Transcript Low Dose Naltrexone in the Treatment of Autism Spectrum

Low Dose Naltrexone in the
Treatment of
Autism Spectrum Disorders
Phillip C. DeMio, MD
320 Orchardview Ave.
Suite 2
Seven Hills, OH 44131
216-901-0441
www.drdemio.com
© Phillip C. DeMio, MD 2005
Low Dose Naltrexone (LDN)
• Orginally for heroin addiction/opiate
addiction. (Depade®, formerly Trexan®,
ReVia®
• Concept behind such treatment
– Opiate receptors
– Drugs
– Endorphins/opiate peptides
© Phillip C. DeMio, MD 2005
Low Dose Naltrexone (LDN) cont.
• “side” effects of such treatment
– Depressed mood
– Respiratory symptoms
• “hidden” immune toxicity
• Other abnormal immune symptoms: brain; others
• “sub clinical” rise in endorphins
– …but fully blocked by the high dose of Naltrexone
» This led to the syndrome of opiate/endorphin
withdrawal
-agitation
-respiratory (SOB, huffing, stuffy, cough)
-diarrhea/cramps
-“crawling skin”/gooseflesh
© Phillip C. DeMio, MD 2005
Opiate Peptides, Naltrexone, and
the Immune Connection
• T-Lymphocytes
– Are white blood cells (WBC’s)
– Eg. Th-1 and Th-2
• Excess Th-2 activity means autoimmunity, allergy,
and lowered healthy immunity
• Peptides
– Those from gluten, casein, and others
(“exorphins”) cause peptide-specific Th-2
stimulation (increased activity)
– That makes people sick! (symptoms in: ASD,
MS, ALS, IBD, HIV, RA, SLE, asthma, allergy,
and cancer to name a few)
© Phillip C. DeMio, MD 2005
Immune Connection cont.
• Endorphins
– Compete with exorphins
– So endorphins redirect Th-2 WBC’s away
from allergy/autoimmunity
– Endorphins also stimulate healthy immunity
(by heightening Th-1 activity)
• Endorphins are abnormally and strikingly
low in children and adults who have ASD
(and MS, ALS, IBD, HIV, RA, SLE,
asthma, allergy, and cancer)
(c) Phillip C. DeMio, MD 2005
Low-Dose Connection
• Recall the rise in endorphins with full dose
Naltrexone
– “side effects can be good” (a clue, a foot in
the door)
• But full dose Naltrexone blocks the
endorphins
© Phillip C. DeMio, MD 2005
Low-Dose Connection, cont.
• Why the low dose?
– Naltrexone at low dose retains it abliity to
cause an endorphin rise
– If the dose is low enough, the endorphinblocking effect of Naltrexone is gone in as
little as two hours
• So most of the day yields higher endorphins
• They are not blocked
• They are free to “do good” (immune; other)
© Phillip C. DeMio, MD 2005
Low-Dose Connection, cont.
• Great benefit for ASD (and MS, ALS, IBD,
HIV, RA, SLE, asthma, allergy, and
cancer)
• The dose:
– Less than one tenth the orginal dose used for
addiction.
– Currently the target doses are:
• 3mg/24 hours if less than 45kg
• 4.5mg/24 hours if over 45kg
• We will revisit “the”dose
© Phillip C. DeMio, MD 2005
LDN in Clinical use for ASD
• Immune dysfunction, autoimmunity and, allergy
in ASD affects:
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Brain/nerves
Gi tract/dysbiosis
Lungs/respiratory/sinus systems
Thyroid (and other hormonal organs)
Frequent severe infections/fever
Other/adult immune problems as mentioned
Allergy (skin, respiratory, food)
© Phillip C. DeMio, MD 2005
Clinical use, cont.
• This connects to variants of ASD:
– OCD
– Tics/Tourette Syndrome
– Immunity/autoimmunity/allergy (asthma)
– Clinical and laboratory abnormalities
– Parents, siblings, and other relatives of
persons with ASD (“later onset”)
© Phillip C. DeMio, MD 2005
Clinical Use, cont.
• Preparations
– Topical or oral
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Currently, same dose for each
Swallowing, taste, and timing issues
11pm dose
Maybe oral is better if:
– Constipated
– Crampy
• Diarrhea: start with topical
• What about gluten and casein?
– Make exorphins
– LDN may cause withdrawal if not gf/cf
• But may actually cause improvement
– We will revisit the dose
© Phillip C. DeMio, MD 2005
Clinical Use, cont.
• Sources
– Coastal Compounding Pharmacy (topical)
– Lee-Silsby Compounding Pharmacy (topical
or oral)
– Others (experience/communication)
• Dr. McCandless after Dr. Bihari: Many
responders
• More science and numbers than Dr.
Kanner!
© Phillip C. DeMio, MD
What to Expect in Clinical Use
• “Effects”
– Bowels and brain
– Immune system
– They overlap!
• “Side” effects
– Bowels and brain
– Immune system
– Stimulation
• “good”: endorphins/transient
• “not good”
– Die-off
– Excess blockade of endorphins
– Constipation/agitation/sensory issues
© Phillip C. DeMio, MD 2005
Other Clinical Issues
• Itching and rash
• Unique situations
– Opiate drugs
• Pain
• Anesthesia
– Clonidine/guanabenz
– Enzymes
• Long term
– Will effects sustain?
– Experience outside of ASD
© Phillip C. DeMio, MD 2005
Revisiting the Dose
• Kids/adults can get the “not good”
responses
• Some patients may not sustain
• Revisiting the dose
– Unsustained group
• Raise the dose (chasing your tail?)
• Pulse dose
– Kids on gf/cf diet
• Ultra-low-dose Naltrexone
– Start low and slow
© Phillip C. DeMio, MD 2005
LDN Conclusion
• Ultimately, as with other treatments
– Naltrexone helps many persons
– May help a little or a lot
– “effects” vs “side” effects
• Q and A
© Phillip C. DeMio, MD 2005