Ketamine HCl Uses

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What is Ketamine HCl?

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

Ketamine HCl 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 HCl hydrochloride injection is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Ketamine HCl hydrochloride is best suited for short procedures but it can be used, with additional doses, for longer procedures.

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

Ketamine HCl 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 HCl?

Use Ketamine HCl 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 HCl.

Uses of Ketamine HCl 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 HCl 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 HCl in this condition. Since there is limited data on the safety and efficacy of Ketamine HCl in this setting, the Neurocritical Care Society recommends reservation of Ketamine HCl for patients who do not respond to more frequently recommended antiepileptic drug treatment.

Ketamine HCl description

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

Ketamine HCl dosage

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

If the Ketamine HCl hydrochloride dose is augmented with diazepam, the two drugs must be given separately. Do not mix Ketamine HCl 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 HCl hydrochloride administration, some airway protection may be afforded because of active laryngeal-pharyngeal reflexes. However, since aspiration may occur with Ketamine HCl hydrochloride and since protective reflexes may also be diminished by supplementary anesthetics and muscle relaxants, the possibility of aspiration must be considered. Ketamine HCl 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 HCl 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 HCl 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 HCl 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 HCl 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 HCl 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 HCl 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 HCl 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 HCl hydrochloride administered, the longer will be the time to complete recovery.

Adult patients induced with Ketamine HCl hydrochloride augmented with intravenous diazepam may be maintained on Ketamine HCl 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 HCl 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 HCl per mL.

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

Supplementary Agents

Ketamine HCl 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 HCl 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 HCl hydrochloride injection is supplied as the hydrochloride in concentrations equivalent to Ketamine HCl 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 HCl interactions

See also:
What other drugs will affect Ketamine HCl?

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

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

The use of halogenated anaesthetics concomitantly with Ketamine HCl can lengthen the elimination half-life of Ketamine HCl and delay recovery from anaesthesia. Concurrent use of Ketamine HCl (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 HCl 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 HCl may be required with concurrent administration of other anxiolytics, sedatives and hypnotics.

Ketamine HCl 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 HCl.

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

When Ketamine HCl 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 HCl 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 HCl side effects

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

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Cardiovascular: Blood pressure and pulse rate are frequently elevated following administration of Ketamine HCl 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 HCl hydrochloride. Laryngospasms and other forms of airway obstruction have occurred during Ketamine HCl hydrochloride anesthesia.

Eye: Diplopia and nystagmus have been noted following Ketamine HCl 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 HCl 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 HCl has been reported being used as a drug of abuse.

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

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

Ketamine HCl contraindications

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

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

Before you receive Ketamine HCl, 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 HCl 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 HCl 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 HCl: 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 HCl.

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 HCl:

Ketamine in Israel, United States.


Unit description / dosage (Manufacturer)Price, USD
Ketamine Hcl 100 mg Injection$ 0.03
Ketamine Hcl 500 mg Injection$ 0.08

List of Ketamine HCl substitutes (brand and generic names):

Ketamine-P 50 mg/10 mL x 10 mL
KETANIK 50MG INJECTION 1 vial / 2 ML injection each (Rekvina Laboratories Ltd)$ 0.37
KETANIK INJECTION 1 vial / 10 ML injection each (Rekvina Laboratories Ltd)$ 1.98
Ketanik 50mg/ml Injection (Rekvina Laboratories Ltd)$ 0.18
Ketanik NA Injection (Rekvina Laboratories Ltd)$ 0.20
Injectable; Injection; Ketamine Hydrochloride 100 mg / ml
Ketasol 100 mg Injection (Harson Lab Pvt. Ltd.)$ 0.04
Ketasol 500 mg Injection (Harson Lab Pvt. Ltd.)$ 0.14
KETASOL INJECTION 1 vial / 10 ML injection each (Harson Lab Pvt. Ltd.)$ 1.52
KETASOL INJECTION 1 vial / 2 ML injection each (Harson Lab Pvt. Ltd.)$ 0.48
Ketava 10 mg/1 mL x 20 mL x 1's
KETAVAN 50MG INJECTION 1 vial / 2 ML injection each (Bharat Serums & Vaccines Ltd)$ 0.46
KETAVAN 50MG INJECTION 1 vial / 10 ML injection each (Bharat Serums & Vaccines Ltd)$ 1.83
Ketazol / vial 50 mg/1 mL x 10 mL x 10's (Shalina Laboratories Ltd)
Ketazol 200 mg Tablet (Shalina Laboratories Ltd)$ 0.09
Ketmin 50mg/ml AMP / 2ml (Themis Medicare Ltd.)$ 0.38
Ketmin 50mg/ml VIAL / 10ml (Themis Medicare Ltd.)$ 1.60
Ketmin 50mg/ml VIAL / 2ml (Themis Medicare Ltd.)$ 0.42
50 mg x 1 mL x 10ml (Themis Medicare Ltd.)$ 1.60
50 mg x 1 mL x 2ml (Themis Medicare Ltd.)$ 0.38
Ketmin 500 mg Injection (Themis Medicare Ltd.)$ 0.16
Ketmin 100 mg Injection (Themis Medicare Ltd.)$ 0.06
KETMIN 100MG INJECTION 1 vial / 2 ML injection each (Themis Medicare Ltd.)$ 0.41
KETMIN 10MG INJECTION 1 vial / 10 ML injection each (Themis Medicare Ltd.)$ 1.83

References

  1. PubChem. "ketamine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. DrugBank. "ketamine". http://www.drugbank.ca/drugs/DB01221 (accessed September 17, 2018).
  3. DTP/NCI. "ketamine: The NCI Development Therapeutics Program (DTP) provides services and resources to the academic and private-sector research communities worldwide to facilitate the discovery and development of new cancer therapeutic agents.". https://dtp.cancer.gov/dtpstandard/s... (accessed September 17, 2018).

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