Naltrexone LDN and Tramadol

Hello,

I have read several posts about people using LDN.

Currently I am taking 150-200 mg Tramadol throughout the night and it sort works, each dose for about 90 minutes of relief. I sleep usually 5 am to noon. Now I'm having greater issues. BTW, my flavor features arm involvement sometimes but not always.

I have been prescribed .5 mg naltrexone twice daily.

Any advice when to take the pills? The pharmacist suggested 6 pm and 6 am. However, I have read it should be taken at night after 10p, 2 hours after food. My neurologist said to continue the Tramadol, which I take usually at 10p, 12a, 2a, and sometimes 4a. I know this is counter-intuitive and so does she. The pharmacist said little is known if LDN impacts Tramadol totally or just somewhat.

Now I don't seem to be sleeping at all, maybe 3 hours late morning. This started before the LDN.

Anyone have thoughts on this from your own experience? I know advice cannot be given, however sharing your own experiences would be illustrative. I'm interested in when to take the LDN and how long it might take to show improvement.

Thanks much.

Sleepless in Florida.

[Joolsg]

Low Dose Naltrexone blocks opioids & is often used to get people off opioids so if you take it with tramadol, the tramadol will be less effective

Tramadol is the only opioid that causes an increase in severity of RLS & causes it to move to other body parts (Augmentation). Tramadol is worsening your RLS and is being blocked by the LDN.

LDN can be effective for RLS, so you could use it to help you off tramadol completely and see if it works alone for your RLS.

I know at least 2 members who switched to LDN alone after using it to get off Oxycontin

If LDN doesn't help the RLS once off tramadol, you could try Oxycontin, methadone or Buprenorphine but NOT while you're on LDN.

[CsiguZ in reply to Joolsg]

I’ve never heard before that tramadol can cause augmentation in case of RLS. Do you know any research on it?

[Hidden in reply to CsiguZ]

pubmed.ncbi.nlm.nih.gov/172...

[CsiguZ in reply to Hidden]

Correct me if I’m wrong (I’m not native English), but for me it seems this study from 2007 is about a single patitent, at least this sentence makes me think this: “We report clinical and polysomnographic accounts of a patient developing RLS augmentation after long-term treatment with tramadol”

[Joolsg in reply to CsiguZ]

mdedge.com/chestphysician/a...

There are lots of reports of tramadol causing augmentation. Dr. Buchfuhrer says it's 'rare' but anecdotally, from reading this forum for the last 6 years, it does happen quite a lot, particularly where the patient has previously been on a dopaminergic drug.

[Hidden in reply to CsiguZ]

Thank you for your scrutiny - good point!

[Hidden in reply to Joolsg]

Thank you much for your salient reply. I would prefer to be on methadone, but I cannot find any provider in Florida to treat me as an RLS patient. There are pain clinics and addiction treatment centers, but no doctor will take me for methadone treatment of RLS. So sad.

[Joolsg in reply to Hidden]

I know someone in Florida who is seeing a doctor within the next week who follows the Mayo algorithm and has confirmed they will treat with methadone or Buprenorphine if appropriate. I'll message her to ask for the name. Also, someone on the Melatonin post is seeing a doctor at the Mayo Clinic in Jacksonville, and hopefully they will follow the Mayo algorithm to treat RLS.

[Hidden in reply to Joolsg]

Please let me know - I will drive anywhere in Florida for methadone treatment!

[Joolsg in reply to Hidden]

flsleepspecialists.com/doct...

I added details but in case you didn't see.

[FLfish in reply to Hidden]

Please report back after you see this doc. I'm in Fort Myers and would drive to Sarasota (drove there for first COVID shot, ha ha). Best to you.

[Hidden in reply to FLfish]

I just emailed Dr. Agarwal in Sarasota. We will see! I'll keep you all posted.

[Joolsg in reply to Hidden]

flsleepspecialists.com/doct...

This is the sleep specialist in Florida who follows the Mayo algorithm and will prescribe Methadone for refractory RLS

[Hidden]

 As Jools says, LDN shouldn't be taken with Tramadol. I'm surprised your pharmacist/neurologist didn't raise this...

I know of some people on an LDN forum that seem to think if there's sufficient time between taking an opioid and naltrexone, then it's OK but from memory that was around 12 hours.

I have used LDN on and off for about 3 months. It helps considerably with daytime fatigue that i experience (most likely a result of the medication i take).

 I do need to take it first thing in the morning as any later and it causes me insomnia.

[Hidden]

This is why I like healthunlocked so much. You would think that the RLS Foundation Community Bulletin Board would be very active, but it's not. The participants here are wonderful and so knowledgeable. I am grateful for everyone's well-considered and prompt input. Lots of expertise here!

[Hidden]

Continuing conversation about Tramadol and LDN: I have an idea. I cannot cannot use LDN because then Tramadol is ineffective and the suffering is intense, even if I dose the LDN once daily 12 hours before Tramadol. I understand that once you have augmented on ropinerole, you can't go back because the D2 receptors will remember and you'll be right back in the same situation. However, from my last RLS webinar, ropinerole can be used sporadically, for example, if one is traveling via airplane it could be used for the trip to avert symptoms and it works for a few times. How about I go back to ropinerole and get some relief while amping up the LDN? Then I would have relief without the Tramadol. Thoughts?