From the blog
Low-Dose Naltrexone (LDN): How It Works, Who It Suits and Safety
In short: Low-dose naltrexone (LDN) is the prescription medicine naltrexone, taken at a fraction of its standard dose, typically 1.5 to 4.5 mg, usually at night. Naltrexone blocks opioid receptors. At the low dose, proposed explanations for its effects include changes in endorphin signalling and immune-cell activity. Suitability requires individual medical assessment. At SOMA, LDN is physician-prescribed within test-first protocols, compounded to the low dose and monitored, in Mumbai and New Delhi.
What is low-dose naltrexone?
Naltrexone is an approved prescription medicine. At its standard dose, usually 50 mg a day, it is used to treat opioid and alcohol dependence. It works by blocking opioid receptors. These are "docking points" on nerve and immune cells where the body's own pain-relieving chemicals, and opioid drugs, attach.
Low-dose naltrexone uses a fraction of that dose, typically 1.5 to 4.5 mg. This low-dose use is called LDN. A doctor prescribes it for the individual patient.
At SOMA, LDN is compounded to the low dose. Compounding means a pharmacy prepares the medicine at the strength prescribed. The prescriber and pharmacist determine the appropriate formulation and strength.
What does LDN do in the body?
Naltrexone blocks opioid receptors. Proposed explanations for low-dose effects include changes in endorphin signalling and immune-cell activity. Laboratory research demonstrates TLR4-related effects; this does not establish the same response or duration in patients.
In plain words, the two proposed routes are these:
Endorphin signalling. Endorphins are the body's own pain-relieving and mood-supporting chemicals. They act through opioid receptors. One explanation is that a short block of these receptors, taken at night, prompts the body to adjust how it makes and responds to its own endorphins.
Immune-cell activity. Microglia are the immune cells of the brain and spinal cord. When they are over-active, they release inflammatory chemicals linked to pain and tiredness. Microglia carry a sensor called TLR4 (toll-like receptor 4), which helps switch on inflammation. In laboratory research, naltrexone blocked TLR4 signalling, and this did not depend on the opioid receptor. Laboratory findings like this explain a possible route; they do not show that every patient responds the same way.
What have studies of LDN measured?
Research on LDN has measured symptoms in a range of long-term conditions. One example is long COVID, where tiredness and other symptoms linger after a COVID-19 infection.
An uncontrolled Irish study enrolled 52 people; 38 started LDN and 36 completed two-month questionnaires. Six of seven measures improved, but without a comparison group these changes cannot be attributed to LDN alone.
Responses vary from person to person. That is why a doctor starts low, adjusts the dose and checks your response.
Who is LDN suitable for?
Suitability requires individual medical assessment; existing treatment should continue as prescribed.
A doctor looks at your history, your current medicines and your test results before deciding. The firm exclusion is opioid use, because LDN blocks opioid receptors. Other conditions and medicines are checked at screening. LDN is not a cure for any condition.
Is low-dose naltrexone safe?
LDN is generally well tolerated. The most commonly reported effects are vivid dreams and brief sleep changes in the first weeks. Some people also notice a mild headache or nausea at the start. These usually settle, and your doctor can adjust the dose or timing if needed.
These are screening points a doctor checks, not a complete list:
Opioid pain medicines. LDN blocks opioid receptors. It must not be combined with opioid painkillers, including some prescription cough medicines and medicines for opioid dependence. It can stop them working and can bring on withdrawal. If you need surgery or strong pain relief, tell every doctor that you take LDN.
Liver disease. The liver processes naltrexone. At full dose, naltrexone carries liver cautions, so your liver health is checked first.
Pregnancy and breastfeeding. Tell your doctor if you are pregnant, planning a pregnancy or breastfeeding.
Other medicines. Every medicine you take is reviewed, and your doctor coordinates with your other prescribers where needed.
Where LDN does not fit, your doctor will say so.
What does LDN treatment at SOMA look like?
SOMA prescribes LDN following individual medical assessment. Dose, timing and follow-up depend on the prescription and response.
Starting: after screening, your doctor prescribes LDN at a low starting dose, usually taken at night.
Adjusting: the dose is adjusted gradually over weeks, guided by how you respond and how well you tolerate it.
Reviewing: your response is assessed at follow-up. LDN then continues, changes or stops based on your response.
LDN is a prescription medicine, not an over-the-counter supplement. See low-dose naltrexone at SOMA for more.
How does a SOMA doctor decide if LDN is right for you?
Your doctor starts with your history, your current medicines and detailed testing. LDN is started only where your testing and history support it. It is one option among several. Your doctor may also discuss nutrition, other medicines or other therapies, each chosen on its own merits. You get a clear plan with what to measure and when, as one part of a plan built around you. SOMA's pages on immunity and autoimmune conditions and pain and regeneration explain how assessment works in those areas.
SOMA centres in Mumbai and New Delhi
Low-dose naltrexone is prescribed through consultation at both SOMA centres, after diagnostic assessment:
Mumbai: A-507, Kohinoor Square, N.C. Kelkar Marg, Shivaji Park, Dadar West, Mumbai 400028. Phone +91 98671 94033.
New Delhi: E-354, Greater Kailash II, New Delhi 110048, serving Delhi NCR and Gurugram. Phone +91 87969 92001. More about the New Delhi centre.
The New Delhi centre is independently operated under licence from SOMA Longevity Sciences, and its own doctors lead care there. Both centres follow the same SOMA assessment and diagnostic standards. Online consultations are also available. Contact either centre.
Questions people ask
How does low-dose naltrexone work?
Naltrexone blocks opioid receptors. Proposed explanations for low-dose effects include changes in endorphin signalling, the body's own pain-relieving chemicals, and immune-cell activity. Laboratory research shows effects on TLR4, an inflammation sensor on immune cells; this does not establish the same response or duration in patients.
Is low-dose naltrexone available in India?
Yes, on prescription. Naltrexone is an approved prescription medicine in India at its standard dose. LDN uses a fraction of that dose and is prescribed for the individual patient. The prescriber and pharmacist determine the appropriate formulation and strength. It is not sold over the counter.
How long does LDN take to work?
Dose, timing and follow-up depend on the prescription and response. Your doctor sets when your response is reviewed. Responses vary from person to person.
What are the side effects of LDN?
The most commonly reported effects are vivid dreams and brief sleep changes in the first weeks, and these usually settle. LDN must never be combined with opioid painkillers. Liver health, pregnancy and your other medicines are checked at screening.
Where can I get low-dose naltrexone in Mumbai or Delhi?
SOMA prescribes LDN through consultation at its centres in Dadar West, Mumbai and Greater Kailash II, New Delhi. Every prescription follows a doctor's assessment and testing, with follow-up to review your response.
Sources
Younger J, Parkitny L, McLain D. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clinical Rheumatology 2014;33(4):451–459. https://pubmed.ncbi.nlm.nih.gov/24526250/
Hutchinson MR, Zhang Y, Brown K, et al. Non-stereoselective reversal of neuropathic pain by naloxone and naltrexone: involvement of toll-like receptor 4 (TLR4). European Journal of Neuroscience 2008;28(1):20–29. https://pubmed.ncbi.nlm.nih.gov/18662331/
O'Kelly B, Vidal L, McHugh T, et al. Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study. Brain, Behavior, & Immunity – Health 2022;24:100485. https://pubmed.ncbi.nlm.nih.gov/35814187/
Toljan K, Vrooman B. Low-dose naltrexone (LDN): review of therapeutic utilization. Medical Sciences (Basel) 2018;6(4):82. https://pubmed.ncbi.nlm.nih.gov/30248938/
Kim PS, Fishman MA. Low-dose naltrexone for chronic pain: update and systemic review. Current Pain and Headache Reports 2020;24(10):64. https://pubmed.ncbi.nlm.nih.gov/32845365/
This article is for education and general information. It is not a substitute for a medical consultation, diagnosis or treatment. Results vary by individual biology.
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