Q:  Hi! My compounding pharmacy uses sodium bicarbonate as a filler for my LDN [Low Dose Naltrexone]. This led to a discussion on a forum and now I’m curious if this is a bad filler to use? This particular forum was discussing other fillers as well, namely sea salt and sucrose. I’d love to know your thoughts!

A:  Fillers are a necessary part of almost all compounded preparations. In a dose of 3 mg, something has to be added to make up for the space in the capsule, which holds over 200 mg. Almost anything could be used, but the best fillers are inert, meaning they don’t exert any activity of their own.

Sodium bicarbonate is also known as baking soda. Tiny doses of 200mg are usually irrelevant to health. A person probably ingests far more than that in every cupcake they eat. However, in some very rare situations, the added sodium might be an issue. I can’t think of any specific situations, however.

We regularly use a cellulose product (Avicel) at The Compounder, the same basic material our veggie caps are made from. It’s inert and causes no problems. However, some people insist on other fillers and we don’t usually argue. We will object if the filler might be considered another therapeutic item, or if it is known to interfere with the use of the naltrexone (calcium carbonate, for example).

I would have no problem making LDN with sodium bicarbonate or even sucrose. However, we’ve standardized on the cellulose powder and it has served our customers very well for well over a decade.