29/7/2025
A treating physician may decide to prescribe LDN. Because this is an 'off-label' treatment, the physician makes their own assessment as to whether or not to prescribe the medication. It is important that patients only take LDN as a trial treatment in close contact with the treating physician, so that the physician can provide proper guidance.
People with other post-infectious conditions, such as Q fever, also have questions about this. Are you a healthcare professional and do you still have questions about LDN in Q fever patients after reading the information below? Please contact our medical advisors via the contact form on Q-support.
LDN can have a positive effect on symptoms as long as it is used. Upon discontinuation, there is a high chance that symptoms will return. However, we sometimes hear that LDN use leads to improved energy balance, which allows the body to recover (some) naturally over time. They may then experience longer-term stability after discontinuing LDN, as LDN is no longer necessary.
Health Benefits
At low doses (<5mg/day), LDN exerts opioid-blocking and immunomodulatory effects, among other things. LDN partially blocks (for approximately 4–6 hours) the opioid receptors in certain brain cells (glial cells). Normally, endorphins bind to these opioid receptors, leading to a reduction in pain. LDN blockade increases endorphin production, resulting in reduced pain symptoms and an increased sense of well-being. Endorphins also modulate the immune system by inhibiting B- and T-cell proliferation, significantly reducing the symptoms of post-infectious diseases such as post-COVID-XNUMX and ME/CFS.
LDN can also act directly on immune cells (e.g., as an antagonist of TLR4 or directly on the opioid receptor on immune cells) to stimulate or restore normal immune functions. For example, it has an inhibitory effect on the production of pro-inflammatory cytokines such as IL-6. IL-6 is significantly elevated during acute infections and in (especially critically ill) post-COVID patients. Given these immunomodulatory properties, LDN could play a role in supporting the viral clearance of SARS-CoV-2 and in preventing immune thrombosis resulting from infection.
Scientific state of affairs
Available scientific studies (pilots and cohort studies) are small-scale in design and conducted in patients with post-COVID or ME/CFS, a condition that shows strong similarities with post-COVID.
Conclusions from available literature (see references at the bottom of this document):
- Treatment with LDN may improve quality of life, fatigue, pain, PEM, sleep, functioning, and mental complaints in a subgroup of patients with post-COVID-19.
- The drug appears safe in post-COVID patients, but there are possible (transient) side effects.
- The quality of the scientific evidence is still low. We also don't know in which patients the drug is effective and for whom the improvement lasts longer than a few months.
A study into the drug's effectiveness in post-COVID care is underway in Canada, with findings expected in late 2025.
Low-dose naltrexone for post-COVID fatigue syndrome: a study protocol for a double-blind, randomized trial in British Columbia – PubMed
Off-Label Use of LDN in Post-COVID
Indications for the use of LDN (0,25-4,5mg) in post-COVID include pain, fatigue, PEM, neurological symptoms, cognitive complaints.
LDN intake
There is a construction schedule This is based on 0,25 mg drops. Dropping these drops into the mouth and swallowing is an option; it does not need to remain in the mouth for several minutes. If there is an unpleasant taste, it can also be dissolved in a little water and drunk. Take the medication before bedtime, unless the doctor advises otherwise.
Important: LDN is not a miracle cure. Generally, 60% of people respond well to LDN, with some experiencing significant benefits and others experiencing only minor ones. Sometimes the effect is temporary. This is impossible to predict in advance.
Information for healthcare providers considering prescribing LDN off-label
LDN can sometimes be prepared magistrally in consultation with your own pharmacy. In that case, the medication is not reimbursed by your health insurer, and magistrally preparation also involves costs. Alternatives include: mijnapotheek.nl, Preparation pharmacy Transvaal, Pharmacy the Magistrale preparer, Ceban en Infinity Pharma Oldenzaal who offer LDN in drop and capsule form.
Are you a healthcare professional with questions about LDN for post-COVID and/or Q fever patients? Please contact our medical advisors. For questions about post-COVID patients, please contact us via the contact form on C-support and for questions about patients with Q fever via the contact form on Q-supportOur doctors can provide general information about post-COVID and/or Q fever, offer specific advice on appropriate interventions, and consider whether LDN is a viable option as a trial treatment.
Literature
- Bolton MJ, Chapman BP, Van Marwijk H: Low-dose naltrexone as a treatment for chronic fatigue syndrome. BMJ Case Rep. (https://doi.org/10.1136/bcr-2019-232502)
- Bonilla H, et al. Low-dose naltrexone use for the management of post-acute sequelae of COVID-19. 2023. Int Immunopharmacol. (https://doi.org/10.1016/j.intimp.2023.110966)
- O'Kelly B, Vidal L, McHugh T, Woo J, Avramovic G, Lambert JS. 2022. Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study. Brain, Behavior, & Immunity – Health, Volume 24 (https://doi.org/10.1016/j.bbih.2022.100485)
- Isman A, et al. 2024. Low-dose naltrexone and NAD+ for the treatment of patients with persistent fatigue symptoms after COVID-19. Brain Behavior Immune Health. (doi: 1016/j.bbih.2024.100733)
- Tamariz, L et al. 2024. Low-dose Naltrexone Improves post–COVID-19 condition Symptoms. Clinical Therapeutics, Volume 46, Issue 3, e101 – e106; https://www.clinicaltherapeutics.com/article/S0149-2918(24)00003-1/abstract
