very nice theres hope

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Subject: DR MR LAWRENCE ON LDN USE

I Thought that everyone either on LDN or thinking about it would find

this informative.....sally

(Dr M R Lawrence MRCS; LRCP)

Low-dose Naltrexone in the Treatment of Multiple Sclerosis

These notes are important. It is essential that you read and

thoroughly understand them before starting the low-dose naltrexone

(LDN) treatment.

LDN is a treatment method that has been in use in the USA since 1985

but is relatively new in this country. Despite its claimed successful

use in America, until fully proved here, it must be considered as

experimental and that no beneficial response can be guaranteed.

In addition, despite the fact that the drug is at a very low dose,

the absence of significant introductory or prolonged side-effects

cannot be excluded. The treatment can only be provided if these

conditions are accepted.

Naltrexone is a drug, referred to as an opiate antagonist. Its normal

use is to treat opiate drug addicts addicted to such as heroin or

morphine. Doses used for this purpose is usually 150 mg or more each

day.

This method was devised, and has since been developed, by Dr Bernard

Bihari, a practicing neuro-physician in New York, USA. Dr Bihari is

qualified in Internal Medicine, Psychiatry and Neurology.

His address is 29w 15th Street, New York, New York; telephone number:

212 929 4190.

His website is

www.low dose naltrexone.com

The method was first put to use, in the treatment of MS, in 1985.

It has since been reported that those receiving this drug in the

treatment of MS, initially at a dose of just 3 mg per day, have

experienced a range of improvements, including such as: reduced spasm

and fatigue, improved bladder control, improved heat tolerance, with

improvements in mobility, sleep, pain, tremor and other symptoms.

The two main symptoms that appear to improve most significantly are

muscle spasm and fatigue.

The current maximum recommended dose is 4.5 mg per day, taken after 9

pm at night. The introductory dose however, remains at just 3 mg for

the first month of treatment.

After this period, in the absence of any introductory side-effects,

and for greater therapeutic response, the dose may be increased to

4.5 mg/ day if desired.

How Naltrexone Works: The benefits of this drug are apparently due to

the temporary inhibition of brain endorphins (a natural pain-killer,

produced in the brain). This results in a reactive increase in the

production of endorphins, which would expectedly result in a

reduction in painful symptoms and an increase in the sense of

wellbeing.

In addition, increased levels of endorphins would also be expected to

stimulate the immune system, promoting an overall increase in the

numbers of T lymphocytes. This effect has been observed in Dr

Bihari's research. This increase in T-cell numbers apparently

restores a more normal balance of the T-cells such that the effects

of the disease process is reduced.

Thus, it has been observed that, in those suffering the relapsing-

remitting form of MS, the number of relapses is reduced, and the rate

of progression of the disease is diminished. In fact, Dr Bihari's

research suggests that no-one receiving this treatment as a regular

therapy, has experienced a relapse while actually on the treatment.

Occasionally however, there may be a short-term increase in symptoms

during, for example, periods of infection or stress, arising from

previously active lesions already present in the brain or spinal cord.

In chronic, progressive MS (either primary or secondary) there

appears to be a similar reduction in the progression of disease

symptoms.

It must also be emphasised that a positive beneficial response to

this treatment cannot be assured or guaranteed.

Side-Effects: When starting this therapy in the treatment of MS, the

possibility of adverse side-effects due to the drug, cannot be

entirely excluded. The likelihood of damaging side-effects is

believed to be minimal however, as the drug is used at such a low

dose. Reversible liver damage has been found to occur only in those

receiving doses greater than 300 mg per day.

Due to the possible toxic effects of this drug upon the liver it is

required that anyone previously suffering liver or kidney problems

should report this condition before starting therapy. Due to the

extremely low dose of the drug however, this risk is believed to be

minimal.

In addition, there may also be some initial transient, though

temporary, increase in MS symptoms.

Experience in using this method has demonstrated most commonly, such

as disturbed sleep, occasionally with vivid, bizarre and disturbing

dreams, tiredness, fatigue, spasm and pain. These increased symptoms

usually fade and disappear within five to seven days.

Rarely, other transient symptoms have included more severe pain and

spasm, headache, diarrhea or vomiting. These additional symptoms

would appear to be associated with the previous frequent use of

strong analgesics, which effectively create an addiction and

dependency, thus increasing the body's sensitivity to pain.

It has also recently become apparent that some patients have

experienced additional symptoms, such as muscle stiffness or pain,

after a few weeks of therapy. This is believed to be due to an

occasional increased sensitivity to the lactose filler used in the

capsules. If this should occur, a similar preparation, using calcium

carbonate filler, may be provided as an alternative.

The early but temporary increase in symptoms may also perhaps be

explained when we consider the manner in which this drug is expected

to work.

Initially, MS occurs due to a reduction in the activity of the

controlling influence of the suppressor T-cells within the immune

system. During an acute relapse, the overall number of T-cells is

reduced, the normal balance of helper T-cells and suppressor T-cells

is disrupted and the damaging helper (CD-4) T-cells tend to

predominate. This is the situation most pronounced during an acute

relapse but occurs similarly, but to a lesser extent, in chronic

progressive MS.

Under the influence of LDN there will be an expected increase in the

overall numbers of T-cells but, because the CD-4, helper T-cells tend

to predominate at this time, an increase in their numbers will

expectedly tend to increase MS symptoms.

It is only when the numbers of suppressor T-cells effectively " catch

up " that the normal balance is restored and symptoms once again

diminish and improve.

Contraindications and Special Precautions: In addition, because LDN

stimulates the immune system and many of the drugs routinely used by

the NHS in the treatment of MS further suppress the immune system,

LDN cannot be used in company with steroids, beta interferon,

methotrexate, azathioprine or mitozantrone or any other immune

suppressant drug. If there is any doubt, please submit a full list of

the drugs you are presently taking so that their compatibility may be

assessed.

In addition, because LDN will also block the analgesic effects of any

opiate drugs (includes codeine, dihydrocodeine, tramadol, morphine,

pethidine or diamorphine) presently being taken, the use of LDN will

initially greatly increase the level of pain experienced. It is

therefore advisable that any opiate-like drugs be discontinued at

least two weeks before this treatment is initiated.

Intermittent Therapy: When a drug is used for a prolonged period of

treatment, even at the very low dose as used in this circumstance, it

remains possible that the body will slowly adjust to the continuous

presence of the drug, when the response to that drug will eventually

diminish. This process is referred to as accommodation.

In addition, as a result of this process of accommodation, continuous

use of a drug will also create a situation of dependency. In this

circumstance, what was previously considered to be a normal state of

physiological activity (in this case, the level of brain endorphins

produced) will become dependent upon the continuing presence of the

drug.

To prevent this situation developing, and contrary to the advice

suggested by Dr Bihari, it is considered advisable to use a form of

intermittent therapy. The suggested routine is to take the naltrexone

each day for three weeks, after which treatment is stopped for one

week.

This pattern of intermittent use will allow the body, during the non-

treatment period, to readjust back to a normal state of activity so

that when the drug is reintroduced once again, it will have a renewed

and enhanced effect, thus maintaining the therapeutic benefits.

Thus, after the introductory first month of treatment at 3 mg, take

one week of the 4.5 mg capsules to establish the level of response at

this dose. It would then be appropriate to stop treatment for one

week, after which therapy is continued with three weeks on and one

week off in a regular repeating pattern of use.

It is anticipated that this method of use will reduce the risk of MS

relapse following temporary or prolonged withdrawal of the drug for

whatever reason.

This method has been tested with no apparent increase in MS symptoms

during the period of non-treatment.

When starting the treatment it is essential that any untoward or

adverse side-effects are reported immediately so that the treatment

process can be further assessed and, if necessary, modified.