top of page
Search

Optimizing Your Child's Health with LDN



Low-Dose Naltrexone (LDN) in Children: Dosing, Safety, and Clinical Use

Low-dose naltrexone (LDN) is not FDA-approved for pediatric use. However, it is increasingly prescribed off-label for children with conditions such as chronic pain, Crohn’s disease, and autism spectrum disorders. Because of limited large-scale pediatric trials and the complexity of child development, LDN therapy in children should be carefully managed by a pediatrician or a physician experienced in LDN.

Pediatric Dosing Guidelines for LDN

Pediatric LDN dosing is typically weight-based and titrated slowly to maximize benefits while minimizing side effects. Common strategies include:

1. Standard Pediatric Dosing

  • Range: 0.1–0.5 mg/kg/day, with a ceiling of 4.5 mg/day (the standard adult maximum).

  • Starting Dose: 0.5–1.5 mg/day, increasing by 0.5–1 mg weekly until the therapeutic dose is reached or side effects emerge.

  • Example: A 20-kg child might begin at 0.5 mg/day and titrate to 2–4.5 mg/day depending on tolerance and response.

2. Condition-Specific Dosing

Chronic Pain

  • Studies have used 0.1–4.5 mg/day.

  • Titration is based on symptom response.

  • Reported side effects include vivid dreams and fatigue, which are generally mild and self-limited.

Crohn’s Disease

  • A pilot study in children aged 6–17 used 0.1 mg/kg/day (up to 4.5 mg).

  • 67% of participants showed clinical improvement with good safety and tolerability.

Autism Spectrum Disorders

  • Doses ranged from 0.5–2.0 mg/kg/day in open-label trials.

  • Improvements noted in speech, focus, and behavior.

  • A U-shaped dose-response was observed; higher doses (>1.5 mg/kg/day) were sometimes less effective or caused sedation.

3. Titration and Administration

  • Approach: Start low and go slow—typically 0.5–1.5 mg/day, increasing weekly by 0.5–1 mg.

  • Formulations: Because LDN is not commercially produced in low doses, it must be compounded into capsules, flavored liquids, or troches for pediatric use.

Special Considerations

Safety and Side Effects

LDN is generally well-tolerated. Mild side effects occur in <8% of pediatric patients and may include:

  • Fatigue

  • Headaches

  • Vivid dreams

  • Gastrointestinal upsetNo serious adverse events (e.g., liver damage) were noted in short-term studies.

Developmental Concerns

The long-term effects of LDN on brain development and opioid receptor function remain unknown. Therefore, LDN should only be considered when benefits outweigh risks, especially in younger children.

Contraindications

  • Do not use LDN in children taking opioids; it may trigger withdrawal.

  • A 7–14-day opioid-free period is typically required before initiating LDN, often verified via a naloxone challenge or urine test.

Dosing Challenges in Obese or Undernourished Children

In children with atypical body composition, dosing by total body weight may be inaccurate. Some clinicians consider lean body mass, though evidence-based protocols are lacking.

Recommendations for Use

Physician Oversight

LDN should only be prescribed by a pediatrician or a specialist experienced with LDN. Monitoring should include:

  • Symptom tracking (e.g., Pediatric Crohn’s Disease Activity Index)

  • Laboratory tests if needed (e.g., liver enzymes)

Compounding Pharmacy

Because standard 50 mg naltrexone tablets are unsuitable for pediatric use, work with a trusted compounding pharmacy (e.g., VLS Pharmacy or ClearSpring Pharmacy) for accurate dosing and formulations.

Regular Monitoring

Ongoing follow-up ensures safety and optimal response. This may include:

  • Dosing adjustments

  • Symptom and side effect logs

  • Periodic lab testing

Caregiver Involvement

Parents and caregivers play a vital role in:

  • Tracking adherence

  • Monitoring symptom changes

  • Reporting any behavioral or physical side effects

Relevance to Cancer or Integrative Care

Although your inquiry may relate to stage 4 breast cancer, pediatric studies on LDN in oncology are limited. Preclinical data suggest that LDN may modulate immune responses via Toll-like receptor 4 (TLR4) antagonism, potentially complementing ketogenic metabolic therapy (KMT) or other integrative approaches. However, no pediatric-specific cancer data currently support its routine use in this setting. Consultation with a pediatric oncologist is essential when considering LDN in children undergoing cancer treatment.

Conclusion

LDN in children is an evolving area of off-label use. While promising for certain conditions like chronic pain, Crohn’s disease, and autism, its use requires careful physician oversight, individualized dosing, and access to reliable compounding. Long-term safety in pediatric populations remains uncertain, but short-term data suggest a favorable tolerability profile. If you are considering LDN for a child—or in the context of a broader integrative cancer plan—consult specialists familiar with both the condition and LDN therapy.

Further Reading & Sources:


Dr. Yoon Hang Kim MD practices virtual integrative & functional telemedicine serving areas near Quincy IL, Carthage IL, and Macomb IL and surrounding MO (Kahoka & Hannibal) and IA (Burlington, Fort Madison, and Keokuk)

 
 
 
bottom of page