Pediatric and Geriatric Dosing for LDN

1. Pediatric and Geriatric Dosing for LDN Deanna Windham, D.O.

2. Chronic Caregiver Status • Millions of people and families impacted nationwide • Increased rates of illness and job challenges for caregivers • Social impact • kids develop less social skills • adults withdraw from social interactions

3. All Chronic Disease Sufferers Deserve a Primary Care Advocate • Information intensive and Information dependent, but worth the effort • Stigma of growing up with and isolation associated with chronic illness • Simple approaches often ignored • Contributing factors usually not addressed • Medication risks on growth & development or aging process unknown • Drug-induced nutrient deficiencies lead to increased side effects • Patients on more than 3 medications highly likely to be experiencing some form of interaction reaction • Many medications subverting treatment of other problems

4. LDN Helps in Many Chronic Diseases • Only medication contraindication is chronic high dose opioids or opioid pain patch • Has virtually no potential for causing harm • Stabilizes inflammation, which is part of every chronic disease • Improves sleep, which improves ability to heal, repair and regenerate • Improves moods which has a global positive impact • Decreases methylation damage to DNA, which is the key to epigenetic disease processes

5. LDN as First Approach • May be able to prevent use of more dangerous meds • Capable of actually treating some of the root causes of disease as opposed to symptom treatment only • Good compliance due to lack of side effects • Can be used long term with no risk of side effects or nutrient depletion (due to low dose) • Not usually considered by specialists, but changing • Easy to defend to colleagues and specialists due to large amount of research

6. Special Considerations in Dosing • Body weight may not be best factor to decide dosing • Underweight / low muscle mass • Obesity • Sensitivity, medication / vaccination reactions • Compliance • Route of administration • Taste may be a factor • Ability to swallow

7. Body Weight • For patients who are obese or who have muscle wasting, body weight dosing can be unreliable • Obesity considerations: Weight based dosing may lead to supra therapeutic dosing • Use ideal body weight in children • Consider muscle mass in adults • With muscle wasting or in underweight adults, decrease dosage by 0.5 to 1.5 mg (3-4 mg total daily dosage)

8. Sensitivity • History of sensitivity to medications? • History of sensitivity to foods, supplements, herbs, chemicals, additives, etc: • History of vaccine reaction? • On multiple other medications? • Yes to any: use lower dosage, taper up more slowly • Primary or serious GI illness? • Consider cream or gel dermatologic delivery

9. Compliance • Intermittent use increases risk of continued side effects, especially sleep and neurologic complaints • Side effects are usually minimal and short lived if used consistently and tapered slowly • Assess willingness to be consistent with a protocol and monitor use

10. Route and Dosage Administration • For patients that can’t swallow pills or have GI concerns: • liquid expires quickly and is expensive • creams and gels usually preferable: • full dosage / gm or mL • start at 1/4 dosage and increase by 1/4 every week until full dosage reached

11. Dosing • 0.1 mg/kg body weight • In obese children, use ideal body weight to calculate • Decrease for muscle wasting to 0.05 or 0.75 mg/kg • Decrease for sensitive patients to 0.05 mg/kg, start at 1/4 to 1/8 dosage and increase every 2 weeks. After 1 month at 0.05 mg/kg dosage or longer, may consider increase to higher dosage.

12. Dr. Deanna Windham DrWindham@RMG.life DoctorWindham@icloud.com