Ketamine Uses

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What is Ketamine?

Ketamine injection is used alone or together with other medicines to produce loss of consciousness before and during surgery or a medical procedure. It belongs to the group of medicines called general anesthetics.

Ketamine is given only by or under the immediate supervision of a medical doctor trained to use it. If you will be receiving Ketamine during surgery, your doctor or anesthesiologist will give you the medicine and closely follow your progress.

Ketamine indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Ketamine hydrochloride injection is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Ketamine hydrochloride is best suited for short procedures but it can be used, with additional doses, for longer procedures.

Ketamine hydrochloride injection is indicated for the induction of anesthesia prior to the administration of other general anesthetic agents.

Ketamine hydrochloride injection is indicated to supplement low-potency agents, such as nitrous oxide.

Specific areas of application are described in the CLINICAL PHARMACOLOGY Section.

How should I use Ketamine?

Use Ketamine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Ketamine.

Uses of Ketamine in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications

Anesthesia: Induction and maintenance of general anesthesia

Off Label Uses

Agitation, severe

Data from a limited number of patients in open-label, prospective clinical trials suggest that Ketamine may be beneficial for the treatment of severe agitation and violent behavior. However, the dosage range varies considerably and an optimal dosage has not been established. Additional data is necessary to further define the role of Ketamine in this condition. Since there is limited data on the safety and efficacy of Ketamine in this setting, the Neurocritical Care Society recommends reservation of Ketamine for patients who do not respond to more frequently recommended antiepileptic drug treatment.

Ketamine description

Ketamine contains Ketamine HCl equivalent to Ketamine base per mL. It also contains benzethonium chloride and water for injection. Additionally, the 10-mg/mL vial also contains sodium chloride.

Ketamine dosage

Note: Barbiturates and Ketamine hydrochloride, being chemically incompatible because of precipitate formation, should not be injected from the same syringe.

If the Ketamine hydrochloride dose is augmented with diazepam, the two drugs must be given separately. Do not mix Ketamine hydrochloride and diazepam in syringe or infusion flask. For additional information on the use of diazepam, refer to the WARNINGS and DOSAGE AND ADMINISTRATION Sections of the diazepam insert.

Preoperative Preparations

  1. While vomiting has been reported following Ketamine hydrochloride administration, some airway protection may be afforded because of active laryngeal-pharyngeal reflexes. However, since aspiration may occur with Ketamine hydrochloride and since protective reflexes may also be diminished by supplementary anesthetics and muscle relaxants, the possibility of aspiration must be considered. Ketamine hydrochloride is recommended for use in the patient whose stomach is not empty when, in the judgment of the practitioner, the benefits of the drug outweigh the possible risks.
  2. Atropine, scopolamine, or another drying agent should be given at an appropriate interval prior to induction.

Onset And Duration

Because of rapid induction following the initial intravenous injection, the patient should be in a supported position during administration.

The onset of action of Ketamine hydrochloride is rapid; an intravenous dose of 2 mg/kg (1 mg/lb) of body weight usually produces surgical anesthesia within 30 seconds after injection, with the anesthetic effect usually lasting five to ten minutes. If a longer effect is desired, additional increments can be administered intravenously or intramuscularly to maintain anesthesia without producing significant cumulative effects.

Intramuscular doses, in a range of 9 to 13 mg/kg (4 to 6 mg/lb) usually produce surgical anesthesia within 3 to 4 minutes following injection, with the anesthetic effect usually lasting 12 to 25 minutes.

Dosage

As with other general anesthetic agents, the individual response to Ketamine hydrochloride is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. The drug should be titrated against the patient's requirements.

Induction

Intravenous Route

The initial dose of Ketamine hydrochloride administered intravenously may range from 1 mg/kg to 4.5 mg/kg (0.5 to 2 mg/lb). The average amount required to produce five to ten minutes of surgical anesthesia has been 2 mg/kg (1 mg/lb).

Alternatively, in adult patients an induction dose of 1 mg to 2 mg/kg intravenous Ketamine at a rate of 0.5 mg/kg/min may be used for induction of anesthesia. In addition, diazepam in 2 mg to 5 mg doses, administered in a separate syringe over 60 seconds, may be used. In most cases, 15 mg of intravenous diazepam or less will suffice. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this induction dosage program.

Note: The 100 mg/mL concentration of Ketamine hydrochloride should not be injected intravenously without proper dilution. It is recommended the drug be diluted with an equal volume of either Sterile Water for injection, USP, Normal Saline, or 5% Dextrose in Water.

Rate of Administration

It is recommended that Ketamine hydrochloride be administered slowly (over a period of 60 seconds). More rapid administration may result in respiratory depression and enhanced pressor response.

Intramuscular Route

The initial dose of Ketamine hydrochloride administered intramuscularly may range from 6.5 to 13 mg/kg (3 to 6 mg/lb). A dose of 10 mg/kg (5 mg/lb) will usually produce 12 to 25 minutes of surgical anesthesia.

Maintenance Of Anesthesia

The maintenance dose should be adjusted according to the patient's anesthetic needs and whether an additional anesthetic agent is employed.

Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia. However, it should be noted that purposeless and tonic-clonic movements of extremities may occur during the course of anesthesia. These movements do not imply a light plane and are not indicative of the need for additional doses of the anesthetic.

It should be recognized that the larger the total dose of Ketamine hydrochloride administered, the longer will be the time to complete recovery.

Adult patients induced with Ketamine hydrochloride augmented with intravenous diazepam may be maintained on Ketamine hydrochloride given by slow microdrip infusion technique at a dose of 0.1 to 0.5 mg/minute, augmented with diazepam 2 to 5 mg administered intravenously as needed. In many cases 20 mg or less of intravenous diazepam total for combined induction and maintenance will suffice. However, slightly more diazepam may be required depending on the nature and duration of the operation, physical status of the patient, and other factors. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this maintenance dosage program.

Dilution

To prepare a dilute solution containing 1 mg of Ketamine per mL, aseptically transfer 10 mL from a 50 mg per mL vial or 5 mL from a 100 mg per mL vial to 500 mL of 5% Dextrose Injection, USP or Sodium Chloride (0.9%) Injection, USP (Normal Saline) and mix well. The resultant solution will contain 1 mg of Ketamine per mL.

The fluid requirements of the patient and duration of anesthesia must be considered when selecting the appropriate dilution of Ketamine hydrochloride injection. If fluid restriction is required, Ketamine hydrochloride injection can be added to a 250 mL infusion as described above to provide a Ketamine hydrochloride concentration of 2 mg/mL. Ketamine hydrochloride injection 10 mg/mL vials are not recommended for dilution.

Supplementary Agents

Ketamine hydrochloride is clinically compatible with the commonly used general and local anesthetic agents when an adequate respiratory exchange is maintained.

The regimen of a reduced dose of Ketamine hydrochloride supplemented with diazepam can be used to produce balanced anesthesia by combination with other agents such as nitrous oxide and oxygen.

How supplied

Ketamine hydrochloride injection is supplied as the hydrochloride in concentrations equivalent to Ketamine base.

NDC 42023-137-10 - Each 20-mL multi-dose vial contains 10 mg/mL. Supplied in cartons of 10.

NDC 42023-138-10 - Each 10-mL multi-dose vial contains 50 mg/mL. Supplied in cartons of 10.

NDC 42023-139-10 - Each 5-mL multi-dose vial contains 100 mg/mL. Supplied in cartons of 10.

Store between 20° to 25°C (68° to 77°F).

Protect from light.

Manufactured and Distributed by: JHP Pharmaceuticals, LLC, Rochester, MI 48307. Revised: Feb 2013

Ketamine interactions

See also:
What other drugs will affect Ketamine?

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Prolonged recovery time may occur if barbiturates and/or narcotics are used concurrently with Ketamine.

Ketamine is chemically incompatible with barbiturates and diazepam because of precipitate formation. Therefore, these should not be mixed in the same syringe or infusion fluid.

Ketamine may potentiate the neuromuscular-blocking effects of atracurium and tubocurarine including respiratory depression with apnoea.

The use of halogenated anaesthetics concomitantly with Ketamine can lengthen the elimination half-life of Ketamine and delay recovery from anaesthesia. Concurrent use of Ketamine (especially in high doses or when rapidly administered) with halogenated anaesthetics can increase the risk of developing bradycardia, hypotension or decreased cardiac output.

The use of Ketamine with other CNS depressants (eg, ethanol, phenothiazines, sedating H1-blockers or skeletal muscle relaxants) can potentiate CNS depression and/or increase risk of developing respiratory depression. Reduced doses of Ketamine may be required with concurrent administration of other anxiolytics, sedatives and hypnotics.

Ketamine has been reported to antagonise the hypnotic effect of thiopental.

Patients taking thyroid hormones have an increased risk of developing hypertension and tachycardia when given Ketamine.

Concomitant use of antihypertensive agents and Ketamine increases the risk of developing hypotension.

When Ketamine and theophylline are given concurrently, a clinically significant reduction in the seizure threshold is observed. Unpredictable extensor-type seizures have been reported with concurrent administration of these agents.

Incompatibilities: Ketamine is chemically incompatible with barbiturates and diazepam because of precipitate formation. Therefore, these should not be mixed in the same syringe or infusion fluid.

Ketamine side effects

See also:
What are the possible side effects of Ketamine?

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Cardiovascular: Blood pressure and pulse rate are frequently elevated following administration of Ketamine hydrochloride alone. However, hypotension and bradycardia have been observed. Arrhythmia has also occurred.

Respiration: Although respiration is frequently stimulated, severe depression of respiration or apnea may occur following rapid intravenous administration of high doses of Ketamine hydrochloride. Laryngospasms and other forms of airway obstruction have occurred during Ketamine hydrochloride anesthesia.

Eye: Diplopia and nystagmus have been noted following Ketamine hydrochloride administration. It also may cause a slight elevation in intraocular pressure measurement.

Genitourinary: Severe irritative and inflammatory urinary tract and bladder symptoms including cystitis have been reported in individuals with history of chronic Ketamine use or abuse.

Psychological:

Neurological: In some patients, enhanced skeletal muscle tone may be manifested by tonic and clonic movements sometimes resembling seizures.

Gastrointestinal: Anorexia, nausea and vomiting have been observed; however, this is not usually severe and allows the great majority of patients to take liquids by mouth shortly after regaining consciousness.

General: Anaphylaxis. Local pain and exanthema at the injection site have infrequently been reported. Transient erythema and/or morbilliform rash have also been reported.

For medical advice about adverse reactions contact your medical professional. To report SUSPECTED ADVERSE REACTIONS, contact JHP at 1-866-923-2547 or MEDWATCH at 1-800-FDA-1088 (1- 800-332-1088) or http://www.fda.gov/medwatch/.

Drug Abuse And Dependence

Ketamine has been reported being used as a drug of abuse.

Reports suggest that Ketamine produces a variety of symptoms including, but not limited to anxiety, dysphoria, disorientation, insomnia, flashbacks, hallucinations, and psychotic episodes.

Ketamine dependence and tolerance are possible following prolonged administration. A withdrawal syndrome with psychotic features has been described following discontinuation of long-term Ketamine use. Therefore, Ketamine should be prescribed and administered with caution.

Ketamine contraindications

See also:
What is the most important information I should know about Ketamine?

You should not receive Ketamine if you are allergic to it, or if you have untreated or uncontrolled hypertension (high blood pressure).

Before you receive Ketamine, tell your doctor if you have heart disease, high blood pressure, a history of alcoholism, or if you recently drank large amounts of alcohol.

Ketamine may be harmful to an unborn baby. Tell your doctor if you are pregnant.

You may feel strange or slightly confused when you first come out of anesthesia. Tell your caregivers if these feelings are severe or unpleasant. It may take you longer to recover from anesthesia with Ketamine if you have recently used a barbiturate (Butisol, Mebaral, Seconal, Nembutal, Solfoton, and others) or narcotic medication (Vicodin, Dilaudid, OxyContin, Percocet, Actiq, Duragesic, Methadose, Dolophine, Kadian, MS Contin, and others).

Tell your caregivers at once if you have any of these serious side effects within 24 hours after you receive Ketamine: severe confusion, hallucinations, unusual thoughts, or extreme fear.

This medication may impair your thinking or reactions. You will probably not be allowed to drive yourself home after your surgery or medical procedure. Avoid driving or operating machinery for at least 24 hours after you have received Ketamine.

Call your doctor at once if you have a serious side effect such as slow heart rate, weak or shallow breathing, feeling like you might pass out, pain or burning when you urinate, or jerky muscle movements that may look like convulsions.



Active ingredient matches for Ketamine:

Ketamine


Unit description / dosage (Manufacturer)Price, USD
Injectable; Injection; Ketamine Hydrochloride 50 mg / ml
Injectable; Injection; Ketamine Hydrochloride 100 mg / ml
Injectable; Injection; Ketamine Hydrochloride 10 mg / ml
Injectable; Injection; Ketamine Hydrochloride 10%
Ketamine hcl powder$ 7.22
Ketamine hcl-ns 50 mg/5 ml syr$ 2.82
Ketamine 100 mg/ml vial$ 2.36
Ketalar 100 mg/ml vial$ 1.95
Ketamine hcl-ns 100 mg/10 ml$ 1.95
Ketamine HCl 50 mg/ml Solution$ 1.77
Ketalar 10 mg/ml vial$ 0.99
Ketamine 10 mg/ml vial$ 0.99
Ketalar 50 mg/ml vial$ 0.75
Ketamine 50 mg/ml vial$ 0.61
Ketamine 20 mg Injection$ 0.16
Ketamine 100 mg Injection$ 0.06

List of Ketamine substitutes (brand and generic names):

Ketamine Hcl 100 mg Injection (Modern Laboratories)$ 0.03
Ketamine Hcl 500 mg Injection (Modern Laboratories)$ 0.08
Ketamine Hydrochloride 500 mg Injection (Ciron Drugs & Pharmaceuticals Pvt Ltd)$ 0.17
Ketamine Hydrochloride injection 50 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Hydrochloride injection 100 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Hydrochloride injection 10 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Hydrochloride injection, solution 10 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Hydrochloride injection, solution, concentrate 100 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Hydrochloride injection, solution, concentrate 50 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Hydrochloride injection, solution 50 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Hydrochloride injection, solution 100 mg/mL (Ciron Drugs & Pharmaceuticals Pvt Ltd)
Ketamine Sanavita 20 mg/1 mL x 1 Bottle
Ketamine Sanavita 20 mg/1 mL x 25 Bottle

References

  1. PubChem. "ketamine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. PubChem. "ebastine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "Ebastine". http://www.drugbank.ca/drugs/DB11742 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Ketamine are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Ketamine. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

1 consumer reported useful

Was the Ketamine drug useful in terms of decreasing the symptom or the disease?
According to the reports released by ndrugs.com website users, the below mentioned percentages of users say the drug is useful / not useful to them in decreasing their symptoms/disease. The usefulness of the drug depends on many factors, like severity of the disease, perception of symptom, or disease by the patient, brand name used [matters only to a certain extent], other associated conditions of the patient. If the drug is not effective or useful in your case, you need to meet the doctor to get re-evaluated about your symptoms/disease, and he will prescribe an alternative drug.
Users%
Not useful1
100.0%


1 consumer reported price estimates

Was the price you paid to purchase the drug reasonable? Did you feel it was expensive?
The below mentioned numbers have been reported by ndrugs.com website users about whether the Ketamine drug is expensive or inexpensive. There is a mixed opinion among users. The rating about the cost of the drug depends on factors like which brand drug the patient purchased, how effective it was for the price paid, the country or place the drug is marketed, and the economic condition of the patient. The users who feel the drug is expensive can look for an alternative brand drug or a generic drug to save the cost.
Users%
Not expensive1
100.0%


1 consumer reported time for results

To what extent do I have to use Ketamine before I begin to see changes in my health conditions?
As part of the reports released by ndrugs.com website users, it takes 2 days and a few days before you notice an improvement in your health conditions.
Please note, it doesn't mean you will start to notice such health improvement in the same time frame as other users. There are many factors to consider, and we implore you to visit your doctor to know how long before you can see improvements in your health while taking Ketamine. To get the time effectiveness of using Ketamine drug by other patients, please click here.
Users%
2 days1
100.0%


1 consumer reported age

Users%
16-291
100.0%


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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