Low Dose Naltrexone in Lyme Patients

Lyme disease is a growing epidemic on the Eastern Shore. When it is not treated early, the standard treatment protocols may fail in curing the patient of all symptoms. More and more patients complain of persistent symptoms years and years after being treated, termed, Chronic Lyme Disease. More and more doctors are looking to treatments outside of the CDC recommendations
to find their patients relief. One treatment, now showing great value is low dose naltrexone (LDN). It is being used to treat patients with fibromyalgia, Crohn’s disease, multiple sclerosis, autism, sarcoidosis, and Lyme disease.^1,2 Naltrexone is a drug which was developed in the 1970’s to treat heroin addiction.³ Since its development, it has been studied for its other effects on the body and other possible uses. A neurologist by the name of Bernard Bihari was the first to perform a trial with LDN (1986).³ Most of the patients enrolled in the study had AIDS, and he noticed an improvement in the patient’s immune function.³ Fast-forward to today and LDN is used for many diseases and disorders. Doses of 1-4.5 mg of naltrexone are prescribed to alleviate symptoms frequently experienced by Lyme patients such as fatigue, myalgia (muscle pain), arthralgia (joint pain), and to reconstitute the immune system.¹ Generally patients are started on a lower dose and titrated to the 3 to 4.5 mg dose. In one open label study 75% patients experienced a reduction in their symptoms.¹ Dr. Horowitz cites increased cytokine levels as the main cause of inflammation and pain, and decreasing these levels may be the key to relieving those symptoms. He further explains patients experiencing localized pain can benefit from creams containing low-dose naltrexone, glutathione, resveratrol, curcumin, or alpha-lipoic acid.¹

Human scientific studies using low dose naltrexone are rare, but many studies have been performed in rats. These studies have allowed us to understand the exact mechanism to LDN’s benefits. LDN has shown to have a suppressive effect on the central nervous system microglia cells. This results in a reduction of the production of inflammatory cytokines and neurotoxic superoxides.² It is postulated these effects are not mediated by the drug’s opioid receptor activity, but instead its activity on toll-like receptor 4.² Activation of toll-like receptor 4 leads to a release of inflammatory modulators, while antagonizing it as LDN does can have the opposite effect.

One study, published in 2009, boasted positive results when treating fibromyalgia patients with LDN (doses of 3-4.5mg) for their chronic pain. In this single-blind, placebo-controlled, cross-over study, researchers saw a 30.2% reduction in symptoms during LDN treatment over and above placebo.² The symptoms which were most impacted by the drug were average pain, fatigue and stress.² It was recognized in the study that higher baseline erythrocyte sedimentation rate (ESR) levels directly correlated with a positive response to the LDN therapy. Higher ESR levels are indicative of an increased inflammatory response which may be due to many different diseases or factors. Whether these patients had Lyme disease is not known, however, the results may still be transposed to a patient suffering from chronic pain due to Lyme disease as the mechanism for the pain is the same. Similar to other studies with LDN the time to peak effect was 28 days.² It should also be noted that LDN was very tolerable showing few side effects. The most frequent side effects seen with LDN are vivid dreams and trouble sleeping. These side effects are generally transitory and disappear in a few days after tapering.

It has been recognized that in many diseases, including Lyme, the body may be lacking endorphins. LDN therapy has been shown to boost the immune system by increasing these endorphins.⁴ This therapeutic effect is thought to be achieved by increasing the body’s production of beta-endorphin and metenkephalin.⁴ Both are important regulators of the immune system. These endorphins can increase the circulating quantities of natural killer cells and lymphocyte-activated CD-8 cells, both of which are important immunity.⁴ They also help regulate the t-helper 1 (TH1) and t-helper 2 (TH2) balance.⁵ TH1 is responsible for helping the body fight chronic diseases while TH2 is responsible for autoimmune and allergy-like responses. LDN helps to promote th1 while suppressing TH2.⁵ It is this dynamic which may help to improve Lyme patient’s immune function. It may be especially beneficial in those patients with Lyme disease and an autoimmune disease. In addition to endorphin production being helpful for immunity, it also serves as a natural pain killer.⁴

LDN seems to be a viable and beneficial option for Lyme patients. Many Lyme patients are plagued with chronic muscle and joint pain, which may be relieved by LDN. Not only that, but LDN has shown improvements in patient’s energy level. The immunological benefits will be advantageous for Lyme patients since they frequently suffer from co-infections. With a limited side-effect profile, LDN is a low-risk medication worth trying.

LDN is a specialty drug that must be compounded. It can be compounded into a topical cream, an oral solution, or capsules. However, it should never be compounded with any sugar and/or additives that might be detrimental to patients.

For more information on how LDN might be beneficial for you, call Community Farmacy at (410) 749-1899 or send your inquiry to compounding specialist, Melissa Richardson at melissa@CommunityFarmacyMD.com.

References:
1. Horowitz MD, Richard. Pain-Management Strategies in the Chronically Ill Lyme disease Patient. Pharmacy and Therapeutics. 2012 April; 37(4): 247–248.
2. Younger J, Mackey S. Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study. Pain Medicine [serial online]. May 2009;10(4):663-672. Available from: Academic Search Premier, Ipswich, MA. Accessed December 12, 2012.
3. Moore, Elaine A., Wilkinson, Samantha, The Promise of Low Dose Naltrexone Therapy. Jefferson, North Carolina; 2009:7-9.
4. Low Dose Naltrexone. Sunridge Medical Wellness Center. http://www.sunridgemedical.com/ treatments/low-dose-naltrexone. Accessed 12/12/12.
5. Dr. Gironi. “Beta-endorphin Past Present and Future.” http:///www.Lowdosenaltrexone.org Accessed 12/12/12