Everything You Need to Know About Using LDN (Naltrexone) Off Label

Everything You Need to Know About Using LDN (Naltrexone) Off-Label

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Have you heard about the medication LDN?

Are you wondering if it works or if what you’ve heard is all hype?

In this post I will dive into all aspects of LDN treatment including what conditions it can be used for, how to determine if you will respond to it, side effects associated with its use, and more

What is LDN (Low Dose Naltrexone) & Does it Work?

Low-dose naltrexone commonly referred to as LDN, is a prescription medication that can be used off-label to treat different kinds of diseases. 

The diseases that people and Doctors claim that it works for tend to be difficult to treat diseases such as autoimmune disease and fibromyalgia. 

Some of these claims are backed by scientific studies while others are anecdotal (meaning personal experience based). 

LDN use is especially high among integrative, function, and holistic doctors for these conditions. 

But what exactly is LDN?

LDN, as a medication, was originally designed to treat alcohol and drug abuse (1).

It binds to certain receptors in the cells which removes the impact of alcohol and narcotics and blocks the pleasure sensation associated with their use. 

The standard dose for this type of treatment is around 50mg or so (sometimes higher). 

LDN differs from Naltrexone in that it is a much smaller dose, usually around 1.5mg to 4.5mg taken each day

Because this dose is much smaller than the standard 50mg tablet it is usually acquired from compounding pharmacies. 

But before you jump into using this medication it’s important to understand some of the basics. 

Like what does it mean to use a medication off-label? 

All prescription medications are approved to be used to treat very specific medical conditions. 

What Doctors and patients have found, however, is that these medications can also be used to treat other medical conditions that they weren’t originally designed for. 

This actually happens quite often and is fairly standard among conventional physicians, so the idea of using a medication off-label is not necessarily a new one.

A good example is the use of topical tretinoin

Topical Tretinoin is used to treat acne, but doctors and patients found out that it actually reverses wrinkles and can be used as an anti-aging product as well (2).

This has sparked the use of Tretinoin in cosmetic dermatology clinics and plastic surgery clinics around the United States.

But generally, the decision to use a medication off-label comes as the result of thousands of physicians and patients claiming some benefit for using it. 

Because LDN is predominately used by alternative physicians the use is not quite as broad as it would be if conventional physicians decided to use it as well. 

But that doesn’t necessarily mean it doesn’t work.

When we talk about if a medication works we need to focus on 2 different aspects:

#1. How well does it actually work? In other words, how efficacious is the medication?

For instance:

If we are talking about a blood pressure-lowering medication we are interested in a meaningful reduction in blood pressure. 

A blood pressure medication that reduces systolic blood pressure by 1mmhg, even though it works, is not meaningful or effective in any way. 

So in our example with LDN we need to know if it actually helps reduce your symptoms (weight loss, autoimmune disease, etc.) in a meaningful way. 

If it only helps improve your symptoms by 1%, even though it is technically effective, that’s not really a meaningful reduction. 

#2. If it works, how frequently does it tend to work among patients?

The next most important point is how often does it actually work?

If we give LDN to 100 people, will 90 people experience some benefit or will 10 people out of the 100 experience some benefit?

This number matters because it can help explain why certain people feel better using LDN and why others seem to experience no benefit at all. 

These might sound obvious, but they are important for understanding LDN (and many other integrative medications and therapies). 

Where does LDN fit in when thinking about it in this way?

In my experience, LDN has variable effectiveness (meaning it works very well in some patients and not at all in others) and tends to work in around 20-40% of patients. 

This means that out of every 10 patients treated, around 2-4 patients will experience significant benefits from using it

Note: This number tends to be higher for weight loss (probably closer to 6-7 out of 10 patients)

This doesn’t mean that you should avoid this medication completely, but it does mean that you should walk into using it with realistic expectations. 

With this in mind let’s discuss some of the potential uses:

LDN for Weight Loss

Believe it or not, LDN is actually FDA approved to treat obesity. 

LDN by itself isn’t FDA approved but the medication Contrave is. 

Contrave is a combination weight loss medication that contains naltrexone HCl and bupropion HCl. 

Bupropion is Wellbutrin the anti-depressant and naltrexone is another name for LDN. 

What’s interesting is that naltrexone in Contrave is dosed at 8mg per tablet. 

This puts naltrexone at a slightly higher concentration than what is generally prescribed for treating an autoimmune disease which is normally around 1.5mg to 4.5mg. 

You can read more about Contrave and how it works for weight loss in this post

It’s important to discuss naltrexone in the setting of weight loss because it is FDA approved for this use. 

The other indications we will talk about below (such as autoimmune disease) are not as well established when compared to its use for weight loss. 

But how does it work? 

It’s not well understood how naltrexone helps with weight loss but we do know that it affects the body in several ways:

#1. It helps regulate appetite

LDN seems to help reduce binge eating episodes and help normalize appetite (3).

#2. It helps sensitive your body to insulin (4).

#3. May help improve sleep (5) (reducing stress and other hormones)

Lack of sleep has been implicated in weight gain through its effects on hormone systems in the body. 

#4. May modulate hypothalamic body set point (6).

Your hypothalamus helps regulate your body weight by controlling your appetite and metabolism. 

LDN may be able to alter hypothalamic function and normalize both appetite and metabolism (though this still needs more research).  

Remember that weight gain is a complex issue and one that is caused by multiple problems (not one issue). 

Because weight gain is multi-factorial it means that not all weight medications will work for all people and LDN is no different. 

In my experience, LDN tends to work best as a second or third-line weight loss medication or as a medication that is paired with other, more effective, weight loss medications

As always, weight loss medications should never be used in isolation (meaning by themselves) and they should ALWAYS be accompanied by changes to your diet and exercise routine. 

Bottom Line: LDN can be used for weight loss but it is often used at higher dosages. It can be combined with bupropion in the medication Contrave or both medications can be prescribed separately. 

LDN for Hashimoto’s & Other Autoimmune Diseases

LDN is sometimes used to treat autoimmune diseases such as Hashimoto’s thyroiditis, Rheumatoid arthritis, and Crohn’s disease. 

It is used off-label for these conditions, meaning it is not FDA-approved. 

Some studies, however, have shown that LDN can be effective at treating conditions such as Crohn’s disease (7).

It’s important to realize that these studies are relatively small and while some studies show benefit, others have failed to show that benefit. 

Again, it doesn’t mean that you shouldn’t use LDN if you have an autoimmune disease but you should learn more about the potential pros and cons before you jump in. 

So how does it work? 

The idea is that low doses of naltrexone tend to modulate the immune system and may help reduce the immune attack on your own body and tissues. 

Autoimmune diseases tend to result from an impaired immune function in which your body attacks itself (8), confusing your own tissues as foreign invaders. 

The conventional treatment for autoimmune disease generally focuses on reducing how effective the immune system is and not on “educating” your immune system between what is self and what isn’t. 

Conventional therapies such as steroids and biologics (TNF alpha inhibitors) alter immune function which may leave you susceptible to other infections as they reduce immune function in the entire body. 

LDN may act to “teach” or “educate” your immune system without suppressing immune function. 

In this way, it may be used as monotherapy (meaning by itself) or combined with other immune-suppressing therapies. 

In terms of efficacy (meaning how effective it is), not all patients with autoimmune disease tend to be responders. 

Somewhere around 20-30% of patients who use LDN for an autoimmune disease may report a reduction in symptoms, but a large majority of patients will not experience any benefit

But given the side effects of conventional medications and the safety of LDN, it may seriously be worth considering in many patients

LDN for Chronic Pain & Inflammation

LDN can also be used to treat chronic pain syndromes and even fibromyalgia. 

Several studies have shown that the use of LDN may help reduce chronic pain associated with these conditions (9).

How and why it works is not well understood but it may be through its effects on inflammatory pathways. 

LDN has been shown to act as a novel anti-inflammatory medication (10) which may cool down inflammation in the body and reduce pain. 

LDN may also help reduce pain by causing a rebound endorphin effect after temporarily blocking opioid receptors (11).

LDN should be considered if you have fibromyalgia simply because it is well tolerated (it has few side effects), it is generally very cheap and it is widely available. 

Side Effects

Whenever you think about using a medication you always need to consider the pros and the cons. 

The pros would be the positive outcomes while the cons would be the potential negative side effects. 

The good news about LDN is that even though it is not always effective, it is generally very well tolerated (12).

What this means is that most people who use it will either experience some benefit or no benefit at all. 

Of those who experience no benefit, they will most likely not experience any negative side effects. 

Rarely, some individuals can experience the following side effects: 

  • Nausea or stomach upset
  • Insomnia (if this occurs you can take it in the morning)
  • Loss of appetite (usually dose-dependent)
  • Fatigue (rare)

An effective strategy for LDN is to give it a 1-2 month trial to see if it works for you. 

If you experience negative side effects, without any positive benefits, then you can discontinue the medication. 

Likewise, if you do not experience any improvement (weight loss, reduction in inflammation, reduction in pain, etc.) then you will most likely not experience any benefit and you can stop using the medication. 

Bottom Line: LDN generally is not associated with negative side effects which means that it can be used for a trial period (just to see if it works) without too much concern. 

Should you Use it?

So, after reading all of this, should you use LDN?

The answer probably has to do with where you are currently at in terms of what therapies you’ve already used and which you have left. 

In my opinion, LDN definitely has some therapeutic benefits for some patients, but it needs to be used correctly. 

In terms of importance and benefit, I often put LDN as a 3rd or 4th tier medication.

What that means is that I will try other therapies as 1st line medications over LDN and only use LDN when/if these therapies are no longer effective. 

This strategy seems to work well given that certain people and patients tend to “respond” better to LDN than others. 

The difficulty with using LDN is that it’s difficult to predict who will fall into this responder category. 

Another point worth considering is that generally LDN is very well tolerated (meaning it has few side effects), so the risk of using it early in your treatment is quite low. 

With that in mind, it may be worth taking the risk and determining if you respond to the medication or not. 

I find that LDN works better for weight loss versus treating patients with autoimmune diseases. 


LDN is a medication that is often used off-label to treat certain medical conditions ranging from autoimmune disease to chronic pain. 

Naltrexone is also commonly used to treat weight loss, either by itself or in combination with Wellbutrin/bupropion. 

LDN is generally well tolerated and associated with few side effects which makes it a relatively safe medication. 

Because LDN does not work for everyone you may need to give yourself a trial period of 1-2 months of therapy to see if you are a “responder”

Now I want to hear from you:

Have you used LDN before?

Did it work for you? 

What conditions did you use it for?

How long have you been using it?

Leave your questions and comments below! 

#1. https://www.ncbi.nlm.nih.gov/pubmed/1345133

#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699641/

#3. https://www.ncbi.nlm.nih.gov/pubmed/9226337

#4. https://www.ncbi.nlm.nih.gov/pubmed/9831304

#5. https://insights.ovid.com/pubmed?pmid=24346745

#6. https://www.ncbi.nlm.nih.gov/pubmed/3006087

#7. https://www.ncbi.nlm.nih.gov/pubmed/24558033

#8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1566249/

#9. https://www.ncbi.nlm.nih.gov/pubmed/23359310

#10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/

#11. https://www.ncbi.nlm.nih.gov/pubmed/28325149

#12. https://www.ncbi.nlm.nih.gov/pubmed/29377216

how to use ldn off label for weight loss, autoimmune disease, and more-1

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

P.S. Here are 4 ways you can get more help right now:

#1. Get my free thyroid downloads, resources, and PDFs here.

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36 thoughts on “Everything You Need to Know About Using LDN (Naltrexone) Off-Label”

  1. Is there any possible way to get any help or tips? I have PCOS with all those symptoms that come with. Weight gain, losing hair and also unwanted hair, cysts on ovaries etc. I also think I have hypothyroidism, my doctor only took one test and said it was normal. But I have so many symptoms. Reading this post https://www.restartmed.com/hypothyroidism-symptoms-checklist/. I can click check on many of those symptoms and I feel worse every day. What can I do? Is PCOS causing this?
    Really hope to hear from you, I have been sick since I was 15/16 and am now 26

  2. I had Hashimoto’s. LDN – If found out about this therapy in 8/2014. Started with 1.5 mg. My TPO’s were 39. The range is less than 9.
    I also did a 200 foods ALCAT test, gluten sensitive. I limited my “white” gluten especially. I took LDN off and on over the past 4 years, watching my TPO numbers go down SLOWLY. 1/2018, I increased the dosage to 3 mg (which seems to work better), I took about 1 month 1.5mg is too low. As of 4/2018, my TPO levels are right under 9.

  3. I am 21 yrs old and have been struggling with PCOS since I was 16. I tried Qsymia and had modest weight loss results (5-7 pounds) but decided to suspend use due to anxiousness side effects. In lieu of Qsymia, my doctor has suggested experimenting with LDN @ 4.5 mg as a compliment to my PCOS drug cocktail. I am tolerating it well. How do I know when I reach a dose that may be most effective for me? I hate to give up on LDN before reaching an ideal dose for me – I’m sleeping well and reduced food cravings to a minimum. My pharmacist implied that slowly increasing until I have sleep issues (then dropping back to next lowest dose) is one approach. As an aside and specific to weight loss, I’m reluctant to try Contrave since I have no eating disorders. Any commentary would be so helpful! Thanks in advance!

  4. Hi,
    Thank you for your posts here, I have lifetime autoimmune issues, dx w Hashimoto’s 28 yrs ago. My docs are stuck on antidepressants and levothyroxine, which just make my symptoms worse. Now I can go to endocrinologist/immunologist armed with a new idea at least!

  5. Hi, I have fibromyalgia and have tried numerous medications that did not help. I have been on LDN for over 2 weeks now, I started at 1.5 now up to 3mg. I have no side effects, and the horrible muscle pain is almost gone. This has been a lifesaver for me, I highly recommend it for anyone with chronic pain or inflammation.

    • I have been diagnosed with fibromyalgia and need to lose weight. How do I get the doctor to prescribe this? They seem so reluctant to prescribe any weight loss aids

    • My doc just prescribed this for me for FM. I also have arthritis and need to lose a significant amount of weight. Your post is encouraging. How long did it take for you to feel some relief?

  6. Hello again. I found a website that sells LDN without a prescription. In your opinion is this a legitimate site and is the product pure? I asked my rheumatologist for it and he said no that he would rather give me a drug that keeps me sleepy all the time. I have a hard time functioning. Any advice on this would be greatly appreciated.

  7. This is an older post, but I’ll throw in my very new experience.

    I’m only on day 3 and I have already noticed a change in appetite — not to the point of anorexia, but reaching satiety sooner and struggling to find food that feels appealing. I have a weird feeling of calm, which is saying a lot for someone with complex PTSD; I guess that’s why I think its weird, but its probably most people’s normal.

    I know that something is up with my brain because I’ve responded really well in the past to topamax; however, I have some hormone imbalances and topamax can cause hair loss so I discontinued. I am currently taking 25mg of naltrexone in the morning. I also take 100mg of spironolactone, 2x a day. I don’t have PCOS but I have symptoms of high androgens. No negative side effects to report.

    • Hi Tiffany,

      Thanks for sharing! Yes, this post is older but the information should stay relevant for many years 🙂 It’s also updated as things change.

  8. I had Valley fever as bad as you can get it with pneumonia in 2003. The problem was diagnosis took 10 months. I have been on and off anti fungal medication since. I get flare ups. I have also been diagnosed with chronic fatigue in 2015 by doctors at the chronic fatigue center at UC Berkeley medical center in California. There they prescribed me LDN. At that point I didnt feel what I call a flare up of symptoms, so during a few months if taking LDN I didnt feel that much had changed. However recently I had a flare where I was having chronic pain throughout my hands back chest and vision issues and More. (To be honest I kind of think I have undiagnosed MS, but who knows) I started taking 5mg of naltrexone over day 2.5 in the morning and 2.5 in the evening with my anti fungal meds and within just a couple of days my pain has decreased by at least 50%. I was surprised that it worked but I am impressed at how it has made me feel. Also during these past few weeks flaring up acne had really taken over my shoulders and back and some on my face. It has substantially cleared my acne. I have a lot of health issues that are as of now undiagnosed causing me pain but regardless the LDN has been great.

    I also saw a post of someone trying to find a doctor to prescribe LDN and I also am looking for a doctor that can prescribe it but also listen to me and help me look into the pains I have and perhaps see if there is a root cause for these issues I’m having. If anyone knows of a good doctor I would be willing to travel. Dr. Westin where are you located? Thanks. I’m at simonmcmeekin@gmail.com

  9. Hello, this is a really insightful website with information, thank you. I’ve been dealing with MS for 14 years; gave up on LDN 10 years ago after only three nights because of spasticity, but life is different now—so I’m giving it a final try. No DMD’s ever. I have been bumping up very slowly; began October 1 last year at 0.5 mg and now vacillating at 3-4.5, and I think I may be ready to throw in the towel because I can’t see it really helping.

    My walking is still poor, vision a bit off, feet Edema and pain, and most importantly I’m not seeing a lot of change in ankle strength because I have not been driving and that is huge—a goal I have to bring it back.

    With all the crazy weather and stress, I may give it one more month of 3 mg either Avicel filler or sucrose, resuming stretching and strengthening, and then decide. Feel free to comment. Thank you.

  10. I am a CRPS patient and I tried 6 different anti-seizure medicine for my pain. Some I had severe allergic to, while others made mode switches, foggy brain and extreme tiredness.
    I have been using ldn for the last 3 weeks, my pain level is 2-3 instead of 6-7, my energy is back, and I have no side effects.
    I am crossing my fingers that it will continue to work.

  11. Hello, I have fibromyalgia with frequent flare-ups. In November, I began having severe pain in my low back and sacrum area. Additionally, numbness and tingling to my foot. Pain meds and topical cream did nothing for this pain. Last week my Rheumatologist, write me a prescription for LDN 4.5 a day. I was absolutely amazed by the pain relief I had after day two. Almost pain-free and decreased numbness to my foot. So far, no noticeable side effects. I take at bedtime with my melatonin and sleep so much better. Wake up, no pain and ready to get out a bed without needing to ice or heat my back before I get going. I wish I would have known about this option three years ago. I will certainly keep taking it for now.

  12. Talked to my Dr. and plan to go in and discuss LDN next week – he is willing to RX, has other patients on it and says he sees it works about 50% of the time. I have Hashimoto’s, (NP and cytomel)and definitely inflammation as my CRP is always slightly elevated. Insulin is up at times as well. I also typically have chronic pain somewhere in my body though never diagnosed with fibro. In perimenopause, currently using T, E, P creams to try an alleviate some symptoms as they are all very low (currently lots of HEAT!) Hopeful this may work! I am thinking to start low, maybe 1, and work up to see how it goes.

    • Hi Andrea,

      I see it work about that frequently as well so it sounds like you are on the right track! Keep us updated on your progress.

      • so, I have been taking LDN since Jan 2, I started at .5, currently at 2 and could move up to 2.5 now. I have a bit of improvement of pain, but I literally gained 5 lbs in the first week I started taking it? I did not change anything else??? what does this mean? do i need to get to a higher dose? i am planning to run labs to check hashi and crp, and make a call based on those if I continue – just curious if it would get better on a higher dose or will it get worse? I am so upset!!!

  13. I am a Crohn’s pt past 42 years. I tried biologics, steroids, other immune lowering drugs. Several bowel resections. I now have started LDN and remain on a Gluten-Free Diet. It seems to be decreasing abd pain, stools are formed now. More energy. Iron stores are improving. I am on the 4.5 mg dose. Some insomnia about 4 AM I awaken and have some trouble returning to a deep sleep. The vivid dreams have subsided. I have been on Budesonide 3mg daily for maintenance of Crohn’s and now have decreased to every other day. Less muscle and joint pain also. Overall I believe it is working. Hopefully will be able to get off the steroid completely.

  14. I tried to get my doctor to prescribe this and she states there is not enough evidence or case studies that LDN helps and she refuses to prescribe it to me. : (

  15. I’m using naltrexone for joint/muscle pain that is being caused by Epstein Barr Virus? Ive been on it for almost a month. 1mg. This is the second time I’ve tried it since 2 years ago & that time was 2 mg. I used it for a month back then also & had the same reaction as now. I’m extremely tired all the time & sleep 12 hours at night . Sometimes straight through & sometimes awake at times during night. I would really like to know if I should start at a higher dose and or take for a longer period of time. I have had no relief from pain. Last year was diagnosed with degenerative disc disease in my neck. Is it normal for it to make me this tired all the time??? I just want to sleep all the time. I see holistic dr (gynecologist) & she has done all those hormone tests , homocysteine test, vitamin tests & thyroid. Also immune disorder tests. I am hypothyroid & take Armour thyroid 75mg. I have been taking Bupropion SR 150 for 20 years twice a day. I originally started it when going through divorce & had to work & needed an antidepressant that didn’t put me to sleep. I stopped taking it a few years ago for 6 months & couldnt function without it & that is when I found out I had Epstein Barr which was making me very tired all the time. Can u give me answers? I take supplements: Zinc/selenium, Methyl CpG, Curcumin, Liposomal D3, L Lysine 1000 & probiotic. Also, take Bo Identical HRT sublingual. TY.

    • Hi Lana,

      Why are you so sure that your muscle pain is from EBV? It could be from a number of issues including inflammation, low T3, and so on. Even if you thought it was from EBV it would probably be better to treat the virus using anti-virals (herbal or medications). I find that many cases of chronic muscle pain are from thyroid issues: https://www.restartmed.com/hypothyroidism-chronic-pain/

    • I have the same question. Taking 4.5 for 6 months and have gained 5 pounds, ugh.

      Thank you Dr. Childs! Love reading and listening to your advice.

  16. I had a significant Hashis flare after covid and my antibodies went off the charts, higher than they’ve ever been. I started LDN to bring down the antibodies and reduce the inflammation. It relieved all of my joint and muscle pain and as of last labs, my antibodies are on their way down. Hoping to tackle metabolic repair as my next step in healing.

  17. Hi Dr. Childs,
    Thanks for the great information on your videos. Do you think LDN with the thryoid support supplement might improve T3 enough (2.5 now) so that T3 medicine wouldn’t be even necessary + help leptin resistance (36)?

    • Hi I know this is an old post but I’m seeing this for the first time. I had a score of 68 for my leptin and found through Dr. Childs(see youtube videos) that if you do Intermittent fasting this could solve this issue. I did it for 9 months and my score was 8.70 for my Leptin. Our number should never be over 12.


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