Uses

What is ketamine used for?

Ketamine is a dissociative sedative used as an anesthetic to block the sensation of pain and touch before surgery or certain procedures that do not require skeletal muscle relaxation. It is considered a safe anesthetic because it does not affect blood pressure or the ability to breathe.

How should I take ketamine?

Ketamine is usually administered as an injection at your doctor’s office, hospital, or clinic by those experienced in administering general anesthetics, in maintaining an airway, and in controlling respiration.

How do I store ketamine?

Ketamine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store ketamine in the bathroom or the freezer. There may be different brands of ketamine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush ketamine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using ketamine?

Before taking this drug, tell your doctor if:

You are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement.
You have allergies to medicines, foods, or other substances.
You have a history of alcoholism or you are intoxicated by alcohol.
You take ketamine before you receive any medical or dental care, emergency care, or surgery.
You are allergic to any ingredient in ketamine.
You have a condition in which a large increase in blood pressure would be harmful.
You are taking droxidopa.

Ketamine may cause drowsiness for up to 24 hours. These effects may be worse if you take it with alcohol or certain medicines. Do not drive or perform other possibly unsafe tasks for at least 24 hours following surgery until you know how you react to it.

Ketamine may cause behavior, mental, or mood changes; confusion; or hallucinations that usually go away within 24 hours. Discuss any questions or concerns with your doctor.

Use ketamine with caution in the elderly; they may be more sensitive to its effects.

Ketamine should be used with extreme caution in children younger than 16 years old; safety and effectiveness in these children have not been confirmed.

Is it safe during pregnancy or breastfeeding?

Ketamin is a pregnancy category B drug and is known to cross into the placenta. There isn’t enough data on the safety of using this medication during pregnancy and breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication.

Side effects

What side effects can occur from ketamine?

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most common side effects persist or become bothersome:

Loss of appetite
Nausea
Vomiting

Seek medical attention right away if any of these severe side effects occur:

Rash
Hives
Itching
Difficulty breathing
Tightness in the chest
Swelling of the mouth, face, lips, or tongue
Behavior changes
Confusion
Difficult, frequent, or painful urination
Double vision
Fainting
Fast, slow, or irregular heartbeat
Hallucinations
Involuntary muscle movements
Mental or mood changes (e.g., anxiety);
Pain, redness, or swelling at the injection site
Severe or persistent dizziness, light-headedness, or headache
Slowed or shallow breathing
Uncontrolled eye movements

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with ketamine?

Ketamine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

These products may include:

Carbinoxamine
Topical cocaine or cocaine applied to the nose
Doxylamine (Unisom)
Opioids (e.g., alfentanil, codeine, hydromorphone, oxymorphone)
Tramadol
Barbiturates (e.g., butalbital, butabarbital, pentobarbital)
Benzodiazepines, (e.g. alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan)
Carbamazepine (Carbatrol, Equetro, Tegretol), oxcarbazepine (Trileptal), phenytoin (Dilantin)
Zaleplon (Sonata, Starnoc, Andanta) or zolpidem (Ambien)
Rifampin (Rifadin, Rifamate, Rimactane)
Dexmedetomidine (Precedex)
Suvorexant (Belsomra)

Does food or alcohol interact with ketamine?

Ketamine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Do not take this drug with alcohol as it increases the CNS depressive effects of both substances, which may lead to excessive drowsiness, loss of consciousness, and even death. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with ketamine?

Ketamine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

These health conditions are:

History of head trauma or injury, bleeding in the brain
A stroke
Increased spinal fluid pressure
Increased pressure in the eye
Bladder or urinary problems
Heart problems (e.g., congestive heart failure)
High blood pressure
Mental or mood problems
Thyroid problems

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using ketamine.

What is the dose of ketamine for an adult?

IV:

Induction: 4.5 mg/kg via slow IV injection over the span of one minute. A dose of 2 mg/kg produces surgical anesthesia within 30 seconds after injection, lasting for 5-10 min.

Maintenance: the dose should be adjusted according to the patient’s anesthetic needs and whether an additional anesthetic is employed. Increments of one-half to the full induction dose may be repeated as needed for the maintenance of anesthesia. Alternatively, a total induction dose of 0.5-2 mg/kg via infusion, given at an appropriate rate, and maintained at 10-45 mcg/kg/min, adjusted according to the patient’s response.

IM:

Induction: the recommended dose is 6.5 to 13 mg/kg IV; (9 to 13 mg/kg IV provides 12 to 25 minutes of surgical anesthesia).

For reconstitution/dilution:

50 mg/mL and 100 mg/mL vials may be further diluted in 5% dextrose or 0.9% NaCl to prepare a maintenance infusion containing 1 mg/mL (or 2 mg/mL in patients w/ fluid restrictions).

What is the dose of ketamine for a child?

Children 16 years-old

IV:

Refer to the adult dose.

IM:

Refer to the adult dose.

How is ketamine available?

Ketamine is available in the following brands, dosage forms, and strengths:

Etamine solution for injection 50 mg/mL
Ketamax solution for injection 50 mg/mL

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of ketamine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

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Ketamine