Comparison
Low-Dose Naltrexone vs Nicotinamide Riboside
Side-by-side of Low-Dose Naltrexone and Nicotinamide Riboside. Every row below is pulled from the compound schema and will update as our data grows. For deeper reads, follow through to each compound page.
Low-Dose Naltrexone
Low dose naltrexone at 1.5 to 4.5 mg, one-tenth the 50 mg addiction dose. Compounded Rx. Small trials in fibromyalgia, Crohn's, Hashimoto's.
Nicotinamide Riboside
Nicotinamide riboside (NR) is the most-studied NAD+ precursor in humans. Sold as Niagen by Chromadex; raises plasma NAD+ 30-60% at 250-1,000 mg/day.
Effects at a glance
Low-Dose Naltrexone
- •Off-label use at 1.5 to 4.5 mg, roughly one-tenth the FDA-approved 50 mg addiction-treatment dose
- •Proposed mechanisms include brief opioid receptor blockade triggering rebound endogenous opioid release, plus TLR4 antagonism
- •Compounded prescription only; insurance rarely covers; cash prices 20 to 80 USD per month
- •Younger 2013 reported ~30% pain reduction in fibromyalgia at 4.5 mg in a small crossover trial
- •Smith 2011 reported endoscopic improvement in active Crohn's disease (n=40 placebo-controlled)
- •Vivid dreams affect 20 to 40% in first 2 weeks; manageable by switching to morning dosing
Nicotinamide Riboside
- •Most-studied NAD+ precursor in human trials; the original Niagen formulation by Chromadex
- •Plasma NAD+ rises 30-60% at 250-1,000 mg/day across multiple human PK trials
- •Martens 2018 reported reduced BP and arterial stiffness at 500 mg/day for 6 weeks
- •Dollerup 2018 found no insulin sensitivity change despite plasma NAD+ rise
- •Tissue NAD+ rise inconsistent; hard clinical endpoints not yet measured
- •Larger human safety database than NMN; comparable mechanistic effects
Side-by-side
| Attribute | Low-Dose Naltrexone | Nicotinamide Riboside |
|---|---|---|
| Category | pharmaceutical | supplement |
| Also known as | LDN, naltrexone (low dose) | NR, Niagen, nicotinamide riboside chloride |
| Half-life (hr) ↗ | 4 | 8 |
| Typical dose (mg) ↗ | 4.5 | 500 |
| Dosing frequency | once daily, typically at bedtime | daily, typically morning |
| Routes | oral | oral |
| Onset (hr) | 1 | 1 |
| Peak (hr) | 1.5 | 4 |
| Molecular weight | 341.4 | 255.25 |
| Molecular formula | C20H23NO4 | C11H15N2O5 |
| Mechanism | Brief mu-opioid receptor antagonism proposed to trigger compensatory upregulation of endogenous opioids; secondary TLR4 antagonism on microglia and immune cells contributes to anti-inflammatory effect. | NAD+ precursor via salvage pathway. Phosphorylated to NMN by nicotinamide riboside kinase (NRK), then converted to NAD+. Substrate for sirtuins, PARPs, and CD38. |
| Legal status | Off-label compounded prescription (naltrexone is FDA approved for opioid and alcohol use disorder at 50 mg) | OTC dietary supplement |
| WADA status | allowed | allowed |
| DEA / Rx | Rx only (not a controlled substance) | OTC supplement |
| Pregnancy | Insufficient data; not routinely recommended | Insufficient data at supplement doses |
| CAS | 16590-41-3 | 1341-23-7 |
| PubChem CID | 5360515 | 439924 |
| Wikidata | Q426444 | Q3343054 |
Safety profile
Low-Dose Naltrexone
Common side effects
- vivid dreams
- sleep disruption
- headache
- mild GI upset
- fatigue (early)
Contraindications
- concurrent opioid use
- acute hepatitis or liver failure
- opioid dependence
- pregnancy (insufficient data)
Interactions
- opioid analgesics (oxycodone, morphine, codeine): blocks analgesic effect; precipitates withdrawal in dependent users(major)
- tramadol: blocks opioid component of analgesia(major)
- thyroid hormone replacement: may alter dose requirements after immune modulation; monitor TSH(minor)
Nicotinamide Riboside
Common side effects
- mild GI upset (rare)
- headache (rare)
Contraindications
- pregnancy / lactation (insufficient data)
- active cancer (theoretical, no contraindicating data)
Interactions
- pterostilbene: complementary sirtuin pathway (Basis combination)(minor)
- TMG (trimethylglycine): methylation support during high NAD+ precursor dosing(minor)
Which Should You Take?
Nicotinamide Riboside comes out ahead for most readers on the criteria we weight: 3 catalogued goals, OTC dietary supplement, oral dosing, with a Tier-A outcome catalogued. Low-Dose Naltrexone is the right call when one of the conditionals below applies.
- → If your priority is immune support, pick Low-Dose Naltrexone.
- → If your priority is pain modulation, pick Low-Dose Naltrexone.
- → If your priority is healthspan extension, pick Nicotinamide Riboside.
- → If your priority is energy and stamina, pick Nicotinamide Riboside.
Edge case: If you want to avoid prescription-only, Nicotinamide Riboside is the more accessible choice.
Default choice: Nicotinamide Riboside. Lower friction to source, a Tier-A evidence outcome catalogued, and broader goal coverage. Reach for Low-Dose Naltrexone only if your priority sits squarely in the goals it owns above.
This verdict is generated from each compound's schema (goals, legal status, evidence outcomes, dosing route). It updates automatically as our compound data evolves; the deeper read sits on each individual compound page.
Common questions
What is the difference between Low-Dose Naltrexone and Nicotinamide Riboside?
Low-Dose Naltrexone and Nicotinamide Riboside differ in category (pharmaceutical vs supplement), mechanism, and typical dosing. See the side-by-side table for full details.
Which has a longer half-life, Low-Dose Naltrexone or Nicotinamide Riboside?
Low-Dose Naltrexone half-life is 4 hours; Nicotinamide Riboside half-life is 8 hours.
Can you stack Low-Dose Naltrexone with Nicotinamide Riboside?
Stack compatibility depends on mechanism overlap, legal status, and individual response. Check each compound page for specific interactions and contraindications before combining.
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