Low Dose Naltrexone

[epidural man]

My pharmacy will no longer make 4.5mg Naltrexone solution for me.

I would still like to have that as an options for patients.

The pharmacy has the 50mg tabs, so I was wondering if someone has come up with a good way to get the patient to make it for themselves (dissolving in a diet coke or something).

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[Ducttape]

pill cutter.

cut in half.

cut that in half.

crush that 1/4 of a pill, and mix in to 1 small cup of applesauce, and eat 1/2 cup of applesauce a day. roughly 6.25 mg per dose.

 

[kstarm]

This was discussed a bit in December: LDN?

 

[PinchandBurn]

pill cutter.

cut in half.

cut that in half.

crush that 1/4 of a pill, and mix in to 1 small cup of applesauce, and eat 1/2 cup of applesauce a day. roughly 6.25 mg per dose.

what are you using for ?

does it work?

side effects? any interactions? contraindications?

 

[painfree23]

what are you using for ?

does it work?

side effects? any interactions? contraindications?

Where do u get it from?

 

[DrMDAware]

Beware one indication for Naltrexone 50mg is alcoholism. If a patient gets their chart reviewed for insurance purposes it may get flagged. Or for employment purposes.

I refer patients to Facebook groups before prescribing it. Lots of social support there.

There’s always some (prolonged) discussion about the excipients and so I defer to the Facebook groups.

Side effects: dreams

Most patients aren’t
1. patient enough to give it time to work
2. Financially able to afford it (.70 to 1$ a day)
3. Willing to stop any opioids
4. Able to understand it is addition by subtraction

It works for the right patient, though.

Most of these patients are anxious so I allow them to “do their own research” and set the starting dose. It helps with buy in.

I use it for neuropathies and CRPS.

Edit: and for fibro and centralization

 

[Agast]

Most compounding pharmacies will make this, but they use capsules which means you can’t adjust the dose with half tabs. I believe there are mail order pharmacies you can use if there are none local.

I’ve seen success with fibromyalgia, rheumatology, ehlers danlos, postherpetic neuralgia patients - basically chronic low level inflammation type pain

 

[geauxg8rs]

pill cutter.

cut in half.

cut that in half.

crush that 1/4 of a pill, and mix in to 1 small cup of applesauce, and eat 1/2 cup of applesauce a day. roughly 6.25 mg per dose.

Do you worry about a kid eating the other half cup of apple sauce? Serious question

 

[lobelsteve]

Do you worry about a kid eating the other half cup of apple sauce? Serious question

Drug without risk or side effects.
Possibly vivid dreams.

 

[pastafan]

Warn patients beforehand about dreams by explaining that they may now finally be getting good REM sleep, not necessarily a "side effect".

 

[epidural man]

what are you using for ?

does it work?

side effects? any interactions? contraindications?

CRPS, fibromyalgia, people that really want to take a drug.

 

[Orin]

I just give them regular naltrexone, cut it in half and use that QD vs BID.

There are so many compounding pharmacies out there that'll make it and ship to you if you need, but if you're looking for low cost:

Inexpensive compounding of low-dose naltrexone (LDN) with orange juice - PubMed

Inexpensive compounding of low-dose naltrexone (LDN) with orange juice

pubmed.ncbi.nlm.nih.gov

From above:
"A simple LDN formulation can be compounded by crushing commercially available naltrexone tablets and mixing them with water. This preparation maintains its stability through 90 days when refrigerated, although it can taste bitter or gritty. It also maintains efficacy, as measured by its ability to induce withdrawal in chronically opiate-addicted patients. To help improve its texture and taste, LDN can be compounded by using commercially available tablets and orange juice. I prescribe ten 50-mg tablets of naltrexone (500 mg total) and crush them into approximately 500 mL (16.9 ounces) of juice. This stock 1-mg/mL solution can then be dispensed directly with a dropper or mixed into a larger volume of juice to mask the flavor further. Typical doses are 3 to 5 mL (3-5 mg). To further improve taste, I recommend shaking the mixture before dispensing; other juice flavors can also be used depending on patient preference. By keeping the aforementioned mixture in the refrigerator, patients can expect to get 3 months’ worth of medicine for a cash price of approximately $15.2 This inexpensive mixture is readily available from any local pharmacy, and it should allow for expansion of the use of LDN in our field."

 

[Ducttape]

Do you worry about a kid eating the other half cup of apple sauce? Serious question

nah.

tho if they have a significant opioid withdrawal side effects, it is grounds for mom and dad to talk to kid about what the kid is doing in their bedroom....