Autoimmune diseases are a complex group of conditions in which the immune system mistakenly attacks healthy cells and tissues. While treatment options exist to manage symptoms, there is no known cure for autoimmune diseases. However, recent research has shed light on the potential benefits of Low Dose Naltrexone (LDN) in managing these conditions. In this blog post, we'll explore some of the latest research findings on the use of LDN in autoimmune diseases.

1. The Basics of Low Dose Naltrexone (LDN)

Low Dose Naltrexone (LDN) is an FDA-approved medication typically used in higher doses to treat opioid addiction. However, in low doses (usually 1-4.5 mg per day), it has shown promise in addressing autoimmune diseases. LDN works by modulating the immune system and may help reduce inflammation and promote self-tolerance.

2. Promising Research on Multiple Sclerosis (MS)

Recent studies have examined LDN's potential in treating Multiple Sclerosis (MS), an autoimmune disorder affecting the central nervous system. LDN appears to have a positive impact on MS patients by reducing the frequency and severity of relapses and improving overall quality of life. It may work by inhibiting the activation of microglia cells, which are implicated in neuroinflammation.

3. LDN and Rheumatoid Arthritis

In Rheumatoid Arthritis (RA), LDN has shown potential as an adjunct treatment. A study published in the Journal of Translational Medicine in 2014 suggested that LDN can reduce disease activity and pain levels in RA patients, along with improving sleep quality. LDN's mechanism of action may involve its ability to modulate the immune response and reduce inflammation in the joints.

4. Crohn's Disease and LDN

Crohn's Disease, an inflammatory bowel disease, has also been the focus of LDN research. Several studies have reported that LDN may help reduce disease activity, improve quality of life, and reduce the need for other medications. The anti-inflammatory properties of LDN could be instrumental in providing relief to Crohn's patients.

5. The Immune Modulation Effect

LDN's ability to modulate the immune system is a key feature that makes it relevant for autoimmune diseases. It appears to promote the release of endorphins, which, in turn, influence immune function. By balancing immune responses and reducing inflammation, LDN may be a valuable complementary therapy for a range of autoimmune conditions.

6. Safety and Side Effects

Low Dose Naltrexone is generally well-tolerated, and side effects are typically mild and transient. However, it's essential to work closely with a healthcare provider when considering LDN as part of your treatment plan. Dosage and monitoring should be tailored to individual needs.

Conclusion

While Low Dose Naltrexone is not a guaranteed cure for autoimmune diseases, the recent research findings are promising. LDN's potential to modulate the immune system and reduce inflammation has drawn attention from both patients and healthcare professionals. Nevertheless, it's essential to approach LDN as part of a comprehensive treatment plan, under the guidance of a qualified healthcare provider.

Autoimmune diseases are highly individual, and what works for one person may not work for another. It's crucial to discuss the use of LDN with your doctor to determine whether it's a suitable option for you. With continued research and clinical trials, LDN may play a more significant role in managing autoimmune diseases in the future, offering hope for improved quality of life for those who are affected by these conditions.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss custom compounded prescriptions and the Medicine Center Pharmacy Patient Care Program today with Pharmacists Janice Marciniak and Austin Hopkins.

The role of the pharmacist has broadened, and The Medicine Center Pharmacy has become a destination for patient care.  Medicine Center Pharmacy continues to be an ideal place for health care advice, recommendations for over the counter treatments and point of care testing. But did you know that we have an accredited lab that allows us to formulate custom medications designed specifically for you or your pet.  This morning we will talk with Janice and discuss pharmacy compounding at Medicine Center Pharmacy along with opportunities to develop a relationship with your pharmacist, a valuable member of your health care team.

Topics covered in todays program:

1. How are pharmacies and compounding pharmacies regulated in Ohio?

2. How does a pharmacy earn PCAB Accreditation?

3. How does compounding benefit a patient?

4. What kind of prescriptions can be compounded?

5. What is a bioidentical hormone replacement specialist?

6. What is BHRT?

7. Who can benefit from hormone replacement therapy?

8. What is the Medicine Center Pharmacy Patient Care Program?

9. What vaccines are administered at the Medicine Center?

10. What type of Vitamin D should I be taking?

11. How much sunscreen should I apply to be safe?

Epilepsy is a broad term used to describe people who suffer multiple seizures in their life time.  Seizures are defined as sudden, uncontrolled electrical brain activity.  Depending on how the brain looks at these electrical currents a person may change behavior, display abnormal movement or even lose consciousness.

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As of 2015 about 3.4 million people suffer from epilepsy.1 Most people with epilepsy take one or more medications to prevent seizure activity. However, an estimated 30% of people worldwide do not respond to current FDA approved medications.2 With the rise in popularity of medical marijuana for treatment of epilepsy, scientists have begun to look at opioids again for new uses.  Ultra-low doses of naltrexone along with morphine or cannabis are being studied.

What is low and ultra-low dose naltrexone?

            Naltrexone is currently FDA approved as treatment for opioid and alcohol abuse. Available in pill or as an injection, treatment for opioid and alcohol abuse uses doses from 50mg to 380mg.  Low dose naltrexone broadly refers to dosages below the 50mg mark for opioid and alcohol abuse treatment.3 specifically 0.5mg to 10mg is the studied range when talking about low dose naltrexone. 

Ultra-low dose refers to even smaller doses ranging from 1/1000000000 of a milligram to 1/1000000 of a milligram. To picture how small ultra-low dose naltrexone is think of opioid treatment doses as a swimming pool.  Low doses are a couple of buckets.  Ultra-low doses would be drops.

There is no recommended dose of naltrexone for epilepsy or seizures in humans. The ultra-low doses have only been studied in mice as add-on to opioids and cannabis products.  These doses were administered in injection form.

How does low dose naltrexone work to prevent seizures?

            Ultra-low doses of naltrexone alone do not stop or prevent seizures.  Morphine and cannabis like products work to raise the amount of electrical activity in the brain needed to cause a seizure.  The exact way ultra-low doses of naltrexone works with opioids and cannabis in epilepsy is unknown.  Scientists think ultra-low naltrexone works either to increase the effects of the morphine and cannabis or helps to decrease tolerance.4-6

What are the studies saying about ultra-low dose naltrexone for epilepsy?

            Trials in mice using ultra-low dose naltrexone have been promising.  Data favors further study of ultra-low dose naltrexone with either opioids or cannabis like products.  However, no data yet suggests any safety for trials in humans.  Further animal study is needed to evaluate long term use.  Current trials in mice only looked at one seizure per mouse.4-6 

What are the risks of using low dose naltrexone for seizure control?

            As stated in the above section, current trial data is only for mice after one incident.  The effects of treatment long term have not been evaluated.  Seizure activity may develop again after time on the medications.  Doses tested in mice may not work in humans.

The Medicine Center Pharmacy in New Philadelphia specializes in custom compounded medications in custom dosage forms. The pharmacists are trained experts in low dose naltrexone therapy. LDN therapies can be customized across 23 different dosage forms for 15 different disease state protocols. If you would like to learn more about low dose naltrexone or would like to schedule a phone call or video conference please contact us.

Resources

1.     CDC [Internet]. Epilepsy Fast Facts. Center for disease control: Atlanta (GA); last updated 18 July 2018, accessed 18 April 2020. Available from: https://www.cdc.gov/epilepsy/about/fast-facts.htm

2.     Wahab A. Difficulties in Treatment and Management of Epilepsy and Challenges in New Drug Development. Pharmaceuticals (Basel). 2010 Jul; 3(7): 2090–2110.Published online 2010 Jul 5. Accessed April 2020.

3.     SAMHSA. Naltrexone. Substance Abuse and Mental Health Services Administration. Last updated  September 2019, accessed April 2020. Available from: https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone

4.     Honar H, Riazi K, Homayoun H, Sadeghipour H, Rashidi N, Ebrahimkhani MR, et al. Ultra-low dose naltrexone potentiates the anticonvulsant effect of low dose morphine on clonic seizures. Neuroscience. 2004;129(3):733-42.

5.     Bahremand A, Shafaroodi H, Ghasemi M, Nasrabady SE, Gholizadeh S, and Dehpour AR. The cannabinoid anticonvulsant effect on pentylenetetrazole-induced seizure is potentiated by ultra-low dose naltrexone in mice. Epilepsy Res. 2008 Sep;81(1):44-51.

6.     Roshanpour M, Ghasemi M, Riazi K, Rafiei-Tabatabaei N, Ghahremani MH, and Dehpour AR. Tolerance to the anticonvulsant effect of morphine in mice: blockage by ultra-low dose naltrexone. Epilepsy Res. 2009 Feb;83(2-3):261-4.

The LDN Research Trust released a documentary earlier this month that provides education for patients that are suffering from chronic pain and are dependent on opioid prescription medication.

At the Medicine Center Pharmacy we strive to help educate patients and the medical profession to use an alternative, inexpensive, effective treatment. Watch Pain Specialists talk about using Ultra and Low Dose Naltrexone to treat their patients with Chronic Pain. Our thanks to the speakers in alphabetical order: Asher Goldstein MD, John Kim MD, Neel Mehta MD, Norman Marcus MD, Pradeep Chopra MD, Samyadev Datta MD. This program is not sponsored by any pharmaceutical manufacturer, it is funded by donations to the LDN Research Trust which has been a driving force in providing LDN education and research around the world.

You can learn more about low dose naltrexone at one of our monthly patient education seminars or by contacting the pharmacy. You can register here for the next seminar: Register Here

Both CBD oil products and LDN have prompted many questions at our pharmacy and we are happy to share experiences and feedback with you. We will provide accurate information regarding the potential benefits of LDN and CBD oil from the experiences of our own patients, as well as to provide a forum to connect with others dealing with the difficulties of autoimmune and chronic pain disorders. 

As you drive around town you will probably see signs advertising CBD Oil everywhere. From gas stations to video stores, how are you supposed to know if CBD oil is right for you? How are you supposed to separate the low quality brands from the reputable? Your Medicine Center Pharmacist is the most accessible health care professional to answer your questions.

What is CBD?

CBD is the abbreviation for cannabidiol. It is one of over 100 cannabinoids that are found in the hemp plant. You will not get “high” from CBD Oil as there is no more than 0.3% THC present.

What is the difference between industrial hemp and marijuana?

Hemp and marijuana are the same plant, cannabis sativa. The difference is that hemp is cultivated for significantly lower amounts of THC (tetrahydrocannabinol), less than 0.3% by dry weight. Industrial hemp also has more fibrous stalk and grows taller than marijuana which tends to grow bushy. Marijuana is cultivated to contain much higher percentages, often as high as 10-12% of THC, for psychoactive purposes.

What Kind of CBD Oil Should I Use?

CBD oil products available in the marketplace today can vary in a variety of strengths, ingredients, and dosage forms. CBD oil is available in both oral and topical forms. Oral forms include tinctures and capsules. Topical lotions, salves, lip balms, and massage oils can be applied directly to areas of concern on the skin. The form of CBD Oil you choose would depend on the intended use.

Is CBD Regulated in the USA?

While CBD is not currently regulated by the FDA there are many reputable companies that are setting standards to assure a quality product by testing purity, potency, and safety. The best products are full spectrum, Colorado grown, organic, gluten free, Non-GMO, vegan, cruelty free, highly bioavailable, and undergo independent laboratory testing. The most reputable companies control the process from “seed to sale” meaning that they control the entire chain of command process of planting, growing, harvesting, extracting, and botting. Look for documentation on product packaging for production tracking of testing and certificates of analysis.

Why Do Prices of CBD Vary So Much?

Be wary of lower quality vendors selling cheap CBD products sourcing hemp raw material from China, where growing standards are questionable. These products are often only isolates of CBD and not full spectrum and will not have certificates of analysis available. Higher quality products that have had independent testing and chain of custody documentation will command a higher price, but also have the potential to provide a better therapeutic outcome due to the integrity of the product.

Why Full Spectrum CBD Oil?

Utilizing over 100 of the active ingredients from the hemp plant, the entourage effect is a proposed mechanism by which CBD compounds act together to modulate the receptors in the endocannabinoid system.

Hemp has both terpenes and cannabinoids and plays a role in the expression and flavor of the product.  Terpenes can be damaged in extraction if you are not careful. 

Will CBD Oil Interact With My Prescription Medication?

Cannabidiol is metabolized in the liver by the P450 system and it is possible that CBD Oil could interact with prescription medication metabolism and as a result alter the intended outcome in the body.

How Does CBD Work?

When you ask a pharmacist this type of question you get a technical answer, so here is the technical answer:

The main actions of CBD are centrally; acting on the Endocannabinoid system -specifically the CB1 and CB2 receptors.

• Activates TRPV-1, modulating body temperature, the perception of pain and inflammation.

• Activates Adenosine receptors, promoting anti-anxiety and dopamine/glutamate release.

• Inhibits FAAH (fatty acid amide hydrolase) enzymes, leading to the modulation of the endogenous CB1 receptor.

The simple answer is that this seems to help reduce peripheral pain and inflammation.

Very few licensed drugs act on these receptor groups directly.

• Rather than getting you high, CBD actively blocks the neurological effects of THC (the component removed from all CBD products).

Will CBD Affect My Job or Cognitive Ability?

• CBD has no measurable effect at all on reaction time and can be safely taken when used in our commercially available formulations in recommended doses. It can be taken safely when driving and operating machinery.

• It is possible that you could test positive in a drug screen if you use CBD Oil products for a long enough period of time or in higher doses.

What Medical Conditions Are Patients Treating?

Please consult a health care professional when treating any disease/condition. We are seeing CBD Oil products provide support for the following common conditions:

• Anxiety

• Chronic Pain

• Eczema

• Migraines

• Muscle Pain

• Neuropathy

• Psoriasis

• Sleep Disorders

Have you used CBD Oil and benefited from the therapy? Please share your experiences below so we can all learn together.

CBD Oil In the News:

Arthritis Foundation Statement on CBD Oil 

Recently, NBC News released a report by Dr. Rudi Tanzi, from Massachusetts General Hospital. He has discovered inflammation kills millions of nerve cells, shutting down the area responsible for thinking and memory. Could this be link be a between nervous system inflammation and memory play a factor in Alzheimer’s Disease? If it is true, then treating inflammation could lead to a viable approach to addressing the symptoms of Alzheimer’s. 

This link to neuroinflammation could lead to many new treatment options for patients that suffer from autoimmune diseases like alzheimer’s.

If you would like to learn more about how the mechanism of action of low-dose naltrexone mechanism may affect inflammation in the central nervous system through action on the microglial cells.

“We review the evidence that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone’s better-known activity on opioid receptors.”

— Jarred Younger & Luke Parkitny & David McLain Clin Rheumatol (2014) 33:451–459

Learn more about low dose naltrexone and at our next public seminar.

A recent article published by NPR does a fantastic job of providing legitimacy to a therapy that has been very popular at our compounding pharmacy, low dose naltrexone (LDN). The volume of scientific information is expanding at an enormous pace, and as a result it is challenge to be aware of all the cutting edge therapies, so it is great when the press helps to raise awareness.

The good news is that the research is there, but often takes time to trickle into the mainstream standard of care. This NPR article relays the experience of living with chronic pain from the “other side" of the story, the non-research side, from the point of view of patients.

The article tells the history of LDN, why it's so promising, and the fact that ONLY compounding pharmacies have the ability to prepare this medication in custom dosage forms to meet patients needs.

Patients and providers can quickly read (or listen) to this news story and understand now low dose naltrexone works and it provides legitimacy in coming from a national news source such as NRP

Dr. Bruce Vrooman, an associate professor at Dartmouth's Geisel School of Medicine, was an author of a recent review of low-dose naltrexone research.

The full text of the NPR News story can be found here: In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain

The compounding pharmacists can assist you with your questions about LDN, for more information contact the pharmacy here or call us at 330-339-4466.

Our next public information session on LDN will be October 3rd, 2019 at 6:30pm at the Hampton Inn Meeting Room 1299 West High Avenue New Philadelphia, Ohio 44663.

Do you have experience with LDN you would like to share?

This episode of Health Matters with the Medicine Center Pharmacy covers a variety of services that we offer at your local independent pharmacy. The pharmacist fills a role that covers many aspects of health care. They link the patient to the prescriber and not only check for drug interactions and make sure that your prescription order is accurate, they also help solve problems with insurance billing, manufacturer recalls, and over the counter medication recommendations. Patients visit their pharmacist on average of 12 times a year, making the pharmacist the most accessible health care professional.

In addition to providing services like home delivery and special medication packaging to simplify medication administration, the Medicine Center also offers a Free Kids Vitamin program for kids in grades Kindergarten through Fifth grade. We have convenient pharmacy locations in Canton, Louisville, Minerva, and New Philadelphia, Ohio for you to take advantage of this service.

We also talk about an upcoming informational seminar that pharmacist Brad White will be hosting on September 5th, 2019 about the uses for Low Dose Naltrexone. Low Dose Naltrexone, or LDN, can be of benefit in a variety of autoimmune disorders and chronic pain treatment. You can register here for the seminar to learn more.

This articles's author Brad White, R.Ph

Working as a pharmacist in New Philadelphia for the last 20 years has provided me with an opportunity to meet and learn from thousands of patients. There have been a lot of opportunities to help improve the quality of life of patients, and those experiences have been very rewarding both personally and professionally. There are also those occasions when you are standing across from a person who is so desperate for help, for a solution, for anything that can ease their pain or make them feel better. Those are the challenging times that you wish you had the power and the knowledge to provide a remedy for what ails them.

Just last week I traveled to an educational pharmacy conference that shared developing research on a variety of topics in medicine, and one topic has me really excited! It is called Low Dose Naltrexone (LDN).

What Are Common Health Conditions That LDN Therapy Has Shown Benefits?

• Cancer

• Crohn’s Disease

• Fibromyalgia

• Multiple Sclerosis

• Anti-Inflammatory

• AIDS/HIV

• Complex Regional Pain Syndrome

• Posttraumatic Stress

• Psoriasis and Eczema

Over the last several years there has been an explosion in research on LDN to treat a variety of autoimmune diseases. PubMed, a literature repository for the US National Library of Medicine, lists 230 published studies from respected academic organizations like Stanford, Harvard, Penn State, Brown University and the Mayo Clinic. LDN is most commonly used to treat Fibromyalgia, Chronic Fatigue, Multiple Sclerosis, Psoriasis, and Autoimmune Thyroid Diseases. Additional research is being conducted on over 100 other health conditions.

What is LDN and How Does It Work?

Low-dose Naltrexone (LDN) therapy was developed in 1985 by Dr. Bernard Bihari, a Doctor of Internal Medicine, Psychiatry and Neurology. Dr. Bihari found that AIDS patients had 20% of the normal endorphin levels of healthy patients. Dr. Bihari’s key discovery was that 1% of the normal dose of naltrexone caused an unusual effect of a 300% increase in endorphin levels!

Endorphins are chemicals that interact with receptors in your brain that reduce the perception of pain. Endorphins also trigger a positive feeling in the body, often described as euphoric. This feeling can be accompanied by a positive and energizing outlook on life and a sense of well-being resulting in less pain. Low levels of endorphins are associated with the opposite effect: physical and emotional pain and depressed feelings. Naltrexone has several mechanisms of action that have an effect on opioid receptors that are distributed throughout the brain, spinal cord, nervous system, and digestive tract. LDN appears to enhance immune function and improve the inflammatory reaction.

Why Haven’t I Heard About This Before?

Naltrexone was patented in 1967 approved by the FDA in 1984 for heroin addiction using a 50mg dose and in 1995 the FDA approved it for treatment of alcoholism. Dr. Bihari’s creative application of a medication that is not controlled by a pharmaceutical company has provided a platform for hundreds of independent research projects that may benefit millions of patients worldwide.

The mechanism of action increases endorphin release, and it appears these endorphins can modulate the immune response. More research needs to be done but LDN appears to have promising benefits in a variety of health conditions. On the other hand, higher doses like 50mg doses appear to overwhelm the receptors and negate the immune system effects.

How Is LDN Therapy Initiated?

LDN is a prescription therapy that requires you to work with a physician and your pharmacist. Your doctor will generally begin therapy at a low dose and increase gradually over several weeks until your condition has stabilized and you are side effect free. Doses start generally at 0.5mg and slowly titrate up depending on your health condition and side effect tolerance. Because a pharmaceutical company does not make LDN, prescriptions can only be filled by an accredited and licensed compounding pharmacy.

What Are The Side Effects?

The most common side effects of LDN are sleep disturbances, often due to endorphin response, vivid dreams, or insomnia. Side effects generally resolve in four to seven days. Only 10% of the cases reported side effects for more than a week.

LDN has great potential with clinical research to support multiple immuno-modulated disease states. It is non-toxic and has a low side effect profile. It can be dosed both orally and topically and there is evidence to support use.

LDN doesn’t work for everyone and the slow titration in dose schedule is important, your pharmacist can work with you and your physician to help you achieve the optimal outcome. If you are in a position where you have tried multiple therapies and specialists searching for a solution to your health problems, then LDN may be an option you should learn more about. LDN is a cost effective therapy that promises to evolve in the next decade as more research is done to evaluate the benefits.

How Can I Learn More?

The Medicine Center Pharmacy in New Philadelphia is your resource in Northeast Ohio for LDN information. Brad White R.Ph. is a graduate of Purdue University School of Pharmacy and has experience with customized medication solutions and operates the only PCAB Accredited Compounding Pharmacy in East Central Ohio.

Low Dose Naltrexone FAQ | New Philadelphia Ohio

Compounded Solutions

Medicine Center Compounding Pharmacy in New Philadelphia is PCAB Accredited for preparing Non Sterile Compounded prescriptions. Tuscarawas County, Ohio.