International List of Drugs not to take with LDN & Notes about other Drugs

LDN will block the analgesic effects of MOST opiate drugs. In general, Low Dose
Naltrexone (LDN) should not be taken concurrently with opioid-containing drugs,
immunosuppressive drugs, or immunomodulator drugs. Do not take Low Dose
Naltrexone with any of the following without first consulting your doctor:

List may not include each brand name available on the market.

NOTE: Tramadol (Ultram) (A dose is said to be OK 12 hours after a dose of LDN)

Analgesics approved for use with LDN include Moxxor, aspirin, Tylenol, Advil, Motrin,
Aleve, Naprosyn, Ansaid, Dolobid, Orudis, Voltaren, Feldene, Mobic.

DL-Phenylalanine (DLPA). A natural product that helps to alleviate pain. It should not,
however, be used by people with high blood pressure. Is said to enhance the effectiveness of
LDN and should be taken twice a day on an empty stomach in doses of 500 mg.

Prescription Medications

6MP (need to be off this for 1 week before starting LDN)

Acetyldihydrocodone

Actifed with Codeine Cough Syrup

Actiq (Fentanyl)

Alfenta (Alfentinil)

Alfentinil (Alfenta)

Ambenyl

Amogel PG

Antibuse (Disulfiram)

Aspirin with Codeine

Astramorph PF
Avonex

Betaseron

Broncholate CS

Buprenex (Buprenorphine)

Buprenorphine (Buprenex, Suboxone, Subutex)

Butorphanol (Dorolex, Stadol was recently discontinued by the manufacturer. It is now only
available in its generic formulations, manufactured by Novex, Mylan, Apotex and Roxane.
Butorphanol)

Capital and Codeine Oral Solution

Catapres (Clonidine)

Cellcept (chemotherapy)

Cesamet (Nabilone)

Chemotherapies (Cellcept)

Cheracol

Clonidine (Catapres)

Codeine (Tylenol with codeine or any other brand name)

Codinal PH

Darvocet (Propoxyphene)

Darvon (Propoxyphene)

Deconsal

Demerol (Meperidine)

Diabismul

Diamorphine

Dihydrocodeine
Dilaudid (Hydromorphone)

Dimetane-DC Cough Syrup

Diphenoxylate

Disulfiram (Antabuse)

Doda

Dolophine (Methadone)

Donnagel-PG

Dovolex

Dronabinol, THC (Marinol)

Duragesic/Fentanyl patch

Duramorph

Emprin with Codeine

Endocet (Oxycontin)

Endocodone

Fentanyl (Duragesic, Aqtic, Sublimaze, Fentora)

Fentora (Fentanyl)

Fioricet with Codeine

Fiorinal with Codeine

Heroin

Humira (Need to stop 2 weeks prior to taking LDN)

Hycodan

Hydrocodone (Lorcet, Lortab, Vicodin, Vicoprofen and other brand names)

Hydromorphone (Dilaudid)
Hyrocane

Imidium AD

Infantol Pink

Infumorph

Isoclor Expectorant

Kadian (Morphine)

Kaodene with Codeine

Kaodene with Paregoric

LAAM

Laudanum

Levorphanol (Levo-Dromoran)

Levo-Dromoran (Levorphanol)

Lomotil

Lorcet (Hydrocodone)

Lortab (Hydrocodone)

Marinol (Dronabinol, THC)

Mellaril (Thioridazine)

Meperidine (Demerol, Meperitab)

Meperitab (Meperidine)

Methadone (Dolophine, Methadose)

Methadose (Methadone)

Methotrexate

Morphine (Kadian, MS Contin, MSIR, OMS, Roxanol, Oramorph SR, and other brand names)
M-Oxy (Oxycontin)

MS Contin (Morphine)

MSIR (Morphine)

Nabilone (Cesamet)

Nalbuphine (Nubain)

Naloxone (Pentazocine)

Norco

Novahistine DH

Novahistine Expectorant

Novantrone

Nubain (Nalbuphine)

Nucofed Expectorant

Numorphan (Oxymorphone)

Numorphone

OMS (Morphine)

Opana (Oxymorphone)

Opium

Oramorph SR (Morphine)

Oxymorpone (Opana, Numorphan)

Oxycodone

Oxycontin (M-Oxy, OxyContin, OxyIR, Roxicodone, Endocet, Percocet, Percodan, and other
brand names)

OxyContin (Oxycontin)

OxyIR (Oxycontin)
Oxymorphone (Numorphan)

Paracodine

Paregoric

Par-Glycerol-C (CV)

Pentazocine (Naloxone, Talwin)

Percocet (Oxycontin)

Percodan (Oxycontin)

Pethidine

Pediacof

Phenaphen with Codeine

Phenergan with Codeine

Phenergan VC

Poly-Histine

Promethazine VC with Codeine

Propoxyphene (Darvocet. Darvon and other brand names)

Rebif

Remicade Must be off 50 days.

Remifentinil (Ultiva)

Rescudose

Robitussin A-C

Robitussin DAC

Roxanol (Morphine)

Roxicodone (Oxycontin)
Soma with Codeine

Stadol (Butorphanol)

Sublimaze (Fentanyl)

Suboxone

Subutrex (Buprenorphine)

Sufenta (Sufentinil)

Sufentinil (Sufenta)

Talwin (Pentazocine)

Thioridazine (Mellaril)

Triaminic Expectorant with Codeine

Tussionex

Tussi-Organiden

Tylenol with Codeine

Tylenol with Codeine (#1, 2, 3, or 4)

Tylox

Tysabri

Tussar-2

Tussar SF

Ultiva (Remifentinil)

Ultram (Tramadol)

Vicodin

Vicoprofen

Xodol
Zydone

Note: The list is only a representative sample of the prescription and non-prescription
medications that contain codeine or morphine.

If an emergency situation requires that opioid analgesia be administered to a patient who has
received Naltrexone, the amount of opioid required may be greater than usual, and the resulting
respiratory depression may be deeper and more prolonged. Patients should be closely monitored
for altered efficacy and safety.

In addition, because LDN will also block the analgesic effects of any opiate drugs (includes
Codeine, Dihydrocodeine, Morphine, Pethidine or Diamorphine) presently being taken, the use
of LDN MAY initially greatly increase the level of pain experienced. It is therefore advisable
that any opiate-like drugs be discontinued at least two weeks before this treatment is initiated.
Because LDN blocks opioid receptors throughout the body for three or four hours, people using
medicine that is an opioid agonist, i.e. narcotic medication such as morphine, Percocet,
Duragesic patch or codeine-containing medication should not take LDN until such medicine
is completely out of one's system. Patients who have become dependent on daily use of narcotic-
containing pain medication may require 10 days to 2 weeks of slowly weaning off of such drugs
entirely (while first substituting full doses of non-narcotic pain medications) before being able to
begin LDN safely. If you should take an opiate type drug while taking LDN their effects will
cancel each other out. If you will be needing surgery, SOME RECOMMEND that you should
not take LDN for 24 to 48 hours previously. You may then resume the LDN 24 to 48 hours after
the last dose of an opiate containing drug. LDN can put a person taking narcotics into
withdrawal if started too early.

People who have received organ transplants and who therefore are taking immunosuppressive
medication on a permanent basis are cautioned against the use of LDN because it may act to
counter the effect of those medications.

Steroid use in any auto-immune disease, such as MS, will have a strong adverse effect by
suppressing both the immune system and adrenal function. Thus, when these drugs are stopped,
these reactions will result in an increase in both the risk of further relapse, and the rate of disease
progression. In addition, when steroids are used, it will become necessary to stop taking the
LDN, further disrupting the level of disease stability.

Thus, if a relapse should occur, for whatever reason, the most important action is to continue the
LDN without a break.

Because relapses of MS are related to what is referred to as oxidative stress, the most effective

Anyone who is on steroids would need to follow a doctors advice if coming off them.

Chemotherapy
Because most chemotherapeutic agents are immunosuppressants, they will directly oppose the
beneficial immune system up regulation induced by LDN. While it is possible to take
chemotherapy simultaneously with LDN, it will, in my view, take LDN significantly longer to
accomplish its therapeutic goal. Furthermore, LDN would work against the full effectiveness of
the chemotherapy. The situation would be analagous to a person trying to ride a bicycle with its
brakes on. Since we do not live in a perfect world, there will be circumstances in which the
combination of LDN and chemotherapy cannot be avoided. In such cases, there are a number of
measures one can implement to counteract the side effects of chemotherapy without (hopefully)
further compromising the effectiveness of LDN.

Other cautions from Dr. Lawrence

Immodium AD Naltrexone tested at 25 mg+ blocked the effect of Loperamide Hydrochloride

(Immodium) against diarrhea. Bismuth compounds (Pepto-Bismol) may be used for mild nausea
or diarrhea, and Octreotide Acetate (Sandostatin) may be used for severe diarrhea, and
Ondansetron Hydrochloride (Zofran) may be used for nausea and vomiting especially with
acidental naltrexone- precipitated opiate withdrawal. It has not been established whether
Imodium AD at doses of uder 5 mg would have the same effect.

1. Proton pumps are antacids that work on the parietal cells of the stomach and parts of the
intestines. It reduces the pH of these areas. This is not a problem with LDN.

2. Calcium carbonate is not a problem when taken 2 hours away from a dose of LDN. Calcium
carbonate is not a problem when taken with LDN. CalCarb is an antacid like tums.

3. Calcium carbonate when compounded as the filler for LDN is a problem.

Hashimoto Thyroiditis

Those patients who are taking thyroid hormone replacement for a diagnosis of Hashimotos
thyroiditis with hypothyroidism ought to begin LDN at the lowest range (1.5mg for an adult). Be
aware that LDN may lead to a prompt decrease in the autoimmune disorder, which then may
require a rapid reduction in the dose of thyroid hormone replacement in order to avoid symptoms
of hyperthyroidism.

Multiple Sclerosis

In addition, because LDN stimulates the immune system and many of the drugs routinely used
by the NHS in the treatment of MS further suppress the immune system, LDN cannot be used in
company with steroids, Beta interferon, Methotrexate, Azathioprine or Mitozantrone or any other
immune suppressant drugs. If there is any doubt, please submit a full list of the drugs you are
presently taking so that their compatibility may be assessed.

When starting this LDN(Low Dose Naltrexone) therapy in the treatment of MS, there may also
be some initial transient, though temporary, increase in MS symptoms. Experience in using this
method has demonstrated most commonly, such as disturbed sleep, occasionally with vivid,
dreams, fatigue, spasm and pain. These increased symptoms would not normally be expected to
last more than seven to ten days.

Rarely, other transient symptoms have included more severe pain and spasm, headache, diarrhea
or vomiting. These additional symptoms would appear to be associated with the previous
frequent use of strong analgesics, which effectively create an addiction and dependency, thus
increasing the body's sensitivity to pain. This temporary increase in symptoms may also perhaps
be explained when we consider the manner in which this drug is expected to work. In addition,
because LDN will also block the analgesic effects of any opiate drugs (includes Codeine,
Dihydrocodeine, Morphine, Pethidine or Diamorphine) presently being taken, the use of LDN
may initially greatly increase the level of pain experienced. It is advisable that any opiate-like
drugs be discontinued at least two weeks before this treatment is initiated. When starting the
treatment it is essential that any untoward or adverse side-effects are reported immediately so
that the treatment process can be further assessed and, if necessary, modified.