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Ketamine

Intravenous
Intramuscular
Class
General anesthetics
Subclass
Arylcyclohexylamines
Generic name
Ketamine hydrochloride
Brand names
Ketalar®
Common formulations
Solution for injection
Dosage and administration
Adults patients
Treatment
Major depressive disorder • Off-label
•
0.5 mg/kg IV continuous infusion over 40 minutes
Pain • Moderate-to-severe • Off-label
•
Maintenance: 0.2-0.3 mg/kg IV bolus
•
Maximum: 0.35 mg/kg per day
Induction
Induction of general anesthesia
•
1-2 mg/kg IV once
Other off-label uses
•
Treatment of alcohol use disorder (maintenance of abstinence)
•
Treatment of PTSD
•
Treatment of status epilepticus
Indications for use
Labeled indications
Adults
•
Facilitation of procedural sedation
•
Induction of general anesthesia
Off-label indications
Adults
•
Treatment of alcohol use disorder (maintenance of abstinence)
•
Treatment of major depressive disorder
•
Treatment of pain (moderate-to-severe)
•
Treatment of PTSD
•
Treatment of status epilepticus
Safety risks
Contraindications
Hypersensitivity to ketamine or any of its components
Ketamine hydrochloride alone for procedures of the pharynx, larynx, or bronchial tree
Significant elevation of BP
Warnings and precautions
Cholestasis
•
Use caution in patients with the recurrent use of ketamine and a history of hepatic or biliary impairment.
Hemodynamic instability
•
Maintain a high level of suspicion as, transient increases in BP, HR, and cardiac index are frequently observed following administration of ketamine hydrochloride.
Increased ICP
•
Use extreme caution in patients with head trauma, intracranial mass lesions or abnormalities, intracranial bleeding, and hydrocephalus.
Profound sedation, respiratory depression, coma
•
Use caution in patients receiving opioids with benzodiazepines or other CNS depressants, including alcohol.
Seizure
•
Use caution with concomitant administration of theophylline or aminophylline.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Avoid use. Evidence of fetal harm in humans. Since safe use in pregnancy, including obstetrics (either vaginal or abdominal delivery), has not been established, such use is not recommended.
Breastfeeding
Use with caution during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
Some adverse effects on lactation reported.
Use with caution during breastfeeding.
•
Latest data gathered.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Delirium, hallucinations, nightmares
Common 1-10%
•
Diabetes insipidus, disorientation, hypertension, diplopia, hypersalivation, sinus tachycardia, tachycardia
Uncommon < 1%
•
↑ ICP, myoclonus, psychosis, itching, skin rash, respiratory depression
Unknown frequency
•
Apnea, bradycardia, cardiac arrest, cholelithiasis, exacerbation of arrhythmia, extrahepatic biliary obstruction, hemorrhagic cystitis, hypertonia, hypotension, ↑ intraocular pressure, involuntary movements, laryngospasm, nystagmus, amnesia, anxiety, confusion, dysuria, hematuria, injection site reactions, insomnia, loss of appetite, nausea, urinary frequency, urinary incontinence, urinary urgency, vomiting, respiratory depression, skin erythema
Interactions
Drug(s)
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