I have persistent symptoms after COVID-19 infection or confirmed long COVID, Should I use low-dose naltrexone (LDN) (1.5–6 mg) or continue without LDN?
What should you know?
Long COVID is a condition that that refers to range of symptoms that continue for weeks to months after a COVID-19 infection. Long COVID can affect multiple systems in your body, affecting your overall wellbeing, physical functioning, and your quality of life. Common symptoms include:
1) Fatigue (feeling tired, even after rest).
2) Pain or discomfort.
3) Sleep disturbances.
4) Brain fog or difficulty concentrating.
5) Shortness of breath.
6) Other symptoms.
It is important to know that there is no single cure for long COVID, but treatments could be used to manage symptoms.
Problem with treatment
A systematic review of LDN was conducted and no direct evidence was found for the use of LDN in people with long COVID. There are no published randomized control trials on the use of LDN in people with long COVID. Four randomized control trials of LDN in people with fibromyalgia and one trial in people with chronic pain showed low certainty evidence that LDN may result in little to no difference in pain intensity, fatigue, physical functioning, and health-related quality of life compared with placebo.
LDN is generally considered safe but could result in mild side effects such as fatigue, headache, nausea, and sleep disturbances.
LDN is currently not approved for long COVID and must be obtained through a compounding pharmacy. This will lead to out-of-pocket costs, with insurance coverage being limited in many places.
We also do not have any long-term data on the use of LDN, and we do not know whether any short-term improvements will persist. We also have concerns that LDN can mask other underlying health issues, that could lead to delayed diagnosis.
Even though there is very limited evidence on the benefits and harms regarding LDN use in people with long COVID, some people may decide to trial LDN if they place higher value on the potential benefits compared to the harms.
Treatment
In standard doses (50 mg), naltrexone is used to treat opioid or alcohol dependence. In lower doses, it has been studied (off-label) for chronic pain and inflammatory conditions. Low-dose naltrexone (LDN) is given at doses ranging from 1.5 mg to 6 mg daily for treatment of long COVID. There is limited but emerging evidence for using LDN in adults with long COVID.
Topics that you should discuss with your healthcare professional
It will be important to speak with your healthcare professional to:
- Confirm that you have long COVID.
- Discuss the main symptoms affecting your daily life.
- Discuss what improvements you are hoping to see.
- Discuss any other condition you may have or if you are on opioid medications.
- Discuss access to LDN, such as out-of-pocket costs or insurance coverage.
- Discuss a follow up plan to check for side-effects or symptom changes.
- Discuss available alternatives to LDN.
- Discuss when and how to stop LDN if it doesn’t help or causes side-effects.
Explanations of outcomes used in process
Outcomes are things that may happen as a consequence of a treatment, such as taking LDN. To make a clinical recommendation the CAN-PCC collaborative looked at the best available evidence to understand the benefits and harms of LDN treatment. We selected outcomes that are critical in making the decision: