What is the Appropriate Dose of Low Dose Naltrexone (LDN)?

Town & Country Compounding – Experts in the Compounding of LDN

Our accreditations place us in the top 1% of compounding pharmacies

Town & Country Compounding

Experts in proper LDN dosing titration.

LDN Dosing

For most patients, a starting titration Rx would be:

  • Rx: Naltrexone 1.5 mg #63 & Naltrexone 0.5 mg, quantity #42
  • SIG: Take 1 (1.5 mg capsule) orally daily prior to bedtime, increasing by 0.5 mgweekly (every 7 days) until a dose between 3 mg to 4.5 mg is achieved


Once dose of 3 mg – 4.5 mg/day is achieved, next Rx can be written as:

  • Rx: Naltrexone __mg capsules, quantity, typically choose #30__ #60__ or #90__ Other__
  • SIG: Take 1 capsule daily as maintenance therapy

If a lower starting dose is desired, the Rx can be written as:

  • Rx: Naltrexone 0.5 mg #___ (#100-300 is suggested)
  • SIG: Take 1 capsule (0.5 mg) daily prior to bedtime and increase each week by 1 capsule (0.5 mg) until an effective dose is reached. (Typically a dose between 3 mg to 4.5 mg)


Once dose of 3 mg – 4.5 mg/day is achieved, next Rx can be written as:

  • Rx: Naltrexone __mg capsules
  • SIG: Take one capsule daily as maintenance therapy. (#30, #60, or #90 is typical).

Patients with Hashimoto’s and Graves’ disease

Patients should be monitored for symptoms of fast pulse, palpitations, or sudden onset of insomnia. If any of these occur, thyroid adjustment may be needed.

How Town & Country Compounding Pharmacists Work with Physicians

Proper Titration

It really does take an experienced pharmacist and experienced physician working together to get to the sweet spot with dosing for the specific condition. It’s not as simple as starting a titration at 1.5mg and then going all the way to 4.5. We have seen situations where the patient gets full pain relief at 3mg and must stop, but if they keep going, they will lose the results.

This is the dosing that most physicians are aware of, however, over the past couple of years, the dosing has been greatly expanded. Many physicians are not aware that when we have patients on chronic opioid therapy we will sometimes start the dose as low as 0.001mg (1mcg) and have witnessed chronic pain patients receive relief on doses as low as 0.002mg (2mcg) daily.  

We have also seen where someone will titrate up too quickly for their body and miss the positive results.  Depending on the disease, we may want to start much lower.  And…when dealing with opioids, it is critical to work with a pharmacy such as Town & Country Compounding who has experience with titration protocols for both ultra-low dose naltrexone and very low dose naltrexone.  Town & Country Compounding works with some of the most experienced pain physicians out there and we are currently working on partnering with them for various clinical trials; this is very exciting.

Truly Customized for Individual Needs

We have worked with doctors to look at what the patient is on and we help slowly wean off the opioid while starting with either very low dose naltrexone or ultra-low dose naltrexone (microgram dosing). 

Then, we help slowly add-back LDN into a customized LDN titration and then offer suggestions to complement this therapy depending on the situation. 

Many practitioners are not aware of these new dosing protocols and Town & Country is able to educate them on these protocols and assist them with their patients.

Video: Learn more about Low Dose Naltrexone (LDN) titration kits from pharmacist John Herr, RPh.

Low Dose Naltrexone (LDN) FAQs

Frequently Asked Questions

It’s important to ask questions when researching medications, especially when it comes to pain relief. Many individuals looking for alternatives to addictive opioids have found Low Dose Naltrexone (LDN) can be the solution. Town & Country Compounding’s  John Herr, RPh., has become a national expert by studying and connecting with global experts in LDN, and has helped a vast amount of patients get through chronic pain. Contact Town & Country Compounding to get more info.

Town & Country Compounding works with the most prestigious providers. We work with you and health providers/specialists to formulate the most customized medication regimens to fit your specific needs.

Low Dose Naltrexone (LDN) Resources

Recommended by Low Dose Naltrexone Experts

Read Latest Articles on Low Dose Naltrexone

Call or Text: 201-447-2020