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Overview

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This medicine contains an important and useful components, as it consists of
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Name

Ketamine

Precaution

Before using **Ketamine**, patients must consult their healthcare provider to ensure its appropriateness for their condition. Key precautions include: - **Mental Health Conditions**: **Ketamine** can induce **hallucinations**, **delusions**, or **psychotic symptoms**, and its use should be carefully monitored in patients with a history of **mental health disorders** like **schizophrenia**, **bipolar disorder**, or severe **anxiety**. - **Cardiovascular Risk**: **Ketamine** may cause an increase in **blood pressure** and **heart rate**, so it should be used cautiously in individuals with **cardiovascular disease**, such as **hypertension**, **heart failure**, or **arrhythmias**. - **Respiratory Depression**: While rare, **Ketamine** can cause **respiratory depression**, particularly when used in combination with other central nervous system depressants (e.g., opioids, alcohol). Close monitoring of **respiratory status** is essential during its administration. - **Liver Function**: Patients with **liver dysfunction** should use **Ketamine** with caution. It is metabolized by the liver, and altered liver function could affect its elimination and increase the risk of side effects. - **Urinary Tract Issues**: Chronic use of **Ketamine** has been linked to **urinary tract issues**, including **bladder dysfunction** and **cystitis**. Long-term use should be carefully monitored for signs of **urinary symptoms**. - **Drug Abuse Potential**: **Ketamine** has the potential for abuse due to its **dissociative** and **hallucinogenic** properties. It is a **controlled substance** in many countries due to this risk.

Indication

**Ketamine** is primarily used for: - **Anesthesia**: **Ketamine** is used in both **general anesthesia** and **sedation**, especially in emergency or surgical settings. It is a **dissociative anesthetic**, meaning it induces a trance-like state while maintaining respiratory drive and often without causing a significant decrease in blood pressure. - **Pain Management**: It is used in **acute pain** management, especially in settings like **burns**, **fractures**, or **post-operative recovery**. In some cases, it is used for **chronic pain** management, particularly when other pain medications have not been effective. - **Depression**: **Ketamine** has gained attention in recent years as a **rapid-acting antidepressant**, especially in cases of **treatment-resistant depression**. It has shown significant promise in reducing depressive symptoms in a very short time frame, sometimes within hours. - **Anxiety and PTSD**: Off-label, **Ketamine** is being studied for its effects in **anxiety disorders**, **post-traumatic stress disorder (PTSD)**, and **acute stress reactions**, offering a potentially novel therapeutic approach when traditional treatments fail. - **Status Epilepticus**: It has been used as an **adjunct therapy** in the management of **status epilepticus**, especially when other treatments have not controlled the seizure activity.

Contra indication

**Ketamine** should not be used in the following situations: - **Hypersensitivity**: Patients with known **allergies** or hypersensitivity to **Ketamine** or any of its components should avoid using the drug. - **Severe Cardiovascular Disease**: Due to its potential to **increase blood pressure** and **heart rate**, **Ketamine** is contraindicated in patients with **severe cardiovascular conditions**, including **uncontrolled hypertension**, **acute heart failure**, and **coronary artery disease**. - **Psychotic Disorders**: **Ketamine** can exacerbate symptoms of **schizophrenia** and other **psychotic disorders** and should not be used in these patients due to the risk of precipitating a psychotic episode. - **Pregnancy**: **Ketamine** should be used with caution during pregnancy, especially in the **first trimester**, due to potential risks to the fetus. It is classified as a **Category C** drug by the FDA, meaning its safety in pregnancy has not been established. It should only be used during pregnancy if the benefits outweigh the potential risks. - **Liver Disease**: Patients with **severe liver dysfunction** should avoid **Ketamine**, as its metabolism could be impaired, leading to prolonged drug effects and increased risk of toxicity.

Side Effect

Common and severe side effects of **Ketamine** include: - **Psychiatric Effects**: Hallucinations, **dissociation**, and **delirium** are common during and after **Ketamine** administration, particularly when used in high doses. These effects are typically transient, but they can be disturbing. - **Cardiovascular Effects**: It can **increase blood pressure** and **heart rate**, leading to a potential risk of **hypertension**, **tachycardia**, and even **arrhythmias**. - **Respiratory Depression**: Although **Ketamine** generally maintains airway reflexes, it can cause **respiratory depression**, particularly when combined with other sedatives or in patients with pre-existing respiratory conditions. - **Nausea and Vomiting**: **Ketamine** can cause **nausea** and **vomiting** during and after its administration, especially in higher doses. - **Urinary Issues**: Chronic use of **Ketamine** has been associated with **bladder pain**, **incontinence**, and **dysuria**, potentially leading to **ketamine-induced ulcerative cystitis** in long-term users. - **Liver Enzyme Changes**: Prolonged use may lead to **elevated liver enzymes** or liver dysfunction. - **Pain at Injection Site**: When given intramuscularly or intravenously, **Ketamine** can cause **pain**, **irritation**, or **swelling** at the injection site. Severe side effects, such as **severe hypertension**, **respiratory depression**, or **emergence reactions**, require immediate medical attention.

Pregnancy Category ID

2

Mode of Action

**Ketamine** exerts its effects through multiple mechanisms: - **NMDA Receptor Antagonism**: **Ketamine** works primarily as an **NMDA (N-methyl-D-aspartate) receptor antagonist**, blocking the action of **glutamate**, a key neurotransmitter involved in **pain transmission**, **learning**, and **memory**. This mechanism contributes to its **anesthetic** and **analgesic** effects. - **Dissociative Anesthesia**: It induces a **dissociative state**, where the patient is unaware of pain and surroundings but often maintains cardiovascular stability, unlike other general anesthetics. - **Antidepressant Effects**: Recent studies suggest that **Ketamine**’s effects on **glutamate** and other **neuroplasticity-related mechanisms** can rapidly relieve symptoms of **depression**, even in patients who have not responded to conventional antidepressants. - **Sympathomimetic Effects**: **Ketamine** also stimulates the release of **catecholamines** (e.g., **norepinephrine**), leading to its **increased heart rate** and **blood pressure** effects.

Interaction

**Ketamine** may interact with several drugs, potentially enhancing side effects or affecting efficacy: - **CNS Depressants**: Combining **Ketamine** with other central nervous system (CNS) depressants, such as **benzodiazepines**, **opioids**, or **alcohol**, can result in **severe sedation**, **respiratory depression**, or **hypotension**. - **Antidepressants**: Combining **Ketamine** with other **antidepressants**, especially **monoamine oxidase inhibitors (MAOIs)**, could potentially lead to **hypertensive crises** due to its sympathomimetic properties. Caution should be exercised when used with drugs like **SSRIs**, **SNRIs**, or **tricyclic antidepressants**. - **Antihypertensives**: **Ketamine** increases **blood pressure**, potentially counteracting the effects of **antihypertensive medications** like **beta-blockers** or **ACE inhibitors**. - **Barbiturates**: **Barbiturates** and **Ketamine** may have an additive effect on **sedation**, requiring careful monitoring of **respiratory** and **cardiovascular function**. - **Digoxin**: **Ketamine** may **increase digoxin levels**, heightening the risk of **digoxin toxicity**. Close monitoring of **digoxin levels** is required if these drugs are used together.

Pregnancy Category Note

Information not available

Adult Dose

The adult dosing of **Ketamine** depends on the indication and method of administration: - **Anesthesia**: For **induction of anesthesia**, **Ketamine** is typically administered as an **IV bolus** dose of **1-4.5 mg/kg**. Alternatively, it can be given **intramuscularly** at a dose of **6.5-13 mg/kg**. - **Sedation for Procedural Pain**: **Ketamine** can be administered as an IV dose of **0.5-1 mg/kg**, followed by additional doses as needed to maintain sedation. - **Pain Management**: For **acute pain management**, doses of **0.1-0.3 mg/kg/hour** (IV infusion) may be used for continuous analgesia. - **Depression**: **Ketamine** for depression is typically administered in a **subanesthetic dose** of **0.5 mg/kg** via IV infusion over 40 minutes, repeated at regular intervals as part of a treatment protocol.

Child Dose

**Ketamine** is used in pediatric anesthesia and sedation: - **Anesthesia**: For children, the typical dose for **induction** is **2-5 mg/kg** administered intravenously or **4-8 mg/kg** intramuscularly. - **Sedation**: For sedation, the usual dose is **1-2 mg/kg** IV. For pain management in pediatric patients, **0.05-0.1 mg/kg/hour** may be used for IV infusions. Doses must be adjusted based on the child's age, condition, and response to the drug. Close monitoring for respiratory, cardiovascular, and neurological effects is essential.

Renal Dose

In patients with **renal impairment**, **Ketamine** should be used with caution, but no specific dose adjustments are universally recommended. However, since **Ketamine** is metabolized by the liver, **renal dysfunction** does not usually require a change in dosing unless the patient has severe **renal** and **hepatic compromise**. Close monitoring is required for any adverse effects.

Administration

Information not available