Ask CLYR: LDN has been tested in multiple sclerosis in small trials since 2008. One 8-week trial reported better mental health quality of life scores; another found no meaningful difference. It is prescribed off-label, is not a replacement for disease-modifying therapy, and your neurologist should know if you take it.
Multiple sclerosis (MS) was one of the first conditions where researchers tested low-dose naltrexone (LDN). LDN is a compounded capsule, not FDA-approved at this dose, and any use in MS is off-label. The studies are small and the results are mixed. This article walks through them and explains the one rule that matters most. For the basics, see what low-dose naltrexone is.
The short answer
Small trials, mixed results on quality of life, and generally well tolerated. No randomized trial has shown that LDN prevents relapses or slows disability. LDN is not a replacement for disease-modifying therapy.
The studies
| Study | Design | What it found |
|---|---|---|
| Gironi et al., 2008 | Pilot, 40 people with primary progressive MS, 6 months | Main aim was safety; 5 dropouts and 2 major adverse events; authors judged it well tolerated; less spasticity as a secondary finding |
| Cree et al., 2010 | Crossover randomized trial, 80 enrolled, 60 completed, 4.5 mg, 8 weeks | Better mental health quality of life scores; physical scores did not improve |
| Sharafaddinzadeh et al., 2010 | Randomized trial, 96 people, 17 weeks | No meaningful difference in quality of life; authors called efficacy into question |
| Ludwig et al., 2016 | Retrospective chart review, 23 on LDN vs a comparison group | No differences in lab values, timed walk or MRI changes |
| Raknes and Småbrekke, 2017 | Norwegian prescription data, 341 people | Starting LDN was not followed by less use of other MS medicines |
| Kim and Fishman, 2020 | Review of LDN in chronic pain | Background on proposed mechanisms; not an MS efficacy study |
What the results mean
The randomized trials were short, ran for weeks rather than years, and measured quality of life, not relapses or disability. One found a benefit on mental health quality of life scores and the other found no meaningful difference. The real-world data from Norway did not show people using less of their other MS medicines after starting LDN. Taken together, there is no randomized evidence that LDN changes the course of MS.
The firm rule
LDN is not a replacement for disease-modifying therapy. Do not stop, skip or change any MS medicine without talking to your neurologist. If you take LDN, your neurologist should know.
Talking to your care team
If you are interested in LDN, raise it with your neurologist and share your full medicine list with any prescriber. Most MS studies used 4.5 mg, which is the low dose CLYR offers; see LDN dosing: why 4.5 mg. Side effects and screening are covered in LDN side effects. For another autoimmune condition where LDN is discussed, see LDN and Hashimoto's.
At CLYR, a licensed provider reviews your screening and decides whether LDN is appropriate for you. At CLYR, low-dose naltrexone 4.5 mg is $119 for 30 capsules or $169 for 90 capsules. Each order is billed once and nothing renews. Provider review and shipping are included, and your provider sets the days of supply. Details are on the LDN page.
Frequently asked questions
Does LDN help MS?
The evidence is limited and mixed. One small 8-week trial reported better mental health quality of life scores, and a larger 17-week trial found no meaningful difference.
Can LDN replace my MS medicine?
No. LDN is not a replacement for disease-modifying therapy, and it has not been shown to prevent relapses or slow disability. Do not stop or change MS medicine without your neurologist.
Is LDN safe for people with MS?
Trials reported it as generally well tolerated. A provider still screens for liver problems, allergies and medicines that cannot be combined with it.
What dose was used in MS trials?
Most MS studies used 4.5 mg a day. Your provider sets your dose.
Important safety information
Compounded low-dose naltrexone is a prescription capsule dispensed only after a licensed provider independently reviews your intake and determines it is appropriate for you. Do not take naltrexone if you take any opioid medicine or have taken one in the last 14 days, including tramadol, codeine, methadone or buprenorphine, because naltrexone blocks them and can cause sudden withdrawal; do not take it if you currently take or need opioid medicines, have liver disease, hepatitis or abnormal liver tests, or are allergic to naltrexone. Tell your provider about kidney disease, pregnancy, breastfeeding or plans for pregnancy, and about every medication and supplement you take. Side effects may include vivid dreams, trouble sleeping, headache, nausea, dizziness or anxiety. Carry a note that you take naltrexone, because opioid pain medicines may not work normally while it is in your system. Compounded medications are made by a licensed U.S. 503A pharmacy to a provider's prescription; they are not FDA-approved and have not been reviewed by the FDA for safety or effectiveness. Individual results vary. Not everyone qualifies. This page is informational and is not medical advice. Call 911 in an emergency.
The same text appears in the Important Safety Information on the LDN page.