What to do if You Need Surgery While Taking Low Dose Naltrexone
A common question we are asked during our consultation with patients is “What if I need surgery?”.
The main concern with Low Dose Naltrexone (LDN) and any surgery is the possibility of needing to take an opioid painkiller for a short time post surgery. Opioids like Percocet, Lortab, and Oxycontin cannot be taken in conjunction with LDN because they bind to the same receptors, your OGFR receptors. If you are taking LDN and then try to take a painkiller, it’s possibly the receptors will be blocked by the LDN and you will not receive relief from the post surgical pain. On the flip side, if you take a painkiller and then try to continue taking the LDN, you will not experience the same effects as you normally do because it will not be able to bind. This means that while painkillers are being used, if they are needed post surgery, you will need to pause your LDN.
Another concern is that LDN could potentially trigger general anesthesia to be less effective. This is one reason it is so important to share with both your surgeon and anesthesiologist that you are taking LDN, and also to let them know when you will stop taking it prior to surgery. If either your surgeon or anesthesiologist has instructions that differ, you would want to default to their instructions while under their care. Most doctors agree however that LDN has a short lifespan and is cleared from the body in 24-48 hours.
Dr. Zalzala’s recommendation is to stop taking LDN 48 hours prior to any surgery, to ensure that all naltrexone is out of your system completely prior to administration of anesthesia. While it might possibly be cleared within 24 hours, it is not worth the risk of having to have extra anesthesia administered. Often times morphine is administered directly after an inpatient surgery, and the LDN would be cleared by that time as well so as not to interfere with pain relief.
When a surgery is planned, stopping LDN 48 hours prior will ensure that any complications due to interactions are minimized or reduced as much as they possibly could be.
What if an emergency surgery is necessary?
In the unlikely event of surgery being necessary without being able to stop LDN 48 hours prior, it is important to let your doctor and surgeon know you are taking LDN, as well as what dose and when your last dose was taken. This can help them to make the best decisions regarding surgery, based on approximately how long the LDN stays bound. LDN is typically only bound to receptors for 2-4 hours. Letting your doctor know, or having this information readily accessible in your phone or via family members will allow for the best health decisions to be made.
How to restart after surgery?
Since most patients only take painkillers for a few days or weeks after surgery, they can typically return to their previous dose with no issues. It’s not uncommon to experience some mild headaches or insomnia upon restarting if it has been over two weeks, or if a patient was sensitive to LDN when they first began taking the medication. If a patient uses tablets or liquid form of LDN, they can easily restart at half their normal dose and then quickly titrate back up to help avoid any unpleasant side effects. If a patient has to stop their LDN for over 4 weeks, it is likelythey’ll need to restart at a lower dose to avoid side effects.
Remember to always defer to the instructions of your surgeon or anesthesiologist!