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

[Swimmingdancer]

Has anyone actually tried this? I am talking about extremely low doses of naltrexone, like anywhere from 1mcg to 5mg. NOT the Revia pills that are 50mg or the naltrexone injection or implant or anything like that. It's also known as ULDN (ultra low dose naltrexone, normally under 1mg), LDN (low dose naltrexone), VLDNTX (very low dose naltrexone) etc. I know that low doses of naltrexone have been used to prevent tolerance and dependence to opioids, reduce tolerance, reduce withdrawal symptoms during a taper, to prevent or reduce acute withdrawal symptoms, to help with chronic pain, etc (and there are la number of studies on those uses in both animals and humans), but I'm having a lot of trouble finding any reports from individuals who have actually tried it for withdrawal or post-acute withdrawal from opioids.

I am going to try it for my PAWS (lethargy, apathy, pain, hyperalgesia, etc). I figure the worst that could happen is I don't figure out the correct dose and take too much and it makes me feel temporarily worse.

I would really like some help in figuring out how to do this and to hear from anyone who has tried it, even people who have tried ULDN or LDN for other reasons (fibromyalgia, MS, depression, etc). I was thinking of maybe starting with 10mcg and then adjusting from there, because even though I won't be taking it with any opioids as I've been off methadone for around 4-5 months and all opiates/opioids for over 1 month (aside from some very low doses of DXM, the last of which was about 1 week ago - don't plan on taking it again), I'm still scared of just starting with 1mg of naltrexone.

Thanks!

Also I think I will start a blog about my experiences once I start the naltrexone and so I'll come back and link to it in this thread.

EDIT: Here is my blog. The first 3 parts are a ton of background info, links to studies, links to others' experiences etc if anyone is interested, then I report on my experiences taking it. Update: I'm currently taking a break but plan to restart it again soon, see my blog for more details).

 

[tricomb]

My biggest question/concern.

HOW DO YOU DO LDN/ULDN?!? I also want to try it, but how the hell am I going to get naltrexone into accurate doses below the milligram level?! Certainly not from the 50mg naltrexone tablets, not factoring in at all whether I could/would even seek generic ReVia (50mg naltrexone tablets)....

So how do you intend to get low doses? Does Canada have a form of LDN/ULDN? I'm confused about how we can even have the concept of LDN/ULDN if I can't even find a formulation of naltrexone (besides naltrexone for injection) lower than 50mg in tablet form, so how are we supposed to achieve ULDN?!

If I could figure that part out, I'd be down to do a trial of it with you!

 

[bingey]

Can someone explain why dissolving the revia pills in water and diluting won't work? Does it have to do with slight variations in the product itself? If so couldn't this be circumvented by making up a big batch as it were, the more pills you dissolve the closer you are going to get to 50 mg.

let's see 50mg pill in 1 l of water it would be 5 mic a ml right?

 

[tricomb]

I wouldn't be willing to bet precipitated withdrawals on such a rough/not-accurate-enough-for-this-application leap of faith.

 

[KillSurfCity]

I wouldn't be willing to bet precipitated withdrawals on such a rough/not-accurate-enough-for-this-application leap of faith.

true for some people. last night, i had nothing but codeine, though, and took 150mg. i woke up sick, regardless. stayed in bed until noon when i took 2mg suboxone / >1mg nalaxone (different chemical but similar)...i didn't get PWD at all. it had been about 24 hours since my last dose of oxy and 12 hours since my rather small dose of codeine. scored a small around 7:30 PM (CDT) and did half of it. feel great, actually. subxone strips are very forgiving to me when i score something hours later. everyone is different, though. it's all about how quickly your body rids itself of bupe/nalox. i'm sure the rest i have tomorrow will have a stronger effect. i recall a time i took 60mg oxycodone around 6PM one night and took a strip the next morning at 9AM. did not get any PWD...i was probably rather lucky that i didn't, in retrospect. i have seen another person take suboxone 24 hours after their last dose of oxyC and they got sick as hell about 4 hours later...depends on your body. hard response.

 

[Swimmingdancer]

^Buprenorphine is a totally different animal from low dose or ultra low dose naltrexone. Buprenorphine itself can cause precipitated withdrawal, with or without the naloxone and naloxone is not very active orally.

tricomb - I am getting it prescribed (it's still an off-label use though) and getting it from a compounding pharmacy. Options available from compounding pharmacies are either capsules containing a tiny amount of naltrexone with a filler that should not impact absorption (apparently what filler they use can make a difference and you don't want something that slows absorption - lactose or sucrose are good) or else a solution in water with a given number of mcg per ml. I think I am probably going to try for the latter. Some compounding pharmacies do make pressed tablets too but I think absorption would be more reliable with the other options. It all depends on what's available at the compounding pharmacies in your area of course, but LDN/ULDN actually appear to be more widely available than I expected. There are some sites with lists of reliable compounding pharmacies where you can get LDN or ULDN but they are nowhere near exhaustive. You should be able to order it online if you can't find one locally.

Quite a few people do make their own dilution from Revia tablets though (dissolving one 50mg tablet in 1L of water, then taking 1 ml of that and adding that to 99 ml of water for example) and it is supposedly effective enough. But I thought a pharmacy sounded easier and wiser, especially for doses in the mcg range - maybe if one was dosing 5mg (not an advisable dose for most people currently taking opioids) a tiny error in measurement wouldn't matter much, but if one is going to dose, say, 2mcg, for example, you'd want to be very precise. Not all compounding pharmacies are able to accurately measure such minuscule doses either, so I'm thinking one that is experienced with ULDN would be the best option, and/or getting the liquid version or else getting, say 1mg capsules and dissolving the contents in water yourself.

let's see 50mg pill in 1 l of water it would be 5 mic a ml right?

That would be 50mcg per ml wouldn't it?

I think the concern with dissolving 50mg naltrexone pills is that if the goal was to take a precise dose in the mcg range there could potentially be too much room for error. Like if someone is currently taking opioids so only wants to take an extremely low dose (like under 10mcg) they wouldn't want it to risk having it vary by even a few mcg. Naltrexone is scary for someone physically dependent on opioids (even 1mg could potentially induce WD in some people), plus if you want a specific dose you want to know you are actually getting that dose and not 0.5mcg one day and 5mcg the next). However people do dissolve the 50mg pills.

---

Dosages:

I am not sure what to even dose, that's why I figured 10mcg would be a good initial starting point and go from there. For people physiologically dependent on opioids who are taking it with opioids I have seen wildly varying doses, for example: 0.5mcg per 200mg of codeine; 10mcg-3mg/day with unspecified amounts of opioids; 1mcg per every 10mg of oxycodone; 125-250mcg with unspecified amounts of methadone and so on. This guy's doses (with hydromorphone) are all over the map.

For people like me who are using it for PAWS there is much less info to go on. LDN for pain and other illnesses in people who presumably(?) have not been recently dependent on opioids varies a lot in dose too, but around 4mg at bedtime seems to be a common dose.

 

[tricomb]

I definitely would require a special compounding pharmacy (My main pharmacy happens to compound medications too, they literally do everything, I love them) to compound me a special liquid solution because I am NOT going to do this from a 50mg naltrexone tablet.

Is this all being covered by Health Canada? I would imagine it would cost me a fortune to get ULDN compounded... I know my insurance doesn't like to cover compounded medications.

 

[tricomb]

I definitely would require a special compounding pharmacy (My main pharmacy happens to compound medications too, they literally do everything, I love them) to compound me a special liquid solution because I am NOT going to do this from a 50mg naltrexone tablet.

Is this all being covered by Health Canada? I would imagine it would cost me a fortune to get ULDN compounded... I know my insurance doesn't like to cover compounded medications.

 

[Swimmingdancer]

I definitely would require a special compounding pharmacy (My main pharmacy happens to compound medications too, they literally do everything, I love them) to compound me a special liquid solution because I am NOT going to do this from a 50mg naltrexone tablet.

Is this all being covered by Health Canada? I would imagine it would cost me a fortune to get ULDN compounded... I know my insurance doesn't like to cover compounded medications.

No, they don't cover prescriptions. There is some coverage of prescriptions by provincial programs for low-income people but it only covers certain drugs and I don't know if compounded meds are covered at all - LDN is not covered. The price here is actually pretty reasonable (it's mostly the pharmacist's fee and they can do up to a 3 months' supply which saves a lot of money), you could always look into it in your area.

I'm going to go with the liquid, capsules seem not like the best idea for extremely low doses in my opinion, unless one was going to get capsules with a water-soluble filler and make one's own solution from, say a 1mg capsule (like if capsules were the only option or were substantially more affordable for someone). I can apparently get whatever dose per ml my Dr specifies in a solution. I probably won't be starting it for about a week though.

 

[bingey]

^
I can understand the fear associated with misdosing on naltrexone ( I have been through precipitated withdrawals more than once , always naloxone induced though) , however you do realize that the process they will use in the pharmacy will be more or less the same. However if you can get it done by proffessionals all the better.

I'm very curious about the results. Do you have a plan of action for the off chance that you do take too much? I would recommend having some clonidine on hand it lowers your blood pressure and deals with the hot/chills effectively.

 

[tricomb]

I think it might be easier/cheaper for me to try and get prescribed IV naltrexone and use that to microdose but not with the IV ROA, and in the micrograms like you're saying, I think 1mg would be too much for me, I'd want to start at like.... 1 microgram.... and work my way up from there, seeing how I react to it.

 

[Swimmingdancer]

I think it might be easier/cheaper for me to try and get prescribed IV naltrexone and use that to microdose but not with the IV ROA, and in the micrograms like you're saying, I think 1mg would be too much for me, I'd want to start at like.... 1 microgram.... and work my way up from there, seeing how I react to it.

I didn't think one could get Rx IV naltrexone, only the IM injection Vivitrol which contains a polyester to make it slow-release. Or am I mistaken?

 

[tricomb]

^You'd be surprised what one can get prescribed, and I'm pretty sure they make an commercially formulation IV naltrexone... not TOTALLY sure though.


Would it be possible to attempt something similar with ULTRA LOW DOSE NALOXONE?!

 

[Swimmingdancer]

^Don't think naloxone would work. Especially not orally. It is too different from naltrexone, just 2 of the differences being the half-life and absorption. I can check if there are any studies using naloxone though.

 

[tricomb]

I wouldn't be taking the naloxone orally, and I wasn't even seriously suggesting it but I am merely interested for the sake of academia, and also because naloxone is extremely easy to obtain and could be dilluted much easier than ReVia.

But just one 50mg naltrexone tablet sure could make a LOT of solution..... but it would be a nightmare to store it. Im not going to use a 50mg naltrexone tablet as my source, I'll have to look into alternative formulations of it.

It just would also seem much more appealing since hypothetically I could just wait until I'm in severe opioid withdrawals and make sure that I don't have ANY full agonists in my system, and I have heard of others using naloxone in this fashion to lower their tolerance. BUT, I can't attest to the safety or efficacy of this. This is ALL a bunch of "what-ifs" for all who are reading this, don't attempt this at home I'm thinking out loud here.

 

[SAMCRO]

I've been looking into this and thinking about doing it myself. I saw some info about using it before bedtime in doses of up to 1 or 1.5 mg's to help boost natural endorphins and help with PAWS. That's if you're no longer dependent on opies but if one was to trying to add ULDN while currently physically dependent on opies to help with tapering or toleranxe then I think you're suppose to start with 1 or 2 mcg and go up to a max of like 10 mcgs.

 

[Swimmingdancer]

but if one was to trying to add ULDN while currently physically dependent on opies to help with tapering or toleranxe then I think you're suppose to start with 1 or 2 mcg and go up to a max of like 10 mcgs.

I think it depends on the specific opioid they're on, the dose, the individual, etc. That methadone study I linked above successfully used 250mcg concurrently with methadone.

 

[tricomb]

That's interesting because methadone's extremely potent. I take oxycodone and have a moderate tolerance, I rarely need to exceed double digit milligram dosing (<100mg), and I've been opioid dependent for years.... So I would definitely research this extensively...

 

[bingey]

This naloxone talk has given me an idea: wouldn't the naloxone in suboxone which is supposed to be inactive " leak through" resulting in infinitesimally small amounts getting into the the brain (explaining the headaches some people report with suboxone as opppsed to subutex) so why doesn't suboxe work as an uldn therapy. ? Or does it lower tolerance like narcan shots do.?

*Edit * just read SWD'z post I agree naloxone probably wouldn't work or you would need a dosage which is in the milligrams and not microgram range

 

[SAMCRO]

I think it depends on the specific opioid they're on, the dose, the individual, etc. That methadone study I linked above successfully used 250mcg concurrently with methadone.

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.