Low dose naltrexone (LDN) requires a prescription and must be prepared by a compounding pharmacy. You cannot pick it up at a standard pharmacy like CVS or Walgreens because naltrexone is only commercially manufactured as a 50 mg tablet, and LDN doses typically range from 0.1 to 4.5 mg. That means getting LDN involves two steps: finding a prescriber willing to write for it, then filling that prescription at a pharmacy equipped to make custom doses.
Why You Need a Compounding Pharmacy
The FDA approved naltrexone in 1984 for treating opioid and alcohol addiction at doses of 50 to 100 mg per day. LDN uses roughly one-tenth of that dose, and no manufacturer produces tablets that small. Compounding pharmacies specialize in preparing custom medications, so they can formulate naltrexone into the precise low doses your prescriber orders.
LDN is available in several forms from compounding pharmacies: oral capsules are the most common, but many pharmacies also prepare liquid solutions (useful for very precise dose adjustments), sublingual tablets that dissolve under the tongue, and topical creams. Your prescriber will typically recommend a form based on your dosing needs. Liquid formulations are especially helpful if you’re following a slow titration schedule that requires tiny dose increases.
How to Find a Compounding Pharmacy
Not every compounding pharmacy stocks naltrexone or has experience preparing LDN. The Alliance for Pharmacy Compounding maintains an online directory at a4pc.org where you can search for compounders by location. Many compounding pharmacies also ship nationwide, so you’re not limited to what’s available locally.
When choosing a pharmacy, look for PCAB accreditation from the Accreditation Commission for Health Care. This is considered the gold standard for compounding pharmacies and means the facility has been independently assessed for quality and compliance. You can also ask whether the pharmacy sources its active ingredients from FDA-registered facilities (required by federal law) and whether it uses third-party lab testing to verify the accuracy and purity of its compounded medications. These details matter because LDN doses are so small that precision in compounding directly affects what you’re actually getting.
Getting a Prescription: Your Options
LDN is an off-label use of naltrexone, meaning no FDA-approved indication exists for it at low doses for pain, autoimmune conditions, or inflammation. Off-label prescribing is legal and common in medicine, but it does mean some doctors are unfamiliar with LDN or reluctant to prescribe it. You have several routes to find a willing prescriber.
Your Current Doctor
Start with whoever manages your condition. If you’re dealing with chronic pain, fibromyalgia, or an autoimmune disease, your treating physician may be open to discussing LDN, especially if conventional treatments haven’t worked well. Pain specialists, rheumatologists, and neurologists are among the specialists most likely to have encountered LDN in their practice. Functional and integrative medicine practitioners tend to be particularly familiar with it and often include it as part of broader treatment plans.
Telehealth Platforms
Several online telehealth services now specialize in LDN consultations. Platforms like AgelessRx connect you with US-licensed prescribers for an online visit, with no in-person appointment required. If the prescriber determines you’re an appropriate candidate, they write the prescription and send it to a partnering compounding pharmacy or one you choose. These services streamline the process, but costs vary and are typically paid out of pocket since LDN is off-label and rarely covered by insurance.
LDN-Specific Directories
The LDN Research Trust, a nonprofit focused on LDN education, maintains resources that can help connect patients with prescribers who have experience with the medication. Searching their site or contacting them directly can point you toward practitioners in your area.
What LDN Typically Costs
Because LDN is compounded and off-label, most insurance plans don’t cover it. Out-of-pocket costs for a month’s supply generally range from $30 to $60 at most compounding pharmacies, though prices vary by pharmacy, dosage form, and your location. The consultation fee for a telehealth visit is separate and varies by platform. Compared to many chronic pain or autoimmune medications, LDN is relatively inexpensive.
Dosing: What to Expect
The most commonly cited dose is 4.5 mg per day, taken once daily, and much of the published research has used this amount. Studies on fibromyalgia, multiple sclerosis, and Crohn’s disease have tested 4.5 mg and found improvements in pain, fatigue, and quality of life. In one trial of people with multiple sclerosis taking 3.5 mg, 60% reported reduced fatigue and 75% reported stable or improved quality of life.
However, effective doses actually span a wide range. An observational study published in the Journal of Pain Research found that patients responded to doses anywhere from 0.1 to 5.6 mg per day, with the most common effective doses clustering at 2 mg or less. The researchers concluded that the standard practice of prescribing a fixed 4.5 mg dose for everyone “may be ill-advised,” since the optimal dose appears to vary significantly from person to person.
Some practitioners start at 4.5 mg right away. Others use a gradual titration, beginning as low as 0.1 mg per day and increasing slowly, sometimes by just 0.1 mg every few days, until the patient notices improvement. This slower approach takes longer to reach a therapeutic dose (often two months or more) but helps identify the lowest effective amount and may reduce side effects. Your prescriber’s approach will depend on their clinical experience and your specific situation.
Conditions LDN Is Used For
At standard doses, naltrexone blocks opioid receptors completely. At very low doses, it appears to work differently: briefly and partially blocking those receptors, which may trigger the body to increase its own production of natural pain-relieving compounds, while also reducing inflammation through effects on immune cells.
The conditions most commonly treated with LDN include fibromyalgia, multiple sclerosis, Crohn’s disease, chronic pain syndromes (particularly nerve pain), and various autoimmune conditions. Clinical evidence is still growing. Most studies have been small, but results have been promising enough that LDN use has expanded significantly among pain and integrative medicine specialists. A case series found that patients with nerve pain responded more strongly to LDN than those with arthritis-related pain.
It’s worth knowing that LDN cannot be used alongside opioid medications. Because naltrexone blocks opioid receptors, even at low doses, taking it while on opioid painkillers can trigger withdrawal symptoms. If you currently take opioids, your prescriber will need to plan a transition before starting LDN.