After we published our post on Degenerative Myelopathy (DM) in dogs, a colleague of ours, Dr. Nancy Barin, reached out and mentioned that she will prescribe low-dose naltrexone for DM.
She has noticed that off-label, low-dose naltrexone slows the progression of the disease in some cases and can improve the quality of life. She and her colleague, Dr. Rosemary Newton, have 20 years of, “anecdotal evidence and dozens of case histories where the medication has helped for a period of time.” They give no guarantees, but say it is worth a try.
We appreciate honesty. Companion dog parents are told that so far, no scientific studies have been completed with naltrexone in dogs diagnosed with DM, and the Food and Drug Administration (FDA) does not indicate it as a medication for DM. Further, Plumb’s Veterinary Drug Handbook does not list naltrexone for DM.
What is Degenerative Myelopathy?
Degenerative Myelopathy (DM) is a degenerative disease of the white matter of the spinal cord in dogs, and was first described in 1973. DM is equivalent to some forms of Lou Gehrig’s disease (human amyotrophic lateral sclerosis [ALS]).
ALS is considered a neurodegenerative disorder. The possible main risk factors for humans are environmental, older age, male, and a family history of ALS. However, while researchers say the evidence is pointing to possible autoimmune components that may contribute to the disease, ALS cannot unequivocally be called a full-blown autoimmune disease.
Indeed, some evidence suggests a possible autoimmune component regarding DM.
What is Naltrexone?
The FDA has indicated use of naltrexone for alcohol abuse disorder and opioid addiction in humans. Off-label human prescriptions have been given for neurodegenerative disorders like Parkinson’s and autoimmune disorders like multiple sclerosis. For dogs, low-dose Naltrexone (LDN) has been given to dogs that have certain behavioral disorders such as tail chasing and acral lick dermatitis.
As of 2021, the ALSUntangled website does not approve naltrexone for treatment of ALS in humans because they want more evidence on the medication’s Mechanisms of Action (MOA).
The LDNScience website states, “FDA-approved naltrexone, in a low dose, can normalize the immune system — helping those with autoimmune diseases, cancer, central nervous system disorders, and HIV/AIDS.”
A relatively small Norwegian study published in 2022 stated that, “Positive correlations between physical quality of life and use of low-dose naltrexone or vitamin B were demonstrated,” in humans diagnosed with ALS.
The Michael J. Fox Foundation funded a blinded study of naltrexone for impulse control disorders (gambling, hypersexuality, binge eating) in Parkinson’s Disease. Basically, people with Parkinson’s are believed to be engaging in these behaviors to achieve a dopamine effect. They found, “The results of this study were negative for the efficacy of naltrexone for the treatment of impulse controls disorders (such as compulsive gambling, buying, sexual behavior and eating) in Parkinson’s disease (PD) using a clinician rating of general improvement, which was the primary outcome measure for the study. However, using a patient-completed, PD-specific assessment of impulse control disorder symptom severity, naltrexone treatment was associated with a significant decrease in symptoms compared with placebo treatment.”
Regarding dogs, the LDNScience website states, “It is currently being used in animals to help lessen the pain of chronic arthritis, to treat some autoimmune disorders and to help slow the growth of some tumors. Good results have been reported in treating lymphoma, adenomas, nasal/sinus cancer, inflammatory bowel disease, degenerative myelopathy and others.”
How does Dr. Barin prescribe Naltrexone for DM?
She starts the companion dogs at a lower dose of naltrexone than recommended by Plumb for behavioral issues, and recognizes it can be increased if need be. She also says to give it at night.
If you are a veterinarian and are interested in trying LDN for your patients with DM, please contact us and we will put you in contact with Dr. Barin who can also help out with explaining the pharmacology of naltrexone and other medications. If you are a companion pet parent, please have your veterinarian contact us.
What do we think?
Research takes a long time and disease progression does not wait for the research. Additionally, since one of our colleagues has stepped up by providing forthright positive experiences over 20 years from her patients with DM this needed to be discussed openly. As Dr. Barin sincerely wrote, “We hope that in some small way it can help improve the lives of the pets and their people that are struggling with this disease.”
Remember, naltrexone does not stop the DM, but may slow its progression and provide a better quality of life.
ALSUntangled Group. “ALSUntangled No. 8: Low dose naltrexone for ALS.” Amyotrophic Lateral Sclerosis: Official Publication of the World Federation of Neurology Research Group on Motor Neuron Diseases vol. 12,1 (2011): 76-8, doi:10.3109/17482968.2010.544386, https://www.tandfonline.com/doi/full/10.3109/17482968.2010.544386.
Ovchinnikova, Leyla A et al. “Extracellular Vesicles in Chronic Demyelinating Diseases: Prospects in Treatment and Diagnosis of Autoimmune Neurological Disorders.” Life (Basel, Switzerland) vol. 12,11 1943. 21 Nov. 2022, doi:10.3390/life12111943, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693249/.
Ralli, Massimo et al. “Amyotrophic Lateral Sclerosis: Autoimmune Pathogenic Mechanisms, Clinical Features, and Therapeutic Perspectives.” The Israel Medical Association Journal vol. 21,7 (2019): 438-443, https://pubmed.ncbi.nlm.nih.gov/31507117/.