Ketamine Fact Sheet
Thinking about having a Ketamine infusion?
This fact sheet was written to help educate you on the benefits and risks associated with ketamine so you can come to an informed decision on whether it’s an appropriate choice. We recommend reading this fact sheet prior to your patient consultation so you are familiar with the terminology and information associated with ketamine. A ketamine infusion may be useful in helping you ward off psychiatric disorders (addiction, anxiety, bi-polar, depression, suicidal ideation) and can aid in reducing chronic pain (fibromyalgia, migraine headaches, neuropathic pain). This fact sheet covers the properties of ketamine, how ketamine infusions are used and the risks that are involved.
What Is Ketamine?
Ketamine was initially developed to provide an anesthetic to patients. The medicine was most often used in operating rooms and on the battlefield. In recent times the use of this medicine has expanded significantly. Doctors and medical experts are finding new ways in which the use of Ketamine could be beneficial for certain patients.
Ketamine is classified as a dissociative anesthetic, but through clinical trials medical scientists have discovered that the medicine holds the potential to help people with major psychiatric disorders, as well as those who are suffering from chronic pain.
Ketamine’s efficacy is because of the effect the medicine has on the human nervous system. Once the medicine is administered, it interacts with particular chemical receptors in the nervous system. With the appropriate dosage, this effect can have nearly immediate positive effects on mental and emotional well being. Because the nervous system is responsible for interpreting pain signals, Ketamine can also give relief to patients who experience chronic pain.
One scientific review paper explains that several previous studies provided evidence that Ketamine has a rapid-onset antidepressant effect in the human body. The medicine is effective at reducing symptoms associated with bipolar disorder as well. Another paper explains that Ketamine is also highly effective in pain management therapy among patients with chronic pain.
Has Ketamine Been Approved By The FDA?
When it comes to looking at the status of Ketamine at the FDA, it is important to consider that two different forms of the medicine exist. The approval status differs between the two.
Racemic Ketamine is the most often used type of ketamine in medical facilities. This form of Ketamine is infused directly into the patient's bloodstream. Administration of racemic Ketamine can be done through an intravenous or intramuscular route. The FDA approved the use of racemic Ketamine for anesthetic purposes but it is not prohibited from being used for other purposes. Using it for other purposes is called off-label-use and this is done at the at the discretion of a physician or prescribing medical professional. It is not uncommon to use FDA approved drugs for off label use.
Esketamine is often sold under the brand name Spravato. It uses an isolated type of Ketamine. The product was approved by the FDA as an antidepressant treatment and is available as a nasal spray.
Who Should Not Receive Ketamine Infusion Treatments?
There are some scenarios where the administration of ketamine may not be appropriate. A full medical history of the patient is usually needed to help a medical practitioner determine if a particular patient may be a good candidate for ketamine treatment.
Patients who are actively abusing drugs or alcohol are excluded as candidates for ketamine infusions. A urine toxicology screening may be required.
Other exclusion criteria that should also be taken into account include:
Women who are pregnant
Patients with uncontrolled hypertension (high blood pressure)
Patients with acute cardiovascular disease
Patients with recent concussions
Any patient who had an unexpected adverse reaction with Ketamine in the past
Patients with conditions that cause an increase in their intracranial pressure
Patients with schizophrenia
What Are The Risks Of Using Ketamine Infusions?
The use of ketamine infusions as a treatment for psychiatric disorders and chronic pain is generally well-tolerated by patients. The side-effects associated with this treatment are usually mild and do not pose a threat to the patient.
In most cases, if the patient experiences side-effects, they tend to include:
A dissociative state of mind
An elevated heart rate
An increase in blood pressure
Some people describe the dissociative mindset as a “floaty” feeling – as if they are disconnected.
Most patients who experience these side-effects will have a full recovery within 1-3 hours following the treatment session.
Other reported side-effects include blurry or double vision, dizziness, nausea, vomiting, and drowsiness. There have also been some cases of insomnia following the use of ketamine and some patients report an increased ability to sleep.
Ketamine Infusion Dosage For Pain and Psychiatric Disorders
When ketamine infusion therapy is used as a treatment for psychiatric disorders or pain it is not for the purpose of full sedation or anesthesia. For therapeutic treatment in our clinic, a low dose of the ketamine will be infused into the patient's bloodstream, which may result in mild to moderate dissociation. Safe range for administration is typically between 0.5 mg-2.5 mg/kg of ideal body weight. Effective dose varies based on the individual and goal of treatment. On average we have found the therapeutic dose range to be between 50-100 mg.
William Beesley, MS
Cynthia N. Shumway, LCSW
Ahmed Zayed, MD
Rita Rutland, APRN