Low Dose Naltrexone & Inflammatory Bowel Disease

Dr. Jessica Moore, ND

Naltrexone is a prescription medication that is often used in the treatment of addiction at doses of 50mg to 100mg. In low doses (3.0 – 4.5mg), there is a growing body of scientific and clinical evidence to support its use in the setting of inflammatory bowel disease (IBD), autoimmune disease, multiple sclerosis, fibromyalgia, HIV and cancer. Low dose naltrexone (LDN) may be used to positively impact the immune system, improve the GI tract microbiome and support wound healing. 

IBD is an umbrella term that encompasses both Crohn’s disease (CD) and ulcerative colitis (UC). Both CD and UC currently have suboptimal rates and maintenance of remission with standard of care drug therapies, including biologics. Patients who fail standard therapy or relapse over time can become steroid medication dependant or need surgery. Therapies are needed to improve remission rates and attenuate the core microbiome, autoimmune and immune-related disease processes that underlie IBD. 

Recent evidence has suggested that LDN may be an effective and safe therapy for the treatment of patients with IBD. A 2018 study looked at 47 patients who were not in remission (they had active symptoms) and were not responding to standard IBD drugs. After being prescribed low dose naltrexone for 12 weeks, clinical improvement or remission were seen in 74.5% and 25.5% of patients respectively. A randomized double-blind placebo-controlled study in 45 patients with active Crohn’s disease showed an 88% response rate in the LDN group versus 40% in the placebo group after 12 weeks of therapy with LDN. Another study concluded that LDN in IBD is associated with a reduced need for other medication use, generally needed in the treatment of CD and UC. LDN appears to be safe and effective in children with IBD. Across studies the side effect profile appears to be favorable.

LDN is not recommended for patients who might be taking a prescribed opiate medication. Although side effects are minimal, some patients can experience sleep disturbances, loose stools or GI upset. Although LDN moderates some of the underlying factors associated with IBD, it does not necessarily treat/resolve the root cause. Therefore, LDN should be used strategically as part of a comprehensive naturopathic and integrative medicine care plan. 

If you have questions or concerns about IBD or your gastrointestinal health, please reach out to me at Sage Clinic Vancouver.

In Health,

Dr. Jessica Moore, ND 

References:

  1. Mitchell R. K. L. Lie, Janine van der GiessenGwenny M. FuhlerAlison de Lima et al. Low dose Naltrexone for induction of remission in inflammatory bowel disease patients. J Transl Med. 2018; 16: 55.
  2. Smith JP, Bingaman SI, Ruggiero F, Mauger DT, Mukherjee A, McGovern CO, et al. Therapy with the opioid antagonist naltrexone promotes mucosal healing in active Crohn’s disease: a randomized placebo-controlled trial. Dig Dis Sci. 2011;56:2088–2097. 
  3. Smith JP, Field D, Bingaman SI, Evans R, Mauger DT. Safety and tolerability of low-dose naltrexone therapy in children with moderate to severe Crohn’s disease: a pilot study. J Clin Gastroenterol. 2013;47:339–345.
  4. Raknes GSimonsen PSmåbrekke L The Effect of Low-Dose Naltrexone on Medication in Inflammatory Bowel Disease: A Quasi Experimental Before-and-After Prescription Database Study. J Crohns Colitis. 2018 May 25;12(6):677-686.

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