LDN for Fibromyalgia: A Compounded Option Prescribed for Chronic Pain Support
For individuals living with chronic pain syndromes such as fibromyalgia, finding options that align with their health goals can be challenging. Conventional therapies may not meet every patient’s needs, and providers sometimes consider alternative or adjunctive approaches.
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal discomfort, fatigue, sleep issues, and cognitive challenges.
One area of interest among some healthcare professionals is low-dose naltrexone (LDN), which may be used in certain cases through compounding pharmacies.
At Health Dimensions Clinical Pharmacy (HDRx), we offer compounded LDN for fibromyalgia and other chronic conditions, working in collaboration with prescribers. Based in Michigan and licensed to ship prescription medications to MI, OH, IN, IL, WI, MN, and FL with a doctor’s prescription, we focus on high-quality, customized medications for patients with unique therapeutic needs.
What Is Low-Dose Naltrexone (LDN)?
Naltrexone was originally developed in higher doses (typically 50 mg) for addressing substance use. In significantly lower doses — typically between 0.5 mg and 4.5 mg — it is referred to as low-dose naltrexone (LDN). These lower doses are not commercially available and must be prepared by a licensed compounding pharmacy.
Some healthcare providers have shown interest in LDN for individuals with chronic pain or immune-related conditions.
Research on LDN for Fibromyalgia Management
LDN and Inflammatory Markers: What the Science Shows
A 10-week study published in Biomedicines (2017) observed significant reductions in 17 pro-inflammatory cytokines with low dose naltrexone (LDN), including:
- TNF-α
- IL-1β
- IL-6
- IL-2
- IL-17A
Participants also experienced a 15% reduction in pain and 18% reduction in overall symptoms.
“...LDN may help chronic pain conditions, such as fibromyalgia, by acting as an atypical anti-inflammatory medication.”
These findings provide biochemical evidence supporting LDN’s potential role in modifying pain-related immune activity — especially relevant for patients with elevated markers like ESR or CRP.
Studies have explored the potential use of low-dose naltrexone (LDN) in fibromyalgia. Two clinical trials have examined LDN at a dose of 4.5 mg taken nightly. In these studies, some participants reported reduced discomfort and an overall improvement in symptoms during LDN use compared to placebo.
“At the end of the LDN treatment, half of the participants reported feeling ‘much improved’ or ‘very much improved’ from LDN.”
How LDN Is Being Explored
Most providers believe LDN works through mechanisms that differ from traditional pain therapies. Current studies examine how it may interact with nervous system pathways and immune responses. For example, researchers are evaluating its effect on:
- The activity of certain receptors in the brain and immune system
- The temporary occupation of opioid receptors
- The body’s natural production of endorphins
Unlike traditional analgesics or anti-inflammatories, LDN appears to operate through dual mechanisms:
- Endorphin regulation: By briefly blocking opioid receptors, LDN triggers a rebound effect that increases the body’s own production of endogenous opioids (e.g., beta-endorphins, met-enkephalin) — chemicals that help naturally reduce pain and modulate immune function.
- Microglial modulation: LDN may act on Toll-like receptor 4 (TLR4) receptors on microglial cells (the brain’s immune cells). This is believed to reduce neuroinflammation — a possible contributor to fibromyalgia symptoms like pain, fatigue, and cognitive disruption.
These combined effects suggest LDN could be the first of a class of central immune-modulating therapies designed to help patients with fibromyalgia and other chronic pain disorders.
Related Article
Reduced pro-inflammatory cytokines after eight weeks of low-dose naltrexone for fibromyalgia
Parkitny, L., & Younger, J. (2017). Reduced pro-inflammatory cytokines after eight weeks of low-dose naltrexone for fibromyalgia. Biomedicines, 5(2), 16.
LDN Dosing Insights
There’s emerging interest in:
- Titration protocols (starting as low as 0.5 mg)
- Alternative dosing schedules (e.g., twice daily for some cases)
- Individualized titration based on side effects and symptom response
Clinicians and compounding pharmacists, like those at HDRx, play a vital role in crafting these patient-specific regimens based on medical history and therapeutic goals.
Clinical Tolerability and LDN Side Effects
Across multiple studies, LDN has shown low incidence of adverse effects. The most common reported symptoms are:
- Vivid dreams (in about one-third of participants)
- Mild headaches
- Occasional reports of anxiety or gastrointestinal discomfort (rare)
No serious safety concerns or abuse potential were identified. Notably, LDN does not cause withdrawal or dependence.
LDN: A Potentially Versatile Option for a Broad Spectrum of Conditions
What Else is LDN Prescribed for?
Low Dose Naltrexone (LDN) has emerged as a potentially promising adjunct therapy in the management of a wide array of health conditions, due to its unique immunomodulatory and anti-inflammatory mechanisms. While initially developed as a therapy for opioid dependence, LDN at significantly lower doses is now being prescribed off-label for several chronic and autoimmune conditions. Below are some of the most common applications, along with supporting clinical evidence:
1. Chronic Pain
LDN has demonstrated potential in reducing chronic pain symptoms, particularly in conditions like fibromyalgia and complex regional pain syndrome (CRPS), by modulating microglial activity and increasing endorphin levels.
2. Autoimmune Disorders
Multiple sclerosis, rheumatoid arthritis, and Crohn’s disease are among the autoimmune conditions where LDN has been explored. It appears to act by increasing levels of opioid growth factor (OGF) and enhancing OGF receptor activity, thereby helping to regulate immune response.
3. Inflammatory Conditions
LDN may help mitigate systemic inflammation by downregulating pro-inflammatory cytokines and modulating nitric oxide production, making it potentially useful in disorders like chronic fatigue syndrome and irritable bowel syndrome.
4. Mood Disorders
Emerging data suggest LDN may help with mood stabilization in patients experiencing anxiety or depression, potentially through its effects on neuroinflammation and central endorphin regulation.
5. Dermatologic Conditions
There is growing interest in the use of LDN for autoimmune-related skin disorders such as psoriasis and eczema, driven by its immunoregulatory effects and capacity to reduce inflammatory cytokine activity.
6. Oncology (Adjunctive Use)
LDN is under investigation as an adjunctive therapy in cancer care, where it may contribute to immune regulation and reduction of tumor-promoting inflammation by enhancing the OGF-OGFr axis.
LDN Compounding Options at HDRx
Because LDN is not manufactured in low doses by commercial pharmaceutical companies, it is available only through licensed compounding pharmacies. At Health Dimensions Clinical Pharmacy, we prepare customized LDN formulations based on a healthcare provider’s prescription.
Common forms include:
Providers determine dosing protocols based on individual considerations. Pharmacists at HDRx are available to support prescribers with formulation options and titration strategies.
Who We Serve
Health Dimensions Clinical Pharmacy is a PCAB-accredited compounding pharmacy located in Michigan. We offer and ship compounded medications to patients with a valid prescription in the following states:
- Michigan
- Ohio
- Indiana
- Illinois
- Wisconsin
- Minnesota
- Florida
Our compounded formulations are prepared in compliance with state and federal guidelines, using pharmaceutical-grade ingredients.
Learn More About LDN for Fibromyalgia and More
If you are a patient or provider exploring LDN for fibromyalgia as part of an individualized care plan, Health Dimensions Clinical Pharmacy is here to support your compounding needs.
Contact our team to speak with a pharmacist or learn about our custom medication services.
References:
Garbutt, J. C., Kranzler, H. R., O’Malley, S. S., Gastfriend, D. R., Pettinati, H. M., Silverman, B. L., … & Johnson, B. A. (2005). Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: A randomized controlled trial. JAMA, 293(13), 1617–1625. Link
J Clauw, D. (2009). Fibromyalgia: An Overview. The American Journal of Medicine, 122(12), S3–S13. Link
Li, Z., et al. (2018). Low-dose naltrexone (LDN): A promising treatment in immune-related diseases and cancer therapy. International Immunopharmacology, 61, 178–184. Link
Mischoulon, D., Syeda, M., Freeman, M. P., S Clark, M., Levitan, R. D., Papakostas, G. I., & Fava, M. (2017). A randomized proof-of-concept trial of low dose naltrexone for patients with breakthrough symptoms of major depressive disorder on antidepressants. Journal of Affective Disorders, 208, 6–12. Link
Parkitny, L., & Younger, J. (2017). Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. Biomedicines, 5(2), 16. Link
Smith, J. P., Stock, H., Bingaman, S., Mauger, D., Rogosnitzky, M., & Zagon, I. S. (2007). Low-dose naltrexone therapy improves active Crohn’s disease. The American Journal of Gastroenterology, 106(3), 417–424. Link
Toljan, K., & Vrooman, B. (2018b). Low-Dose naltrexone (LDN)—Review of therapeutic utilization. Medical Sciences, 6(4), 82. Link
Younger, J., Parkitny, L., & McLain, D. (2014). The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clinical Rheumatology, 33(4), 451–459. Link
