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Can Low Dose Naltrexone help POTS patients?

Introduction One of my specialist interests is in a condition called POTS . This is a condition that affects young patients who struggle with severe chronic fatigue, an inability to stand up for a prolonged period of time, heart palpitations, brain fog, lack of refreshing sleep, IBS-like gut issues, fibromyalgia and chronic pain. Despite self management, lifestyle changes, and medications, patients still continue to struggle. I am always therefore interested in knowing about other possibly even unconventional medicaments that may become available and serve to improve symptoms and quality of life in my POTS patients. Naltrexone is an opioid antagonist and it therefore used in acute and chronic states of abuse. It is classically given in doses of at least 50mg to be taken daily. Whereas some agents have a linear dose-effect curve, Naltrexone is interesting in that it has different pharmacodynamic effects at different doses. This is called the hormetic principle. Therefore different doses of Naltrexone may have different beneficial effects on the body. This is where the interest in lower doses of Naltrexone was generated. Naltrexone doses of 0.5-4.5mg daily are termed Low dose Doses of less than 1mcg/day have been termed ultra low dose Anything in between 1mcg/day to 0.5mcg/day are termed as Very low dose. In discrete low doses of 1-5mg/day Naltrexone acts as a glial modulator and in very simplistic terms reduces inflammation. Given these properties, there has been considerable interest in whether low dose Naltrexone may have beneficial effects in chronic inflammatory diseases such as Crohn’s disease, Fibromyalgia, Multiple sclerosis, cancer and even chronic pain states. I was interested in seeing if there is any evidence that LDN could help my POTS patients.