Is low‑dose Naltrexone safe before surgery for MTHFR?

Question

Hello doctor,

I have MTHFR and have had several bad reactions to propofol and nitrous oxide. We finally found a combination that works well for me: Versed and Fentanyl. My doctor wants to put me on low‑dose Naltrexone for chronic pain because over‑the‑counter medications do not help.

Is this a potential issue for me? Should I need surgery, emergency or otherwise, are there any precautions someone in this position should take moving forward?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Thank you for reaching out, and I completely understand your concerns. Given your history of MTHFR (methylenetetrahydrofolate reductase) mutation and adverse reactions to propofol and nitrous oxide, your caution is absolutely valid. We will break down your query and answer it accordingly.

MTHFR mutation (If I am guessing MTHFR correctly): This mutation can affect methylation and detoxification pathways, but it does not mean you cannot undergo anaesthesia. It is wise to avoid medications and conditions that may increase homocysteine or oxidative stress unnecessarily.

Reactions to propofol and Nitrous oxide: Since you have had adverse reactions to these, we should avoid using them in future procedures. You mentioned that Versed (i.e., Midazolam) and Fentanyl work well for you; this is helpful and should be documented clearly in your medical records.

Low-dose Naltrexone (LDN): LDN can be beneficial in managing chronic pain and inflammation, but it is an opioid antagonist, so it may interfere with opioid-based pain relief, such as Fentanyl or Morphine, during surgery or emergency care.

If you are scheduled for any procedure, LDN should be stopped at least 24 to 72 hours in advance, depending on the dose and your doctor's instructions.

In case of surgery or emergency:

Ensure your allergy/intolerance list includes Propofol, Nitrous oxide, and LDN (if currently used).

Inform all treating physicians and anesthesiologists well in advance of any procedure.

Maintain a written record of medications that are safe for you (such as Versed and Fentanyl); this is crucial during emergencies.

Proceed with LDN only under the supervision of a pain management specialist or functional medicine provider familiar with MTHFR, but it must be paused before any procedure.

In the case of planned procedures, a pre-anaesthesia consultation is essential so alternatives can be planned safely.

You may also consider a genetic pharmacology panel if it has not already been done; it can help predict drug sensitivities more precisely. Feel free to reach out if you need help preparing a preoperative medication safety list.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.