Meta Information
ID:low-dose-naltrexone
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/opioid-agonists
Target name:
Opioid Agonist Medications
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
LDN is an opioid receptor antagonist. Taking it concurrently with opioid medications (e.g., morphine, oxycodone, hydrocodone, tramadol, methadone, buprenorphine) will block their effects and precipitate immediate, severe opioid withdrawal symptoms.
Actionable advice:
Do not take LDN if you are using any opioid-containing medications for pain, cough, or substance use treatment.
Target id:
/condition/opioid-dependence
Target name:
Opioid Dependence
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Initiating LDN in individuals who are physically dependent on opioids will trigger acute and potentially severe withdrawal symptoms, even if they have not recently taken an opioid.
Actionable advice:
You must be completely free of all opioids for at least 7-14 days before starting LDN.
Target id:
/procedure/major-surgery
Target name:
Planned Major Surgery or Medical Procedure
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
72
Hours after target:
null
Description:
LDN blocks opioid receptors, which will render opioid-based anesthesia and post-operative pain medications ineffective. This can lead to inadequate pain control during and after the procedure.
Actionable advice:
Stop taking LDN at least 72 hours before any planned surgery or procedure requiring opioid analgesia.
Target id:
/class/opioid-agonists
Target name:
Restarting LDN After Opioid Use
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
null
Hours after target:
168
Description:
To avoid precipitating withdrawal, a sufficient washout period is required after the last dose of an opioid before LDN can be safely restarted.
Actionable advice:
Wait at least 7 days after the last dose of a short-acting opioid (or 10-14 days for long-acting opioids) before resuming LDN.
Target id:
/condition/hepatic-impairment
Target name:
Acute Hepatitis or Severe Liver Failure
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Standard-dose naltrexone can be toxic to the liver. While the risk is significantly lower with LDN, it is contraindicated in patients with acute hepatitis or decompensated liver disease.
Actionable advice:
Avoid LDN if you have acute hepatitis or severe liver failure.
Target id:
/condition/naltrexone-hypersensitivity
Target name:
Allergy to Naltrexone
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
A prior allergic reaction to naltrexone is an absolute contraindication to its use in any form, including low-dose.
Actionable advice:
Do not take LDN if you have a known allergy to naltrexone.
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
moderate
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
0.5
Hours after target:
null
Description:
Bedtime dosing is theorized to align the transient opioid blockade with the body's natural peak endorphin production cycle (2-4 AM), potentially maximizing the immunomodulatory rebound effect.
Actionable advice:
Take your daily dose of LDN within 30 minutes of bedtime for the most common and potentially effective protocol.
Target id:
/class/immunosuppressants
Target name:
Immunosuppressants for Organ Transplant
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
LDN modulates the immune system, which could theoretically oppose the action of powerful immunosuppressant drugs (e.g., tacrolimus, cyclosporine) required to prevent organ transplant rejection. This combination is not well-studied and carries potential risk.
Actionable advice:
Use only with extreme caution and under the direct supervision of your transplant physician.
Target id:
/intervention/levothyroxine_systemic_disease
Target name:
Levothyroxine (Thyroid Hormone)
Severity:
moderate
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
For individuals with autoimmune thyroid disease (Hashimoto's), LDN may reduce the autoimmune attack, potentially improving natural thyroid function over time. This can necessitate a reduction in the required dose of levothyroxine to avoid symptoms of hyperthyroidism.
Actionable advice:
Regularly monitor thyroid function tests (TSH, free T4/T3) when starting LDN, as your thyroid medication dose may need to be lowered.
Target id:
/circadian/wake
Target name:
Waking Up
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
null
Hours after target:
0.5
Description:
A common side effect of bedtime LDN dosing is vivid dreams or insomnia. Switching to morning administration can alleviate these sleep disturbances while still providing therapeutic benefits for many users.
Actionable advice:
If bedtime dosing consistently disrupts your sleep, switch to taking your dose upon waking.
Target id:
/dietary/alcohol-acute
Target name:
Alcohol
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Naltrexone can blunt the rewarding, euphoric effects of alcohol by blocking opioid receptors involved in the pleasure response. This effect may be noticeable even at low doses.
Actionable advice:
Be aware that you may experience less pleasure or desire for alcohol while taking LDN.
Target id:
/intervention/dextromethorphan
Target name:
Dextromethorphan (Cough Suppressant)
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Dextromethorphan (DXM) possesses weak opioid receptor activity. LDN may antagonize this action, potentially reducing the efficacy of DXM as a cough suppressant.
Actionable advice:
Be aware that cough medicines containing dextromethorphan may be less effective while you are taking LDN.
Target id:
/biomarker/comprehensive-liver-function-panel
Target name:
Liver Function Panel (ALT, AST)
Severity:
minor
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Although the risk of liver injury is very low with LDN, naltrexone is metabolized by the liver. Establishing a baseline and performing periodic monitoring of liver enzymes is a prudent safety measure.
Actionable advice:
Obtain a baseline liver function panel before starting LDN and consider periodic re-testing as recommended by your healthcare provider.