I started off at 4.5 mg in the midst of a major flare. It (LDN) worked, but it took a while (and waiting to see if it would/wouldn't work while I continued a downward spiral flaring wasn't a pleasant experience). I think that many doctors prefer the ramp up method as it is considered safer (whether for them or their patients is a debate I won't get into). If you can get your hands on the full transcript of the original trial by Dr Jill Smith, I'd look into what dosages she trialed her patients on. Back when I started (Nov 2007) I understood very little about how the drug worked (I was more interested in whether it would work). My understanding now (and this is all anecdotal) is that, taken in small doses, it acts like an immune suppressor. If that is actually the case, then it should be safe to combine it with other immune suppressors. I don't know if it is possible, but you might try contacting Dr Smith. Or check the lowdosenaltrexone.org website for answers.
Thing of it is.. since the dose is low to begin with, and the dosage mentioned in the parts of the original study I looked at talked about 4.5mg, I went with 4.5mg and that worked for me. I'd suggest starting at that dose, and if it doesn't harm you in any way, stick with it. If it does, then cut back to 3mg, try again... and then to 1.5mg if 3 gives you grief. Hey, when I started, I got way worse on LDN (due to flare), but then it kicked in and it just kept getting better N better. I wish that my original diary of those first weeks were still on this site. I think you'd find your situation mirrors my own early days. I only hope that 4 years from now you will be the one on here bragging about your success.
I read a post and someone mentioned that it probably isn't a good idea to start LDN while flared. Well, I've been starting to feel worse and experiencing more symptoms of recent. What do you guys think? I have the medicine, just not sure what dose to take startig out. Probably like 1mg or 2mg and gradually up the med to 4.5mg. 
