KETAMINE LIQUID

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Ketamine is a medication primarily used for initiating and maintaining anesthesia. It induces a state known as dissociative anesthesia, which provides pain relief, sedation, and amnesia. Key features of ketamine anesthesia include preserved breathing and airway reflexes, stimulated heart function with increased blood pressure, and moderate bronchodilation. At lower, sub-anesthetic doses, ketamine shows promise for treating pain and treatment-resistant depression. However, the antidepressant effects of a single ketamine administration diminish over time, and the consequences of repeated use remain inadequately studied.

Psychiatric Side Effects and Risks

Common psychiatric side effects include increased blood pressure and nausea. Regular users of high doses for recreational purposes often experience liver and urinary toxicity. Ketamine acts as an NMDA receptor antagonist, which explains most of its effects, except for its antidepressant mechanism, which is still under investigation.

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Ketamine infusions are used for acute pain treatment in emergency departments and during the perioperative period for individuals with refractory pain. These doses are lower than what is used for anesthesia and are termed sub-anesthetic doses. When used alongside morphine or on its own, ketamine can reduce morphine requirements, pain levels, nausea, and vomiting after surgery. It is particularly beneficial for surgical patients experiencing severe post-operative pain or for those who are opioid-tolerant.

In prehospital settings, ketamine is effective and poses a low risk of respiratory depression. It demonstrates similar efficacy to opioids in managing acute pain and controlling procedural pain in hospital emergency departments. Additionally, it may help prevent opioid-induced hyperalgesia and post-anesthetic shivering.

For chronic pain, ketamine is administered intravenously, particularly for neuropathic pain. It also helps counteract spinal sensitization or “wind-up” phenomena associated with chronic pain. Clinical trials have shown that ketamine infusions provide short-term pain relief for neuropathic pain, pain resulting from traumatic spine injuries, fibromyalgia, and complex regional pain syndrome (CRPS). However, the 2018 consensus guidelines on chronic pain concluded that the overall evidence for ketamine’s use is weak for spinal injury pain, moderate for CRPS, and weak or nonexistent for mixed neuropathic pain, fibromyalgia, and cancer pain. Notably, evidence supports medium- to long-term relief specifically for CRPS.

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Ketamine acts as a robust and rapid-acting antidepressant, although its effects are transient. Intravenous ketamine infusions in individuals with treatment-resistant depression can improve mood within four hours, peaking at 24 hours. However, the effects diminish by seven days, and many patients relapse within ten days, though a significant minority may experience improvement lasting 30 days or longer. A notable challenge with ketamine treatment is managing the expiration of its antidepressant effects. Maintenance therapy with ketamine (ranging from twice a week to once every two weeks) appears promising, but the evidence supporting it is insufficient. Ketamine may also reduce suicidal thoughts for up to three days post-injection. While ketamine may be effective for bipolar depression, data on its use in this context are limited.

Although ketamine has not been approved as an antidepressant, the Canadian Network for Mood and Anxiety Treatments recommends it as a third-line treatment option for depression. One enantiomer of ketamine, esketamine, has been approved as a nasal spray for treatment-resistant depression in the United States and elsewhere. Although intravenous infusion of ketamine has not been directly compared with intranasal esketamine, a comparative meta-analysis of clinical trials suggests that intravenous ketamine shows superior overall response and remission rates, as well as a lower dropout rate.

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Ketamine has also been used in the treatment of status epilepticus that does not adequately respond to standard treatments, although limited evidence, consisting mainly of case studies and lacking randomized controlled trials, exists to support its use in this context.