling out.
 
I would not be so naive, what about when you build it up in your system and become foggy? (many ex-sub users report this) what about when or if it stops working? what about if you feel worse later on? the general notion is that LDN helps for a day or 2 but after that it stops giving those feelings and you become depressed even more.

I do not believe it jumps starts or down regulate endorphins because 3 people I know who tried the LDN claimed they felt ever worse a week later and were in a worst fog for 2 more weeks, and then back to PAWS...Perhaps it may helps some and not others but that only proves that it's not proven to help PAWS in the long term..

I remember I tried the LDN and it put me back in withdrawal, it made me feel good for 1 day or 2 days but then stopped working and felt worse..

Do not be so quick to assume that because it didn't work for you, that it isn't possible for it to work for other people with unique body chemistry. You can't just dismiss saaron3's reported experience with "don't believe ya". You have no idea how they reacted to it, and it seems like unnecessary provocation. The way you endured PAWS is going to be radically different from the way 99 other people would if we put 100 PAWS patients in a room, so to speak...

I bet that each and every person would respond best to a different form of therapy, and I know that this is the last thing that many want to hear, but your chances of succeeding in terms of overcoming opioid addiction are the highest (no pun intended) when you integrate NON-MEDICATION ways of repairing your abused opioid receptors.

If you can afford it, a multifaceted approach seems to be undeniably the best way of proceeding. CBT is often a huge piece of the puzzle that most addicts trying to become ex-addicts overlook, probably because everyone gets so used to treating all of your problems with a pill, or that there's just going to be some drug out there that makes everything better so all one needs to do is find this non-existent miracle drug.

Hence why many doctors tend to throw so many scripts at people in PAWS, I sorta visualize/analogize it as being like a blindfolded firing squad suffering vertigo.... and they're hoping that one bullet will manage to hit the target by chance but you can't predict the outcome, so with all of these drugs in your system, it's pretty hard to identify exactly what is doing what.... What is helping, what is NOT helping, etc, especially because it's IMO/IME rather standard procedure for doctors to try doping people up on
1) benzodiazepines- the universal band-aids for gunshot wounds. For some reason, doctors tend to hand out clonazepam or lorazepam, but I've found these to be the least effective minor tranquilizers, my body chemistry favors triazolobenzodiazepines such as alprazolam, but it's short mechanism of action makes it an impractical choice, especially seeing as how PAWS for buprenorphine and methadone can last so long that by the time the worst of it is over, you now have a benzodiazepine habit to deal with.... I get the best results from a specific dose of diazepam and temazepam, but that's just me. Things can get ugly due to the many people who elect to consume obscene amounts of benzodiazepines during PAWS, hoping to force effects out of a drug it's incapable of producing, anything to feel "better". Brute force does not work here, and this kind of dosing will only increase the dependency on benzodiazepines (the general consensus being that it is one of, if not the worst classes of drugs to discontinue... GABAergics as a whole...). The overall time one spends dependent on yet another drug increases and your inhibitions decrease when you are most vulnerable to relapse.... which is the opposite of what one usually is trying to accomplish when one finds themselves ready to stop taking maintenance drugs and attempt the next step: sober living.

2) clonidine- trying to relieve some RLS and withdrawal symptoms with clonidine, and other substances that are not controlled substances, a very popular one being:
3) Hydroxyzine, (Trade name Atarax, is IMO the best form of hydroxyzine as it is the water soluble hydrochloride salt and it already has a long half life, negating the point of Vistaril (Brand name hydroxyzine that breaks down very slowly, way too slowly for my needs) yet... it is a "sedative" which can works wonders or not at all, but usually somewhere in between... depending on your unique body chemistry.

4) Ondansetron (Trade name Zofran, and the generics are just as good for this use) I'd heard reports of this, so naturally the day came when I finally decided to try it, and it helped a great deal with the RLS and hot/cold flashes and overall the menopause-like sensation that withdrawals feel like. I was lucky enough to experience incredible relief from my PAWS, and am very grateful to have this drug in my opioid withdrawal kit/arsenal. NOTE: I have never allowed myself to take buprenorphine regularly enough to become dependent due to the mess that most people find themselves in when they need to get off of it.


The way I see it, even you said it works for two days or so, and I know plenty of people suffering from PAWS that would be extremely grateful for any relief at all, so now that we know that it can be a positive thing.... Just like every single other drug though, the benefits for you were short-lived and dependency brought you depression, a very commonly reported side effect with naltrexone.
 
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