Re: Dr. Lawrences Rcommendations for Lynda Phelps

[Guest guest]

OOPS sorry gang, me things me loosing the plot tonight I msut have

clicked the sent button three times as see my message is now here

three times, sorry!

And Lynda sorry for calling you , I really am not thinking

straight tonight LOL

--- In low dose naltrexone , <@y...>

wrote:

>

> HI

>

> The following information is the document Dr. Bob Larence gives his

[Guest guest]

, this a great! A wonderful piece to share with a doctor unfamiliar (isn't that all of them?) with LDN!

----- Original Message -----

From:

low dose naltrexone

Sent: Friday, April 09, 2004 1:02 PM

Subject: [low dose naltrexone] Dr. Lawrences Rcommendations for Lynda Phelps

HI

The following information is the document Dr. Bob Larence gives his patient and in it you'll see the infomration on Intermittant therapy which I think you are talking about.

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 the United Kingdom. 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 are usually 50 to 150 mg 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 4196; fax: (212) 229-9371.

His website is www.low dose naltrexone.org

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 between 9 pm at night and 3 am in the morning. 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.

For those unable to tolerate even the 3 mg dose, an ultra-low, 1.5 mg dose is available. This is intended to introduce the therapy more slowly, allowing more time for the necessary endorphin response to develop.

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 are significantly 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.

Despite these promising findings it must 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 and kidneys it is required that anyone previously suffering previous liver or kidney problems should report this condition before starting therapy. This risk is believed to be minimal, however, as the dose of the drug is extremely low.

In addition, there may also be some initial transient, though temporary, increase in MS symptoms.

Introductory symptoms, on starting this treatment, may include 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.

In less than two percent of cases treated, these increased symptoms may be more prolonged, lasing perhaps for several weeks. Rarely, symptoms have persisted for two or even three months before the appropriate beneficial response is gained. In this situation, the ultra-low 1.5 mg dose may be introduced to provide a more gentle introduction to the method.

Occasionally, 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 become apparent that some patients, using the early supplies of LDN, have experienced increasing muscle stiffness and/or joint pain, after a few weeks of therapy.

This is believed to be due to an increased sensitivity to the lactose filler used in the initial supplies of the treatment at that time.

All the naltrexone capsules now supplied use only calcium carbonate filler. Calcium carbonate is a beneficial mineral, which is free of any such sensitivity reactions.

The early introductory, but temporary, increase in symptoms may also perhaps be explained when we consider the manner in which this drug is expected to work.

Contrary to the common belief that MS is due to over-activity of the immune system, MS actually occurs due to a reduction in immune system activity. Specifically, it is the reduction in number of the suppressor T-cells within the immune system that permits the damaging CD4, helper T-cells to do their harm. Thus, 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 CD-4, helper, T-cells tend to predominate. This is the situation most pronounced during an acute relapse but a similar situation occurs, perhaps to a lesser extent, in chronic progressive MS.

Under the influence of LDN it has been demonstrated that the numbers of T-cells may increase by more than 300%. Thus, when the number of T-cells is initially increased, the overall predominance of CD4, helper T-cells at this time, will expectedly increase the intensity of the MS, therefore temporarily increasing some symptoms.

As the number of T-cells continues to increase, the normal balance of suppressor to helper T-cells is restored, the activity and intensity of the disease process is reduced, and symptoms once again diminish and improve.

Suggested Method of Therapy: Take the 3 mg starting dose for the first month without a break. If there are no significant introductory side-effects at this dose, start the 4.5 mg dose, again without taking a break. Continue at this dose until your symptoms are stable, with perhaps some modest improvements, then take a two day break. Continue with this regime (ten days on and two days off the treatment). For further options, see "Intermittent Therapy", below.

If you are unable to tolerate the usual 3 mg starting dose, it may be necessary for you to use the ultra-low, 1.5 mg or 2 mg dose instead until your body becomes adjusted to the method.

When starting the 4.5 mg dose, if you notice, at any stage, a tendency to increasing symptoms, this may indicate that this dose is too high for you. In this circumstance you should simply revert back to the 3 mg dose once again. You should then find that these adverse symptoms will once more diminish and the improvements become more apparent.

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, when the body eventually develops a tolerance to the drug.

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. Initially, the suggested routine was to take the naltrexone each day for three weeks, after which, treatment was stopped for one week. It now appears, however, that this method, in some patients, permits a significant level of deterioration during the untreated period.

Current advice therefore is to take the treatment for ten days, after which it may be appropriate to take a break of two days.

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, if there are no excessive problems with this dose, take two weeks of the 4.5 mg capsules to establish the level of response at this dose. It would then be appropriate to stop treatment for two days, after which therapy is continued with ten days on and two days off in a regular repeating pattern of use.

Symptoms are generally not found to increase excessively during this two-day break.

Some patients prefer to take just a one-day break on the same day each week.

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.

When starting the treatment please report any untoward or adverse side-effects immediately so that the treatment process may be re-assessed and, if necessary, modified.

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[Guest guest]

THANK YOU. This is excellent.

Lynda

From:

low dose naltrexone

Sent: Friday, April 09, 2004 1:02 PM

Subject: [low dose naltrexone] Dr. Lawrences Rcommendations for Lynda Phelps

HI

The following information is the document Dr. Bob Larence gives his patient and in it you'll see the infomration on Intermittant therapy which I think you are talking about.

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 the United Kingdom. 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 are usually 50 to 150 mg 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 4196; fax: (212) 229-9371.

His website is www.low dose naltrexone.org

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 between 9 pm at night and 3 am in the morning. 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.

For those unable to tolerate even the 3 mg dose, an ultra-low, 1.5 mg dose is available. This is intended to introduce the therapy more slowly, allowing more time for the necessary endorphin response to develop.

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 are significantly 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.

Despite these promising findings it must 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 and kidneys it is required that anyone previously suffering previous liver or kidney problems should report this condition before starting therapy. This risk is believed to be minimal, however, as the dose of the drug is extremely low.

In addition, there may also be some initial transient, though temporary, increase in MS symptoms.

Introductory symptoms, on starting this treatment, may include 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.

In less than two percent of cases treated, these increased symptoms may be more prolonged, lasing perhaps for several weeks. Rarely, symptoms have persisted for two or even three months before the appropriate beneficial response is gained. In this situation, the ultra-low 1.5 mg dose may be introduced to provide a more gentle introduction to the method.

Occasionally, 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 become apparent that some patients, using the early supplies of LDN, have experienced increasing muscle stiffness and/or joint pain, after a few weeks of therapy.

This is believed to be due to an increased sensitivity to the lactose filler used in the initial supplies of the treatment at that time.

All the naltrexone capsules now supplied use only calcium carbonate filler. Calcium carbonate is a beneficial mineral, which is free of any such sensitivity reactions.

The early introductory, but temporary, increase in symptoms may also perhaps be explained when we consider the manner in which this drug is expected to work.

Contrary to the common belief that MS is due to over-activity of the immune system, MS actually occurs due to a reduction in immune system activity. Specifically, it is the reduction in number of the suppressor T-cells within the immune system that permits the damaging CD4, helper T-cells to do their harm. Thus, 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 CD-4, helper, T-cells tend to predominate. This is the situation most pronounced during an acute relapse but a similar situation occurs, perhaps to a lesser extent, in chronic progressive MS.

Under the influence of LDN it has been demonstrated that the numbers of T-cells may increase by more than 300%. Thus, when the number of T-cells is initially increased, the overall predominance of CD4, helper T-cells at this time, will expectedly increase the intensity of the MS, therefore temporarily increasing some symptoms.

As the number of T-cells continues to increase, the normal balance of suppressor to helper T-cells is restored, the activity and intensity of the disease process is reduced, and symptoms once again diminish and improve.

Suggested Method of Therapy: Take the 3 mg starting dose for the first month without a break. If there are no significant introductory side-effects at this dose, start the 4.5 mg dose, again without taking a break. Continue at this dose until your symptoms are stable, with perhaps some modest improvements, then take a two day break. Continue with this regime (ten days on and two days off the treatment). For further options, see "Intermittent Therapy", below.

If you are unable to tolerate the usual 3 mg starting dose, it may be necessary for you to use the ultra-low, 1.5 mg or 2 mg dose instead until your body becomes adjusted to the method.

When starting the 4.5 mg dose, if you notice, at any stage, a tendency to increasing symptoms, this may indicate that this dose is too high for you. In this circumstance you should simply revert back to the 3 mg dose once again. You should then find that these adverse symptoms will once more diminish and the improvements become more apparent.

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, when the body eventually develops a tolerance to the drug.

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. Initially, the suggested routine was to take the naltrexone each day for three weeks, after which, treatment was stopped for one week. It now appears, however, that this method, in some patients, permits a significant level of deterioration during the untreated period.

Current advice therefore is to take the treatment for ten days, after which it may be appropriate to take a break of two days.

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, if there are no excessive problems with this dose, take two weeks of the 4.5 mg capsules to establish the level of response at this dose. It would then be appropriate to stop treatment for two days, after which therapy is continued with ten days on and two days off in a regular repeating pattern of use.

Symptoms are generally not found to increase excessively during this two-day break.

Some patients prefer to take just a one-day break on the same day each week.

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.

When starting the treatment please report any untoward or adverse side-effects immediately so that the treatment process may be re-assessed and, if necessary, modified.

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[Guest guest]

Thank you , I've been waiting for something like this to come out!

From: [mailto:@...] Sent: Friday, April 09, 2004 4:02 PMlow dose naltrexone Subject: [low dose naltrexone] Dr. Lawrences Rcommendations for Lynda Phelps

HI

The following information is the document Dr. Bob Larence gives his patient and in it you'll see the infomration on Intermittant therapy which I think you are talking about.

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 the United Kingdom. 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 are usually 50 to 150 mg 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 4196; fax: (212) 229-9371.

His website is www.low dose naltrexone.org

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 between 9 pm at night and 3 am in the morning. 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.

For those unable to tolerate even the 3 mg dose, an ultra-low, 1.5 mg dose is available. This is intended to introduce the therapy more slowly, allowing more time for the necessary endorphin response to develop.

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 are significantly 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.

Despite these promising findings it must 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 and kidneys it is required that anyone previously suffering previous liver or kidney problems should report this condition before starting therapy. This risk is believed to be minimal, however, as the dose of the drug is extremely low.

In addition, there may also be some initial transient, though temporary, increase in MS symptoms.

Introductory symptoms, on starting this treatment, may include 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.

In less than two percent of cases treated, these increased symptoms may be more prolonged, lasing perhaps for several weeks. Rarely, symptoms have persisted for two or even three months before the appropriate beneficial response is gained. In this situation, the ultra-low 1.5 mg dose may be introduced to provide a more gentle introduction to the method.

Occasionally, 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 become apparent that some patients, using the early supplies of LDN, have experienced increasing muscle stiffness and/or joint pain, after a few weeks of therapy.

This is believed to be due to an increased sensitivity to the lactose filler used in the initial supplies of the treatment at that time.

All the naltrexone capsules now supplied use only calcium carbonate filler. Calcium carbonate is a beneficial mineral, which is free of any such sensitivity reactions.

The early introductory, but temporary, increase in symptoms may also perhaps be explained when we consider the manner in which this drug is expected to work.

Contrary to the common belief that MS is due to over-activity of the immune system, MS actually occurs due to a reduction in immune system activity. Specifically, it is the reduction in number of the suppressor T-cells within the immune system that permits the damaging CD4, helper T-cells to do their harm. Thus, 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 CD-4, helper, T-cells tend to predominate. This is the situation most pronounced during an acute relapse but a similar situation occurs, perhaps to a lesser extent, in chronic progressive MS.

Under the influence of LDN it has been demonstrated that the numbers of T-cells may increase by more than 300%. Thus, when the number of T-cells is initially increased, the overall predominance of CD4, helper T-cells at this time, will expectedly increase the intensity of the MS, therefore temporarily increasing some symptoms.

As the number of T-cells continues to increase, the normal balance of suppressor to helper T-cells is restored, the activity and intensity of the disease process is reduced, and symptoms once again diminish and improve.

Suggested Method of Therapy: Take the 3 mg starting dose for the first month without a break. If there are no significant introductory side-effects at this dose, start the 4.5 mg dose, again without taking a break. Continue at this dose until your symptoms are stable, with perhaps some modest improvements, then take a two day break. Continue with this regime (ten days on and two days off the treatment). For further options, see "Intermittent Therapy", below.

If you are unable to tolerate the usual 3 mg starting dose, it may be necessary for you to use the ultra-low, 1.5 mg or 2 mg dose instead until your body becomes adjusted to the method.

When starting the 4.5 mg dose, if you notice, at any stage, a tendency to increasing symptoms, this may indicate that this dose is too high for you. In this circumstance you should simply revert back to the 3 mg dose once again. You should then find that these adverse symptoms will once more diminish and the improvements become more apparent.

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, when the body eventually develops a tolerance to the drug.

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. Initially, the suggested routine was to take the naltrexone each day for three weeks, after which, treatment was stopped for one week. It now appears, however, that this method, in some patients, permits a significant level of deterioration during the untreated period.

Current advice therefore is to take the treatment for ten days, after which it may be appropriate to take a break of two days.

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, if there are no excessive problems with this dose, take two weeks of the 4.5 mg capsules to establish the level of response at this dose. It would then be appropriate to stop treatment for two days, after which therapy is continued with ten days on and two days off in a regular repeating pattern of use.

Symptoms are generally not found to increase excessively during this two-day break.

Some patients prefer to take just a one-day break on the same day each week.

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.

When starting the treatment please report any untoward or adverse side-effects immediately so that the treatment process may be re-assessed and, if necessary, modified.

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[Guest guest]

Hi ,

I'm new to the group. I don't have MS (though 4 years ago I was treated for 2 years with Avonex as they thought I had it) I have Primary Lateral Sclerosis a variant of Lou Gehrig's. I enjoyed reading the recommendations from Dr. Lawrence but am a little concerned about dependence being a possibility of LDN since I'm going to start it next week or week after. I know his suggestion is to do 10 days -2 days off, but will this eliminate the possibility of dependence? You may know or may not know, but your opinion is valued. Thanks in advance for sharing and responding. Take care.

God Bless

Yolanda

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From:

low dose naltrexone

Sent: Friday, April 09, 2004 4:02 PM

Subject: [low dose naltrexone] Dr. Lawrences Rcommendations for Lynda Phelps

HI

The following information is the document Dr. Bob Larence gives his patient and in it you'll see the infomration on Intermittant therapy which I think you are talking about.

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 the United Kingdom. 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 are usually 50 to 150 mg 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 4196; fax: (212) 229-9371.

His website is www.low dose naltrexone.org

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 between 9 pm at night and 3 am in the morning. 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.

For those unable to tolerate even the 3 mg dose, an ultra-low, 1.5 mg dose is available. This is intended to introduce the therapy more slowly, allowing more time for the necessary endorphin response to develop.

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 are significantly 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.

Despite these promising findings it must 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 and kidneys it is required that anyone previously suffering previous liver or kidney problems should report this condition before starting therapy. This risk is believed to be minimal, however, as the dose of the drug is extremely low.

In addition, there may also be some initial transient, though temporary, increase in MS symptoms.

Introductory symptoms, on starting this treatment, may include 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.

In less than two percent of cases treated, these increased symptoms may be more prolonged, lasing perhaps for several weeks. Rarely, symptoms have persisted for two or even three months before the appropriate beneficial response is gained. In this situation, the ultra-low 1.5 mg dose may be introduced to provide a more gentle introduction to the method.

Occasionally, 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 become apparent that some patients, using the early supplies of LDN, have experienced increasing muscle stiffness and/or joint pain, after a few weeks of therapy.

This is believed to be due to an increased sensitivity to the lactose filler used in the initial supplies of the treatment at that time.

All the naltrexone capsules now supplied use only calcium carbonate filler. Calcium carbonate is a beneficial mineral, which is free of any such sensitivity reactions.

The early introductory, but temporary, increase in symptoms may also perhaps be explained when we consider the manner in which this drug is expected to work.

Contrary to the common belief that MS is due to over-activity of the immune system, MS actually occurs due to a reduction in immune system activity. Specifically, it is the reduction in number of the suppressor T-cells within the immune system that permits the damaging CD4, helper T-cells to do their harm. Thus, 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 CD-4, helper, T-cells tend to predominate. This is the situation most pronounced during an acute relapse but a similar situation occurs, perhaps to a lesser extent, in chronic progressive MS.

Under the influence of LDN it has been demonstrated that the numbers of T-cells may increase by more than 300%. Thus, when the number of T-cells is initially increased, the overall predominance of CD4, helper T-cells at this time, will expectedly increase the intensity of the MS, therefore temporarily increasing some symptoms.

As the number of T-cells continues to increase, the normal balance of suppressor to helper T-cells is restored, the activity and intensity of the disease process is reduced, and symptoms once again diminish and improve.

Suggested Method of Therapy: Take the 3 mg starting dose for the first month without a break. If there are no significant introductory side-effects at this dose, start the 4.5 mg dose, again without taking a break. Continue at this dose until your symptoms are stable, with perhaps some modest improvements, then take a two day break. Continue with this regime (ten days on and two days off the treatment). For further options, see "Intermittent Therapy", below.

If you are unable to tolerate the usual 3 mg starting dose, it may be necessary for you to use the ultra-low, 1.5 mg or 2 mg dose instead until your body becomes adjusted to the method.

When starting the 4.5 mg dose, if you notice, at any stage, a tendency to increasing symptoms, this may indicate that this dose is too high for you. In this circumstance you should simply revert back to the 3 mg dose once again. You should then find that these adverse symptoms will once more diminish and the improvements become more apparent.

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, when the body eventually develops a tolerance to the drug.

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. Initially, the suggested routine was to take the naltrexone each day for three weeks, after which, treatment was stopped for one week. It now appears, however, that this method, in some patients, permits a significant level of deterioration during the untreated period.

Current advice therefore is to take the treatment for ten days, after which it may be appropriate to take a break of two days.

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, if there are no excessive problems with this dose, take two weeks of the 4.5 mg capsules to establish the level of response at this dose. It would then be appropriate to stop treatment for two days, after which therapy is continued with ten days on and two days off in a regular repeating pattern of use.

Symptoms are generally not found to increase excessively during this two-day break.

Some patients prefer to take just a one-day break on the same day each week.

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.

When starting the treatment please report any untoward or adverse side-effects immediately so that the treatment process may be re-assessed and, if necessary, modified.

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