1. Low Dose Naltrexone in the Treatment of Autism Spectrum Disorders
Phillip C. DeMio, MD
320 Orchardview Ave.
Suite 2
Seven Hills, OH
© Phillip C. DeMio, MD 2005

2. 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 R E N

3. 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

4. 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

5. 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

6. 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

7. 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 endorphin-blocking 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

8. 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

9. LDN in Clinical use for ASD
Immune dysfunction, autoimmunity and, allergy in ASD affects:
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

10. 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

11. Clinical Use, cont. Preparations What about gluten and casein?
Topical or oral
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

12. 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

13. What to Expect in Clinical Use
“Effects”
Bowels and brain
Immune system
They overlap!
“Side” effects
Stimulation
“good”: endorphins/transient
“not good”
Die-off
Excess blockade of endorphins
Constipation/agitation/sensory issues
© Phillip C. DeMio, MD 2005

14. Other Clinical Issues Itching and rash Unique situations Long term
Opiate drugs
Pain
Anesthesia
Clonidine/guanabenz
Enzymes
Long term
Will effects sustain?
Experience outside of ASD
© Phillip C. DeMio, MD 2005

15. 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

16. LDN Conclusion Ultimately, as with other treatments Q and A
Naltrexone helps many persons
May help a little or a lot
“effects” vs “side” effects
Q and A
© Phillip C. DeMio, MD 2005