Low-Dose Naltrexone and RA

Last updated: March 2023

In exploring available medication options for rheumatoid arthritis (RA), the off-label use of low-dose naltrexone (LDN) has gotten a lot of attention in recent years.

What is low-dose naltrexone?

Naltrexone is a medication traditionally used to block the effects of opioid medication, including pain relief, and is most typically prescribed for the treatment of opioid and alcohol abuse.1

Many doctors have prescribed a lower dose of naltrexone, at approximately one-tenth of the typical opioid addiction treatment dosage, to treat the symptoms of rheumatoid arthritis and other chronic pain conditions.

Although there is not yet a plethora of resources to support it, some doctors, patients, and researchers claim that LDN (typically 4.5 mg/day) has improved symptoms in autoimmune patients such as those living with multiple sclerosis, encephalomyelitis, and Crohn’s disease.2

How LDN works for pain relief

LDN has been shown to temporarily block the body’s natural opioid receptors which, in turn, can cause the body to produce more endorphins.

Endorphins, which serve as a natural form of an opioid, can help reduce inflammation in the body and promote healing.

Pain reduction and inflammation

LDN also quiets the body’s tendency to attack itself as seen in autoimmune diseases by blocking the release of pro-inflammatory cytokines and modulating the production of T and B lymphocytes.

This provides a natural sense of pain reduction and inflammation, and may even prove to reduce the amount of inflammatory damage done to tissues.3

As a safe, cost-effective treatment for chronic pain and autoimmunity, LDN has been shown to reduce pain, improve fatigue, improve sleep, and even improve mood as it down-regulates inflammation in the nervous system.4

Limited research on LDN for chronic pain

There have been some limited research studies conducted on the use of LDN with chronic pain and RA patients, although there is still much more to be done.

A 2014 study on the use of LDN as a novel anti-inflammatory treatment for chronic pain found that LDN works as a glial cell modulator to manage chronic pain and autoimmune disorders, one of the first of its kind.5

A 2019 Nationwide register-based study on the effects of LDN in RA and seropositive arthritis found that persistent LDN users found a relative reduction in their cumulative daily doses of other medications taken to manage arthritis including NSAIDs, opioids, and DMARDs.2

There are currently a few clinical trials that are actively recruiting patients for studies on the benefits of LDN on chronic and painful conditions. However, at the time of publishing this article, none are specifically assessing the effects of LDN on rheumatoid arthritis.


LDN is generally inexpensive, well-tolerated, and orally administered. Some physicians may start at 1.5mg/day and increase the dose gradually until the patient experiences a therapeutic effect.

Just like with any RA medication, each patient’s journey or response to treatment is different. Some patients may find relief from LDN faster or at a lower dose than others.

LDN is typically prescribed by a rheumatologist, a general physician, naturopath, or even a pain management physician. It is filled by a compounding pharmacy where regular naltrexone tablets are ground up and reconfigured at low doses.3

Have you used or are you currently using LDN to manage your rheumatoid arthritis? We’d love to hear your experiences in the comments below!

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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