Low dose naltrexone (LDN) is compounded by breaking down standard 50 mg naltrexone tablets into precise doses between 0.1 mg and 4.5 mg, either as custom capsules prepared by a compounding pharmacy or as a liquid solution you can make at home with a prescription. Because no manufacturer sells naltrexone in these tiny doses, compounding is the only way to get LDN.
Why LDN Requires Compounding
Naltrexone is commercially available only as a 50 mg tablet (sold under the brand name Revia). That dose is designed to block opioid receptors fully and continuously for addiction treatment. LDN works on a completely different principle: a brief, temporary blockade of opioid receptors that causes your body to compensate by producing more of its own endorphins and natural pain-relieving compounds. It also appears to calm inflammation through a separate pathway involving immune cell receptors. These effects only happen at doses roughly 10 to 500 times smaller than the standard tablet.
The effective dose range runs from 0.1 mg to about 5 mg per day, with 4.5 mg long considered the default target. However, an observational study published in the Journal of Pain Research found that most patients who responded well settled on doses of 2 mg or less, suggesting that lower is often better and that the right dose varies considerably from person to person.
Compounding Pharmacy Capsules
The most common route is to get a prescription filled at a compounding pharmacy. The pharmacist starts with pure naltrexone hydrochloride powder (not crushed tablets) and measures out the exact milligram amount your prescriber orders. That tiny quantity of powder is then blended with a filler to create a capsule large enough to handle and swallow.
The filler matters more than you might expect. Commercial naltrexone tablets contain lactose, synthetic dyes, and several other inactive ingredients that some people react to. Compounding pharmacies can use hypoallergenic alternatives. The most commonly chosen fillers are microcrystalline cellulose and Avicel, both inert and well tolerated. If you have known sensitivities to gluten, dairy, or dyes, let your pharmacist know so they can select a filler accordingly.
Compounding pharmacies that follow USP General Chapter 795, the national standard for non-sterile compounding, are required to verify the potency and quality of every preparation. This matters because LDN doses are so small that even minor measurement errors can make a capsule significantly too strong or too weak. Ask your pharmacy whether they follow USP 795 guidelines and whether they do potency testing on finished capsules. Not all pharmacies are equal here, and accuracy at sub-milligram levels demands careful technique.
Making a Liquid Solution at Home
Some prescribers instruct patients to prepare their own liquid solution from commercial 50 mg tablets. This is called volumetric dilution, and it works because naltrexone hydrochloride dissolves readily in water (up to 100 mg per milliliter at room temperature).
The standard method: crush ten 50 mg tablets and dissolve the powder in enough distilled water to bring the total volume to 500 ml. This creates a solution with a concentration of 1 mg per milliliter. To get a 1.5 mg dose, you draw up 1.5 ml with an oral syringe. For 3 mg, draw up 3 ml. An oral syringe marked in 0.1 ml increments gives you the flexibility to adjust in 0.1 mg steps.
A few practical details make the difference between a reliable preparation and an inconsistent one:
- Shake thoroughly before every dose. The tablet binders and fillers won’t fully dissolve and will settle to the bottom. Without shaking, your early doses will be weaker and later doses stronger.
- Use distilled or purified water. Tap water introduces bacteria that shorten shelf life.
- Refrigerate the solution. Store it in an amber or opaque bottle in the refrigerator and discard it after 90 days.
- Measure with an oral syringe, not a kitchen spoon. A teaspoon is roughly 5 ml, but the actual volume varies enough to throw off your dose by 20% or more.
The liquid method is less precise than pharmacy capsules because commercial tablets contain binders, coatings, and dyes that don’t dissolve. Those undissolved particles mean each dose is an approximation. For most people this is fine, especially since the effective dose range is broad. But if you’re titrating in very small increments (0.1 mg steps), pharmacy-compounded capsules or a solution made from pure naltrexone powder will be more accurate.
Typical Titration Schedule
LDN is almost always started at a low dose and increased gradually. This reduces the most common side effects, which are vivid dreams, mild headaches, and temporary sleep disruption in the first week or two.
A conservative approach starts at 0.5 mg daily and increases by 0.5 mg every five days until reaching the target dose. Some clinicians use an even slower schedule, beginning at 0.1 mg and increasing by 0.1 mg every third day. The slower approach is more common for patients with high pain sensitivity or conditions like fibromyalgia where flare-ups during titration are a concern.
Most people take LDN at bedtime because the brief opioid receptor blockade peaks during sleep, which is when your body’s natural endorphin production ramps up. If vivid dreams become a problem, switching to a morning dose typically resolves it without reducing effectiveness.
Capsules vs. Liquid: Choosing a Method
Pharmacy capsules are more convenient (one capsule, no measuring, no refrigeration) and more precise, but they cost more. Depending on the pharmacy, a month’s supply runs between $30 and $60 without insurance, since most insurers don’t cover compounded LDN. Each time your dose changes during titration, you need a new set of capsules at the new strength.
The liquid method is cheaper and more flexible. You can adjust your dose in tiny increments without ordering new capsules, which is especially useful during the titration phase. The tradeoffs are the daily measuring step, the need for refrigeration, and slightly less precision per dose.
Some patients start with the liquid to find their optimal dose, then switch to capsules at that dose for long-term use. This combines the flexibility of liquid titration with the convenience of a fixed capsule.
Finding a Compounding Pharmacy
Not every pharmacy compounds LDN. You need one that does non-sterile compounding and ideally has experience with LDN specifically. Your prescriber may have a pharmacy they work with regularly. If not, the Professional Compounding Centers of America (PCCA) and the International Academy of Compounding Pharmacists both maintain directories of member pharmacies searchable by location. Many compounding pharmacies also ship nationwide, so you’re not limited to what’s available locally.
When choosing a pharmacy, ask whether they compound from pure naltrexone hydrochloride powder (preferred) or from crushed commercial tablets, what filler they use, and whether they perform potency verification on finished capsules. A pharmacy that can answer these questions confidently is one that compounds LDN routinely.