Low dose naltrexone (LDN): what it is, evidence and cost

What low dose naltrexone is

Naltrexone blocks opioid receptors. Its FDA label covers two uses: treating alcohol dependence and blocking the effects of opioids taken from outside the body, and it lists 50 mg once a day as the dose for most patients ^[1]. "Low dose" means a prescriber orders less than that, for a condition the label does not cover. We do not list low-dose amounts or step-up schedules on this page. Your prescriber and the pharmacy label set those.

FDA calls this off-label use. Its patient guidance says providers generally may prescribe an approved drug for an unapproved use when they judge it medically appropriate, and that FDA has not determined the drug is safe and effective for that use ^[2].

Approved use vs off-label use

Naltrexone FDA status by use, checked Oct 25 2026

Use	FDA status	Product	Source
Alcohol dependence	FDA approved	Naltrexone 50 mg tablets	[1]
Blocking the effects of opioids	FDA approved	Naltrexone 50 mg tablets	[1]
Fibromyalgia, Crohn's disease and other conditions at a low dose	Not approved; off-label	Usually a compounded capsule, tablet or liquid	[1] [2] [5]

Most LDN is made by compounding pharmacies, which sell it in strengths the approved tablet does not come in ^[5]. Compounded drugs are not FDA-approved, and FDA does not verify their safety, effectiveness or quality before they are sold ^[6]. FDA's rules let 503A pharmacies compound with a bulk ingredient that has a USP monograph or is a component of an FDA-approved drug ^[7], and naltrexone is the active ingredient in approved tablets ^[1]. So naltrexone can be used as a bulk ingredient under that rule. That does not make compounded LDN an FDA-approved product. For how other compounded products compare, see compounded semaglutide and NAD+ injections.

What the research has and has not shown

Fibromyalgia

A 2025 meta-analysis pooled five randomized trials of LDN against placebo in fibromyalgia. Pain scores were lower on LDN (standardized mean difference -0.61), vivid dreams were more common (risk ratio 2.41), and no serious side effects were reported. The authors said more trials are needed ^[3].

The largest single trial we found points the other way. In a Danish trial published in The Lancet Rheumatology in December 2023, 99 women with fibromyalgia took LDN or placebo for 12 weeks. Pain fell by 0.34 points more on LDN on an 11-point scale, a difference that was not statistically significant (p=0.27). The authors wrote that the study "did not show that treatment with low-dose naltrexone was superior to placebo in relieving pain" ^[8].

Crohn's disease

A 2018 Cochrane review found only two small randomized trials with 46 people in all. In the adult trial, remission rates were 30% on LDN and 18% on placebo, a difference that was not statistically significant. Endoscopic response was higher on LDN (72% vs 25%). Cochrane rated the evidence low certainty and said it was not enough "to allow any firm conclusions" ^[9].

Everything else

LDN is also prescribed for other conditions. We did not review trials for those uses for this page, and we make no claim that LDN treats them. If a prescriber suggests it, ask which trials support your condition and how many people were in them.

Risks and interactions on the FDA label

The label below was written for the 50 mg tablet. Its warnings about opioids apply to the drug itself, so ask your prescriber how they apply at a lower dose.

• Do not take it if you use opioids. The label lists people taking opioid pain medicine, people dependent on opioids and people in opioid withdrawal as contraindicated ^[1].
• Sudden withdrawal. Naltrexone can bring on opioid withdrawal. The label recommends at least 7 to 10 days free of opioids before starting ^[1].
• Overdose after stopping. The label reports fatal opioid overdoses in people after they stopped naltrexone ^[1].
• Opioid medicines may not work. Opioid cough and cold products, opioid antidiarrheals and opioid pain relievers may not help while you take it ^[1].
• Liver. The label says to stop naltrexone if signs of acute hepatitis appear ^[1].
• Mood. The label says to watch for depression or suicidal thinking ^[1].
• Common side effects at 50 mg. Nausea (10%), headache (7%), dizziness, nervousness and fatigue (4% each), insomnia and vomiting (3% each) in the label's alcohol study ^[1].
• Pregnancy. The label says to use it in pregnancy only if the benefit justifies the risk ^[1].

What low dose naltrexone costs

Naltrexone and LDN cash prices, checked Oct 25 2026

Option	Price	What it is	Checked	Source
Compounded LDN, licensed pharmacies	$15 to $190	85 listed prices for 7 to 90 units; pharmacy names shown only after a quote request	Oct 25 2026 (data as of October 2026)	[5]
Compounded LDN, 30 units	$15 to $49.95 in the first 25 listings	Varies by strength, form and pharmacy	Oct 25 2026	[5]
Naltrexone, GoodRx coupon	As low as $33.30	Most common version on GoodRx; strength and quantity not stated	Oct 25 2026	[4]
Naltrexone, average retail	$70.19	Without a coupon, most common version	Oct 25 2026	[4]

Costs outside the bottle

• The prescriber visit. In-person or telehealth visit fees are separate from the pharmacy price.
• Shipping and refills. Compounded orders may add shipping, and short supplies of 7 or 21 units cost less per order but more per month ^[5].
• Labs. Ask whether your prescriber wants liver tests, since the label warns about hepatitis ^[1].
• Insurance. We could not confirm insurance coverage for compounded LDN. Ask your plan and the pharmacy before you fill it.

How people get LDN legally

1. A prescriber. LDN needs a prescription. A doctor or other licensed prescriber should review your opioid use, liver health and other medicines first, because those are the label's main warnings ^[1]. Start with your own doctor. If you pay cash, our guides to functional medicine and concierge medicine explain those practice models.
2. A licensed compounding pharmacy. The prescription goes to a state-licensed pharmacy that makes it for you. You can look up any pharmacy with your state board of pharmacy ^[10]. Our compounding pharmacy guide explains 503A and 503B pharmacies.
3. Not a research chemical. Skip any naltrexone sold without a prescription or labeled for research use only. No prescriber or licensed pharmacy stands behind it. Our page on research-use-only drugs explains why.

Naltrexone online

Telehealth prescribers can prescribe naltrexone and LDN where state law allows. We have reviewed two online LDN prescribers that post a price. AgelessRx lists compounded LDN capsules from $25 a month ^[12], and RTHM gives an example of about $104 per 90 days: a $49 assessment fee plus $55 paid to the pharmacy, before shipping and tax ^[13]. Superpower also prescribes LDN but did not post a price when we checked ^[17]. When you compare programs, ask who the prescriber is, which pharmacy fills the order, and whether the visit fee and medicine are priced separately. How we rate companies is on our editorial standards page, and every company we have checked is in our reviews.

We earn commissions from some partners, which can affect where they appear on this page. It never changes a verdict. How we make money

Online LDN prescribers we have reviewed (Clean)

1. AAgelessRx

   Clean

   Good fit for: low posted prices on LDN, rapamycin and metformin

   PriceFrom $25 a month (checked Oct 25 2026) ^[12]

   What you get

   Compounded LDN capsules; monthly, 3-month and 6-month plans ^[12]

   FDA record

   None found ^[15]

   BBB

   A+, not accredited ^[16]

   Note

   Pharmacy not named; serves every state, some treatments limited ^[18]

   Visit AgelessRxon the AgelessRx website

2. RRTHM

   Clean

   Good fit for: LDN for long COVID or ME/CFS with a posted per-request fee

   PriceAbout $104 per 90 days: $49 assessment plus $55 pharmacy, before shipping and tax (checked Oct 25 2026) ^[13]

   What you get

   Telehealth for long COVID, ME/CFS and related conditions ^[13]

   FDA record

   None found ^[15]

   BBB

   No BBB profile found

   Note

   14 states; names Infuserve America for compounded orders ^[14]

   Visit RTHMon the RTHM website

Questions to ask before you start

• Which trials support LDN for my condition, and how large were they?
• What other medicines am I taking that contain an opioid, including cough syrup or antidiarrheals ^[1]?
• Which pharmacy will make it, and is it state licensed ^[10]?
• What will I pay each month for the visit and the medicine together?

Naltrexone also appears on our PT-141 page, whose label says to avoid using it with oral naltrexone products taken for alcohol or opioid addiction, because it may sharply lower naltrexone levels ^[11].