LDN, VLDN or ULDN – which one do I need?

At Integrow Health, we produce three versions of low dose naltrexone in the form of a sublingual spray. They are classified as follows:
LDN: 1 mg naltrexone per spray
VLDN: 200 mcg naltrexone per spray
ULDN: 10 mcg naltrexone per spray

What is naltrexone?

Naltrexone is a synthetic chemical. Pharmaceutically, it is categorized as an opiate antagonist. This means it opposes the actions of opioid drugs such as morphine, tramadol and codeine in the body. It was first approved by the FDA in 1984 to treat opioid addiction (such as heroin) or opioid overdose. It was also used in the operating theatre to reverse the actions of opioid analgesics post-surgery. The usual dose for these indications was 50 mg at a time.

About a decade later, it was discovered that extremely low-doses of naltrexone had superb pain relieving effects, as well as brain and mind benefits, immune boosting effects and anti-inflammatory benefits. Typical doses for these indications ranged from 1 to 5 mg by mouth per day.

Known as LDN, research on LDN demonstrated improvements in a number of diseases. Further studies resulted in even stranger discoveries about the benefits of low doses of naltrexone. It turns out that even lower doses often have greater pain relieving effects and other benefits, with even fewer side effects (not that there were many to begin with). Less is indeed more when it comes to naltrexone.

What Are LDN, VLDN, and ULDN?

Now, based on research, we have three types of LDN: The original low-dose (known as LDN), very low dose (VLDN), and ultra-low dose naltrexone (ULDN). Below, you can find out the differences and why there’s a need for these new dosages.

Low-dose naltrexone (LDN)

Our Low-dose naltrexone (LDN) is administered via a sublingual spray. Each spray provides 1 mg of naltrexone. When naltrexone is taken in capsule form, about 80% of it is destroyed in the liver in a process known as "first pass metabolism". Naltrexone that is absorbed via the blood flow of the tongue skips this metabolism. This firstly means you need less naltrexone for the same level of effect (= you save money).

Secondly, it means fewer side effects (since most of the side effects are triggered by the waste products produced in the liver). Thirdly, it means faster action (usually within a quarter hour or less) compared to capsule dosing. Lastly, it also means you do not have ot increase the dose over time. For oral dosing, the dosage needs to be increased over time, since the liver gets better and better at breaking it down.

A typical dose would be 1 spray, delivered below the tongue between 18.00 and 20.00 at night. However, for the first three days, take the first dose before 14.00, to avoid insomnia. After 3 days of morning dosing, the time of dosing can be shifted to evening for maximal effect on pain relief.

Cancer survivors using the ALA/N protocol (alpha lipoic acid & LDN) need to take 1 spray of LDN below tongue three times daily and take 200 mg or more of ALA three times daily, too.

Uses for LDN
Inflammation (e.g., auto-immune disorders)
Pain relief
Drug / Alcohol withdrawal
Anti-cancer benefits
Loss of libido / erectile dysfunction

Who should NOT take LDN?
Patients taking opioid analgesics for pain relief should not use LDN, since it will increase their pain levels and cause withdrawal symptoms.

Very low dose naltrexone
Our Very low-dose naltrexone (VLDN) provides 200 mcg naltrexone per spray. VLDN is often prescribed for patients who are on a low-dose opioid and are being weaned off their opioid therapy to shift to LDN.

A typical dose for VLDN would be one spray below tongue in the morning and one in the evening between 18.00 and 20.00.

Studies in substance abuse patients revealed decreased withdrawal symptoms, reduced craving, and increased engagement in outpatient treatment during the first week of VLDN treatment. Patients without substance abuse history but are experiencing adverse effects of LDN may also benefit from VLDN.

VLDN is much less likely to produce insomnia as a side effect, compared to LDN. Other side effects are extremely rare.

Uses for VLDN
Withdrawal from drug / alcohol addiction
Opioid withdrawal (but see below)
Patients who are sensitive to LDN
Pain relief
Attention deficit
Auto-immune diseases
Loss of libido / erectile dysfunction
Post-stroke / Traumatic brain injury

Who should NOT use VLDN?

Some patients may be hypersensitive to naltrexone, in which case even VLDN will be too strong for them. They may benefit from ULDN (below).

Ultra-low dose naltrexone
Ultra-low-dose naltrexone (ULDN) uses microgram dosing – dosed twice daily. Our ULDN is formulated as a spray delivering 10 microgram (mcg) per spray. ULDN is typically prescribed for patients who are currently taking regular dose opioids for pain. Regular LDN may trigger opioid withdrawal in such patients. Patients report that ULDN in combination with their opioid analgesics increases pain relief without blocking the effect of their opioid medication. Cancer, pain, and pruritus patients can benefit from ULDN therapy even with opioid therapy.

Uses for ULDN
Patients currently on opioid therapy
Opioid withdrawal
Patients who are sensitive to VLDN
Pain relief
Attention deficit
Auto-immune diseases
Post-stroke / Traumatic brain injury

Who should NOT use ULDN?

ULDN is unlikely to cause any side effects. However, the dosage may be too low to deal with severe chronic pain.

Safety and side effects of low-dose, very low dose, and ultra-low dose naltrexone
The vast majority of patients do not experience any side effects in using LDN, VLDN, and ULDN. Some may experience vivid dreams and insomnia when starting therapy with LDN or VLDN. These go away on their own within a few days of starting therapy. Reports of anxiety in some patients seem to be limited to those undergoing opioid withdrawal. As such, it is probably not related to naltrexone.

In general, LDN, VLDN, and ULDN are all well-tolerated. They are safe, with few side effects and no abuse potential. They are also cost-effective because only a small amount is needed.

Which one do I need?

LDN: Ideal for chronic pain relief currently NOT treated with opioids. Also as part of the ALA/N protocol for cancer (see above). Auto-immune disorders such as lupus and arthritis are also likely to benefit.

VLDN: For those who find LDN too strong, or who are on low dose opioid therapy (and do not wish to stop it). It is also useful in preventing withdrawal effects in those withdrawing from opioids, alcohol, recreational durgs and prescription drugs such as antidepressants and benzodiasepines.

ULDN: Ideal to intensify the analgesic effects of opioid treatment, such as that used to treat cancer pain. Also a good choice for children with attention deficit / hyperactivity. Helpful in withdrawals of all kinds. Moderate pain relieving effects on its own.

Still confused?

If you're not on any opiod treatment, you can safely choose any of the three.  If you've read all the above and you're still not sure which product is best for you, we suggest you start with VLDN. It is affordable and will most likely work for your indication. If it doesn't step up to LDN.

On the other hand, f you are on daily treatment with opiods for pain, we recommend ULDN. Use it to reduce your opioid usage / reliance and then step up to VLDN.