Dose Dilution and Adjusting
There are 3 major methods involved with dilution and it's important not to confuse them.
1. Starting with the 50mg pill and making LDN doses.
2. Starting with a compounded LDN dose and adjusting it up or down
3. Making a ULDN dose (Ultra LDN) typically starting at 0.001mg (1mcg). This can be made from a 50mg pill or a LDN dose. Generally used to assist in coming off opioids.
General comment on dilution for those starting out. I encourage new members to get a professionally compounded dose for at least the first 3 months. Then if you want to try the DIY version you will at least have some basis of comparison. As far as the images below be sure the one you are looking at applies to your particular method of choice. To cover a general concern about using dilutions for dosing. If you use the same amount of LDN and the same amount of distilled water you should at least have a consistently strong solution.
Maybe one makes their mix expecting that 1ml =1mg. But what if 1ml = 0.8mg or 1.2mg? Then you are getting consistently a little lower or higher dose than you expect. While that may not be ideal once one has studied LDN for a while we realize that dosing is largely derived from individual response rather than adhering to a particular number.
So IMO and based on the experience of many members the user will typically experiment and find their way to their "right dose" even with the dilution method. Regarding the question that comes up - "Does Distilled Water Go Bad?"... https://rockymountainwaterdistillers.com/pages/does-distilled-water-go-bad-how-long-does-distilled-water-last
Maybe we can push the 5 to 7 day life after opening and storing in the fridge a bit considering that we are only taking small amounts, but even with ideal conditions we should probably not use the water past our usual 14 to 30 days guidance that we follow for the diluted mixtures. So fresh bottle for each batch beyond that time sounds wise. Those having trouble finding distilled water may be able to get it through Amazon. You can also make it yourself as per
https://www.youtube.com/shorts/n6OdqCGGGGk
At the bottom of this document you will see a picture of a supported bowl that I use.
So first method 1:
Starting with the 50mg pill and making LDN doses. You can get the 50mg pill at a pharmacy via a prescription.
Example for those that are dissolving the 50mg pill –
Put it into 50ml of distilled water (or Reverse Osmosis water – these are to avoid unknown chemical reactions) and let it sit for maybe 20 minutes in a covered glass jar. [LDN Pharmacist Skip Lenz suggests using a clean taller and narrower jar like a capers jar.] Then shake it well and let it settle for about another hour. Then put it in the fridge. There is no need to shake it after that. The Naltrexone stays in solution. Anything that settles out is non-soluble filler which you can mostly avoid by drawing your dose off the top with an oral syringe (I get my 10ml one free at the CVS pharmacy counter). You will still be getting any soluble fillers/ingredients. Those that are very sensitive may instead need to use compounded capsules with a filler specified like sucrose or ginger. Once it has had the initial shaking and 24hr to dissolve it's OK to run the mix thru a coffee filter to get rid of most of the sediment. This image shows some pictures of the process with a 50mg pill and 50ml of water:
https://app.screencast.com/QuakzqpZ4M8H3
If you want to give the mix three or four days to settle more you could work with two batches. Just track the mix date so that you toss by the 14 to 30 day mark (life depends on your level of care).
BTW any ratio of dilution can be used as long as one keeps the math straight. Some may wish to pour the mix thru a coffee filter to trap some of the the filler. A chemist has assured me that the Naltrexone molecules are too small to be effected.
A calculator that may be useful: https://app.landroa.be/pgm/LDN-EN.html
Here is an accurate way to measure the 50ml of Reverse Osmosis water (distilled is the other option) -- 50ml cylinder…. https://www.amazon.com/s?k=50ml+Graduated+Cylinder%2C+Borosilicate+3.3+Glass%2C+Single+Metric+Scale%2C+Class+B%2C+Karter+Scientific&i=industrial&ref=nb_sb_noss
CVS will give you free 10ml oral syringes at the pharmacy counter. If you cover the numbers with a strip of magic tape they won’t wear off.
OK to add a single dose to juice just before taking if you want to improve the taste.
New members -- while many LDN users are happy diluting the 50mg pills no one should feel that they "ought" to be doing it that way. In the interest of transparency the LDN Research Trust and associated pharmacists recommend against both non-prescription Naltrexone and the dilution of doses. They claim that separating the Naltrexone from insoluble ingredients using distilled water is “scientifically impossible.’ It's up to you to do your own research if interested. IMO this is another reason to start with a professionally compounded dose.
There is some discussion of using half distilled water and half 80 proof vodka to extend the life. However there is no testing available so it would be an experiment at your own risk if you find that even with making up 25mg using a pill splitter you are wasting more than you are comfortable with given possible uncertainties with supply. I would still keep the mix in the fridge and discard after 30 days. Obviously this is not a good option for anyone with alcohol issues. Some *may* have problems because of possible alcohol/LDN interactions. It's early days for trying this. Let us know if you try it.
The "standard" method is to get a prescription from a doctor and have the LDN dose made up at a compounding pharmacy.
That said, we have not seen any reports of users noticing a difference in results from the compounded version vs. the "home brew," but this cannot be called a scientific conclusion.
Related links:
Mixtures Solutions, Suspensions, Colloids…. https://www.youtube.com/watch?v=zWwEx6DZu3c
Naltrexone Solubility….
Example of a study where dilution was used…
https://www.frontiersin.org/articles/10.3389/fpsyt.2021.593842/full
Life of Diluted Solution...
https://docs.google.com/document/d/1zYZz_Eox4Y6SxAmcZaTj363B1WJlM-XfumJaq99UkBw/edit?usp=sharing
The abstract of this article discusses compounding LDN with orange juice. The full article (no longer available for free) cautions that it is better to use distilled water for extended life. We suggest making fresh with water and keeping in the fridge no longer than 30 days after mixing. The single dose can be added to juice before taking for taste benefits:
Inexpensive compounding of low-dose naltrexone (LDN) with orange juice... https://www.jaad.org/article/S0190-9622(19)30511-0/abstract
Use of 50mg pill dissolved in distilled water in this article:
Low-dose naltrexone-induced remission in Hailey–Hailey disease maintained in remission with topical combination of ketamine and diphenhydramine…
“One 50 mg naltrexone tablet was dissolved in 50 mL of distilled water in an amber-colored plastic container and left over for 2 h. The insoluble excipients that gave a cloudy appearance were filtered off to obtain a clear, relatively excipient-free solution containing 1 mg/mL of naltrexone. Confirmation of the expected drug concentration done by testing 1 mL solution with high-performance liquid chromatography-electrochemical detection revealed 0.99 mg/mL (almost 1 mg/mL). About 5 mL of the clear solution was administered to the patient after mixing with fruit juice to mask the bitter taste. The filtered stock solution was given to the patient to store in refrigerator at 4°C; stability was maintained for 60 days in contrast to less than 30 days at 25°C.[6]”
https://journals.lww.com/idoj/fulltext/2019/10050/low_dose_naltrexone_induced_remission_in.11.aspx
For drop doses:
A standard dropper held vertically will dispense a metric drop which is 0.05ml. Test by measuring if 100 drops adds up to 5ml.
So doses in a drop can be calculated.
If 0.25mg per drop is the target then
that is 5mg per ml
50mg in 10ml
or
25mg in 5ml
if the tablet is scored. I would not try to do quarters.
Split pills without a pill cutter.... https://www.youtube.com/watch?v=ytkXGqhEM0Y
Next method 2:
Starting with a compounded LDN dose and adjusting it up or down For a few doses see this image https://photos.app.goo.gl/Q8FeVXADDmD7th8LA
Here is the link for a spreadsheet mentioned for making batches: How to change LDN dose using capsules or tablets https://docs.google.com/spreadsheets/d/1FS8VfZnxYcr1jbrdEREz3wboNlXpzBCM_NriTIYNb78/edit?usp=sharing
For those using a sublingual dose. If it is a liquid drop as made by Dickson's it will contain Naltrexone, distilled water and glycerol. It can be diluted treating the glycerol as if it was water. So for example if 1 drop = 0.5mg add 4ml of distilled water to 1ml of the sublingual drops and mix well. Then one drop will give a 0.1mg dose.
New members -- while many LDN users are happy diluting compounded LDN pills no one should feel that they "ought" to be doing it that way. In the interest of transparency the LDN Research Trust and associated pharmacists recommend against the dilution of doses. They claim that separating the Naltrexone and Avicel filler using distilled water is “scientifically impossible.’ It's up to you to do your own research if interested. IMO this is another reason to start with a professionally compounded dose.
OK to add a single dose to juice just before taking if you want to improve the taste.
The third method 3:
Making a ULDN dose (Ultra LDN) typically starting at 0.001mg (1mcg). This can be made from a 50mg pill or a LDN dose. Generally used to assist in coming off opioids. Best to go to this group to better understand working with ULDN.
NOPE Non-Opiate Pain-relief Experiences. ULDN / Naltrexone & other options.. .https://www.facebook.com/groups/1593950197487522/
But here is some info: Starting ULDN --
One of the problems with trying to do a guide for the ULDN dosing process is that dosing levels are so individual and vary. Some are going to be able to taper their opiate doses more quickly, but some will have to take more time. Some will be able to start at a higher ULDN dose and move up towards LDN levels, but some will have to take it more slowly. Different opiates will clear at different speeds and of course the opiate history and dosages are a factor.
The general idea is: Start ULDN dosing low between 1 and 10mcg ( = 0.001 to 0.01mg)
Find the dose of LDN you have in the chart https://app.screencast.com/759FoTmpan9up
Empty the capsule or put the pill into the amount of distilled water shown. If using the 50mg pill split it in half. If it’s a pill give it a few minutes to start to crumble then shake and mix well and allow to settle for an hour before storing in a covered glass jar in the fridge and discard after 14 to 30 days depending on your level of care. Depending on your filler there may or may not be sediment on the bottom. Don't shake/mix again. Draw your dose off the top with an oral syringe.
Starting dose 0.001 will be 0.1ml (use a 1ml syringe).
Re: the 50mg pill if we didn't use as much water it would be too hard to measure an accurate dose. Once you work your way up to a 0.01mg ULDN dose you can use 500ml of water and 0.1ml will give you 0.01mg.
IMO combine with one opiate dose the first day and see what you notice
Dosing is individual. This low dose is a safe place to start for most. You may not notice any effects. The goal will be to use ULDN to make the opiates more effective which will reduce tolerance and make tapering easier.
Keep a journal noting your experience and what you notice as you add ULDN to your existing schedule.
Determine a tapering schedule for your opiate based on your own research and talking with your doctor.
If no issues combine with each opiate dose. Take a minimum of two ULDN doses a day (after the first day). ULDN should make the process easier not harder.
Gradually as able increase the ULDN dose and taper the opiate. Ultimately you want to get to a LDN dose like 0.5mg and be off of the opiates or at most once a day 12hr from the LDN dose. When you get above the 0.1mg area one option would be to try to work towards one opiate dose with a ULDN dose and then start to build a LDN level dose 12 hr later without an opiate dose.
If you have withdrawal issues or pain increases then you are going too quickly and should pull back. This is based on patient experience here and the articles we have posted. I am not a doctor. This chart with a bell curve may be useful in thinking about the general concept:
https://app.screencast.com/yAtSzDicXIjwW
I like this for measuring 50 to 100ml. 1Ml and 10ml oral syringes are useful also.
100ml cylinder…. https://www.amazon.com/dp/B006UKIASI/ref=biss_dp_t_buying_options
Other supplies you may need:
To hold 2500ml of distilled water for initial mix using half of a 50mg pill (smaller is OK if less water is used per chart):
https://www.amazon.com/Anchor-Hocking-3-Quart-Heritage-Glass/dp/B000M9NMEU
Since the mix is only good for 14 days most of it can be tossed after it is well mixed. Any 16oz covered glass jar will be OK to save what you need. Similar to:
For initial measuring (or smaller if appropriate):
For dosing:
https://www.amazon.com/ExactaMed-Medication-Medicine-Dispenser-Exacta-Med/dp/B01628CDEE/ref=sr_1_3_s_it?s=hpc&ie=UTF8&qid=1506361369&sr=1-3&keywords=oral%20syringe%201ml
In this study a 1mg dose of LDN was diluted to make ULDN doses:
“He was offered a trial of “ultra-low” dose naltrexone in an effort to identify an adjuvant analgesic that could be tolerated. A compounding pharmacy prepared a solution of 1 mg of naltrexone (from powder) in 1 liter of sterile water. A total of 100 cc of the solution was stored in a caramel container, delivered to the patient, and kept out of the light in the refrigerator. We instructed the patient to take 1 cc twice daily (Arbuck et al., unpublished observations). We performed daily assessment of potential symptoms of withdrawal as well as of his pain status.
Less than 24 hours after the initiation of oral naltrexone, the patient reported improvement. He had no symptoms of withdrawal and his pain decreased from a score of 9/10 the night prior to the initiation of the naltrexone to a 3/10 the morning after. In addition, his chronic nausea resolved. The methadone dose was decreased to 50 mg four times daily and the methylphenidate dose was kept unchanged. His fatigue improved and the pain remained at the same level. One month later the patient remained with the same degree of pain relief, the same dose of methadone after the dose reduction and utilizing 50% of the short-acting opioid for rescues.”
Ultra-Low Dose Oral Naltrexone Decreases Side Effects and Potentiates the Effect of Methadone… https://www.jpsmjournal.com/article/S0885-3924%2803%2900139-8/fulltext
Let us know how you are doing.
Regarding the life of a home dilution
You can see the 14 day life as a standard concept mentioned here:
"NONSTERILE COMPOUNDING: BEYOND USE DATES and LABELING BEYOND USE DATES: USP Chapter 795 defines Beyond Use Date (BUD) as the date after which a compounded nonsterile preparation (CNSP) should not be used. The BUD is determined from the date the CNSP is compounded. When determining BUD, the pharmacist must take into account stability information regarding the specific drug(s) and specific CNSP. Stability information may come from documentation, literature or stability tests. In the absence of stability information, the maximum BUDs for CNSP packaged in tight, light resistant containers are:
....Water Containing Oral Formulations: no longer than 14 days or the earliest expiration date of any ingredient used, whichever is shorter, and stored at controlled cold temperatures. This includes water being added as an ingredient or water is a component of any ingredient used. For example, diphenhydramine syrup has water as a component."
https://pharmacy.ky.gov/Documents/NONSTERILE%20COMPOUNDING%20BUD%20LABELING.pdf
Storage life test:
Formulation and stability of naltrexone oral liquid for rapid withdrawal from methadone….. https://www.ncbi.nlm.nih.gov/pubmed/9391680
But the more detailed version of this document I saw at some point shows they added preservatives!
“"Formulations of naltrexone oral liquid (I and 5 mg/mL) were prepared from tablets" and powder" and contained ascorbic acid' (0.5%), sodium benzoate" (0.1%), glycerol' (20%), and distilled, deionized water"
https://drive.google.com/file/d/1bXkqB0Yw_rv2wXb6gFn1952hIsbrbyOU/view
A standard liquid formula *with preservatives* specifies a 30 day life
http://www.fshealth.gov.za/subsites/DWoods/Mixtures/naltrexone.html
Anette Møberg is a member of the Chronic group and also works with the Danish group. She wrote:
"About 5 years ago, the LDN Association had a solution analyzed daily for 63 days at a laboratory at Novo Nordisk (a large pharmaceutical company).
The solution was made from 1 pc 50 mg Naltrexone and 50 ml boiled cooled tap water. It was mixed in a scalded glass with a lid, and the syringe used daily just sat on top of the glass from day to day.
The solution was stored in the staff's fridge together with packed lunches etc to mimic how we each do at home.
A sample was taken daily to analyze for bacterial growth and strength. After 63 days the solution had been used up, there had been no significant bacterial growth and the potency had only decreased by 0.2%.
It is obviously not an approved study, but I have full confidence in the laboratory technician who performed the study."
So our guidance which is somewhat of a compromise is that the life in the fridge is 14 to 30 days depending on your care and conditions. After that a fresh batch should be made.
New members -- while many LDN users are happy diluting the 50mg pills no one should feel that they "ought" to be doing it that way. In the interest of transparency the LDN Research Trust and associated pharmacists recommend against both non-prescription Naltrexone and the dilution of doses. It's up to you to do your own research if interested.
The "standard" method is to get a prescription from a doctor and have the LDN dose made up at a compounding pharmacy.
That said we have not seen any reports of users noticing a difference in results from the compounded version vs. the "home brew," but this cannot be called a scientific conclusion
Three links:
Mixtures Solutions, Suspensions, Colloids…. https://www.youtube.com/watch?v=zWwEx6DZu3c
Naltrexone Solubility…. https://pubchem.ncbi.nlm.nih.gov/compound/naltrexone#section=Experimental-Properties&fullscreen=true
Example of a study where dilution was used: The Effects of Low Dose Naltrexone on Opioid Induced Hyperalgesia and Fibromyalgia...
https://www.frontiersin.org/articles/10.3389/fpsyt.2021.593842/full
Interesting that after many years of bad mouthing home dilution LDNRT posted this. (Not that I think it's a good idea to encourage suspensions or preservatives or questionable "flavors.")
What Can Be added to Water to Make Low Dose Naltrexone (LDN) Last Longer and Taste Better?…
You may know that Facebook has deleted the LDN group (Low Dose Naltrexone (LDN) for Chronic Illness & Infections), and the backup group. We think that with the main group some bot decided Naltrexone was an opioid. With the backup group they did not understand that Ageless has legit doctors and prescriptions.
Please join the new groups we are building. Much of our information and support will be available there.
Brian Haviland - LDN International
On Reddit:
https://www.reddit.com/r/LowDoseNaltrexone/
On MeWe:
https://mewe.com/group/68184bdfb6f32649cc96d0f6
Please pass this information on to anyone you know that may be interested.
This is the supported bowl I use for making distilled water as per the earlier post. This keeps the bowl from moving around and creating splashes which might get tap water into the bowl.
