Low-dose naltrexone as a treatment for chronic fatigue syndrome, by Monica Jane Bolton, Bryan Paul Chapman, Harm Van Marwijk, in BMJ Case Reports, Vol 13, #1, January 6, 2020
Naltrexone is used as an off-label treatment in low doses for several chronic immune-modulated disorders in many countries. Although only small-scale clinical trials have been performed, these suggest efficacy in several diseases including Crohn’s disease, fibromyalgia and Gulf War Illness. Despite numerous internet reports of response to low-dose naltrexone (LDN), no clinical trials exist in people with chronic fatigue syndrome.
This condition is characterised by chronic profound fatigue, postexertional malaise, pain and autonomic and neurocognitive disturbances.
This series of three case reports compiled by people with long-term ill-health due to chronic fatigue syndrome shows the range of responses they observed when taking LDN, from life changing to a reduction in some symptoms only. Treatment doses ranged from 4 to 12 mg.
Clinical trials may be warranted to explore the potential use of naltrexone in people with these debilitating illnesses which currently have no licensed treatments available.
The mechanism of action for naltrexone at low dose in this disease group is unknown. It is possibly due to rebound of endorphins following short-term suppression or to direct action suppressing inflammation induced by microglia.39–41 There have been no formal dosing studies of naltrexone at low dose in any disorder. Therefore, although the dose of 3–4.5 mg is established in clinical practice, some practitioners use 9 mg (Klimas, personal communication, 2017) or higher(42) in chronic fatigue syndrome. Causality and dosing need further study.
…Internet reports suggest side effects can be troublesome initially, particularly increased fatigue and headaches.44 Two double-blind, placebo-controlled studies in people with fibromyalgia found no difference in tolerability between LDN and placebo but an increased frequency of vivid dreams and headaches.27 28 Recent work in Norway has found that individuals may experience fewer side effects if starting naltrexone at 6 mg, even if the final dose taken is lower than this (personal communication Brian Haviland 2018).
After 25 years of living with the devastating effects of myalgic encephalomyelitis, I was struggling to cope with the limited options for symptom and pain management. Having had many bad reactions to medications, I was hesitant to try a medication that would affect my immune system so I started out at an extremely low dose and slowly increased dosage. While the dreaming was at times disturbing, the positive changes gave me a hope for improvement I had not had in many years. The subsequent improvements have led to a much higher quality of life and I would like to see this medication as an approved option for others in my situation.