RTHM review: low dose naltrexone online, cost and record

What RTHM charges for LDN

RTHM's medication service charges per request. You pay a safety assessment fee only if a clinician approves your request, then pay the pharmacy for the medicine ^{[1] [2]}. Its LDN page gives this example ^[1]:

RTHM low dose naltrexone, 90-day example

Item	Price	What it covers	Checked	Source
Safety assessment	$49	Clinician review, charged only if approved; repeats every 90 days	Oct 25 2026	[1]
Pharmacy cost	$55	90-day supply, paid to the pharmacy, with RTHM's discount	Oct 25 2026	[1]
Estimated total	$104	Before shipping and tax	Oct 25 2026	[1]

Over a year, four 90-day cycles at that example price come to about $416 before shipping and tax ^[1]. For comparison, AgelessRx lists LDN from $25 a month ^[11], and licensed compounding pharmacies listed LDN from $15 for 30 tablets in October 2026, before any prescriber fee ^[10]. Our low dose naltrexone guide covers the evidence and the full price range.

Costs to check before you start

• Shipping and tax. Not included in the $104 example ^[1].
• Refunds. Once a request is submitted for review, RTHM does not refund the assessment fee; you are not charged if the request is declined ^[2].
• Insurance. RTHM Medications is cash-pay and does not accept insurance directly for assessments or compounded medications, and RTHM does not accept Medicare or Medicaid ^[2].
• Clinic care. RTHM Clinic is a separate service that is not in network with any health plan, and its membership price is not posted ^[2].

What RTHM prescribes

RTHM describes itself as care for people with long COVID, ME/CFS, MCAS, POTS, hEDS and related conditions ^[4]. Its medications page lists nine drugs: low dose naltrexone, metformin, oxaloacetate, ketotifen, pyridostigmine, propranolol, midodrine, ivabradine and guanfacine ^[3]. It does not sell peptides, GLP-1s or testosterone on that page ^[3].

Naltrexone itself is FDA approved as a 50 mg tablet for alcohol dependence and for blocking the effects of opioids ^[8]. Low dose use is off-label, and the low strengths usually come from a compounding pharmacy. Compounded drugs are not FDA-approved, and FDA does not check their safety, effectiveness or quality before they are sold ^[9]. RTHM's page says compounded orders ship from a mail-order compounding pharmacy ^[3].

Clinicians, pharmacy and states

• Clinicians. RTHM names Stuart Malcolm, MD, as medical director of RTHM Clinic, Jennifer Curtin, MD, as chief medical officer and cofounder, and Sarah Almilli, PharmD, as clinical pharmacist ^{[1] [4]}.
• Pharmacy. RTHM names Infuserve America as a preferred mail-order partner "for compounded needs" ^[2]. Other prescriptions can be picked up at a local pharmacy ^[3].
• States for medications. California, Colorado, Florida, Georgia, Illinois, Maryland, Massachusetts, New York, North Carolina, Ohio, Oregon, Texas, Virginia and Washington ^[2].
• States for RTHM Clinic. Arizona, California, Colorado, Florida, New York, North Carolina, Oregon, Tennessee, Texas, Virginia and Washington ^[2].
• Company. Rthm, Inc., 2261 Market Street #10535, San Francisco, CA ^[4].

FDA, BBB and complaint record

FDA. We found no warning letter to RTHM in an fda.gov search ^[5] or in a compilation of 163 telehealth and compounding letters through Sept 30 2026 ^[6]. It is not in our FDA warning letter tracker.

BBB. We found no BBB profile for RTHM or Rthm, Inc. on Oct 25 2026, so there is no letter grade, reason or complaint count to show ^[7]. Under our rating rules, a missing BBB profile does not set a verdict.

Regulators and LegitScript. We found no state board, regulator or court action against RTHM in searches on Oct 25 2026, and it does not sell peptides ^[3]. We could not read LegitScript's lookup for its website.

Who RTHM fits, and who should look elsewhere

• Fits you if you live in one of its 14 medication states and have long COVID, ME/CFS or a related condition ^{[2] [4]}.
• Fits you if you want a posted review fee and to see the pharmacy price up front ^[1].
• Look elsewhere if you live outside its states. AgelessRx says it serves every state, with some treatments limited by state ^[14].
• Look elsewhere if you need insurance billing ^[2].
• If you need lab work first, see our longevity blood test comparison.

Other online LDN prescribers

Online LDN prescribers (Clean)

1. AAgelessRx

   Clean

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

   PriceFrom $25 a month (checked Oct 25 2026) ^[11]

   What you get

   Compounded LDN capsules plus rapamycin, metformin, NAD+ and GLP-1s ^[11]

   FDA record

   None found ^{[5] [6]}

   BBB

   A+, not accredited ^[13]

   Note

   Pharmacy not named; serves every state, some treatments limited ^[14]

   Visit AgelessRxon the AgelessRx website

Superpower also prescribes LDN through its clinic but did not post an LDN price when we checked ^[12]. For other longevity care, start with our longevity guide.

See RTHM priceson the RTHM website