LDN Compounding Pharmacies
Tips for Minimizing Cost
Low dose naltrexone (LDN) must be compounded by a specialty pharmacy as an immediate-release, short-acting formula. If you take LDN for your fibromyalgia at bedtime, it is out of your system by morning. But the cost of LDN varies depending upon the compounding pharmacy you use, so it’s important to know how to get the best price without compromising quality.
Whether you use a local compounding pharmacy or a mail-order company, make sure it is PCAB accredited. This means the pharmacy meets the Pharmacy Compounding Accreditation Board standards set forth in the United States. If you live outside the US, be sure your pharmacy meets the highest standards set forth by your country.
Naltrexone is cheap. The cost of LDN has to do with the labor involved in making the capsules or tablets. Typically, local compounding pharmacies only offer LDN in capsule form, while a few mail-order companies dispense scored tablets.
“The price range is substantial,” says Anne Marie McKenzie-Brown, M.D., a pain specialist at Emory University in Atlanta, GA. “When I found a pharmacy that compounded scored tablets, it substantially reduced cost.” She uses one-half tablets during the titration phase, then she switches patients to the more economical 90-day supply.
While going through a dosing up phase minimizes concerns about side effects, there are two disadvantages: increased cost and the inconvenience of requiring a second script for the target dose (usually 4.5 mg).
If you don’t want to hassle with mail-order pharmacies (or they are not available in your country), expect to pay about $1/capsule. Shop around though, because some places will charge you double.
Getting LDN for Fibro
How does your doctor write the scripts for dosing up and testing LDN? Whether you work with a local or a mail-order compounding pharmacy, the information you need to know is below.
Local Pharmacies
If your local compounding pharmacy dispenses LDN capsules at a reasonable price, use them for the first three months. You can switch to a mail-order pharmacy if LDN provides symptom relief.
If you want to dose up, rather than start out at 4.5 mg at bedtime, you need two scripts (get both from your doctor during the same visit). Assuming you start at 1.5 mg per day, your physician needs to write the following two scripts:
Script #1
1.5 mg capsules of immediate-release naltrexone – quantity 21
Instructions: take one capsule at bedtime for the first week, then take two capsules at bedtime for the second week.
Script #2
4.5 mg capsules of immediate-release naltrexone – quantity 90
Instructions: take one capsule at bedtime
NOTE: If you are drug-sensitive, ask your physician to change the dosing schedule for Script #1 to two weeks and increase the quantity to 42. Just keep in mind that Script #1 is an added expense to your LDN trial period.
If you want to just give 4.5 mg per day a try, you only need the second script above. However, you may ask your doctor to write Script #1, but don’t fill it unless you encounter side effects that can’t be managed.
Mail-Order Pharmacies
For Scored LDN Tablets
Care First Specialty Pharmacy in Mount Laurel, NJ provides scored LDN tablets in doses ranging from 0.5 mg to 6 mg. They are approved to ship to all 50 states plus the Virgin Islands, and the cost is $0.57/tablet. However, Avrio Pharmacy of Scottsdale, AZ offers a unique compounded product: double-scored LDN “Quad” tablets. So, you can dose up on 4.5 mg tablets and conveniently stay with the same script for the long run. Unfortunately, Avrio is not licensed to ship to 13 states.
Care First Specialty Pharmacy
www.cfspharmacy.pharmacy
TEL: (844) 822-7379
Standard Shipping: $3.95; Cost for 90 scored tablets:
Any strength 0.5 mg – 4.5 mg is $46.95
5 mg is $48.95
6 mg is $59.95
Anything above 6 mg must be made into capsules; expect to pay closer to $80.
Dosing up in 1.5 mg increments requires 3 mg tablets; 135 costs $67.50
If you are on an opioid, talk to your doctor about the 0.5 mg strength (half tablets are only 0.25 mg). Care First also makes available “ultra” low dose naltrexone in micro-milligrams (mcg). See website for patient and prescriber forms.
Avrio Pharmacy
avriorx.com
TEL: (480) 270-6700
Standard Shipping: $8; Cost for 90 Quad tablets:
4.5 mg (1.125 mg segments) is $60.00
2 mg (0.5 mg segments) is $60.00
6 mg (1.5 mg segments) is $75.00
If you want the safety net of dropping the dose for a few days without needing a second script, the 4.5 mg quad tablets are ideal. Just keep in mind that Avrio does not ship to the following states: AL, AR, IA, LA, MD, ME, MS, NJ, ND, OK, TN, VT, WV.
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LDN Compounding Pharmacy References
If your doctor is hesitant to prescribe LDN for your fibromyalgia, here’s a great article: Aitcheson N, et al. Aust J Gen Pract. 2023. Low-dose naltrexone in the treatment of fibromyalgia: A systematic review and narrative synthesis 52(4):189-195. Free Report
Learn what four treatment experts say about how to use low dose naltrexone (LDN) for fibromyalgia. See Giving LDN Your Best Shot.
Read about how the drug works for fibromyalgia and what makes LDN different from the other medications you are taking. See LDN for Treating Fibro.