Ketamine: Difference between revisions

From WikiMD's Wellness Encyclopedia

← Older edit
No edit summary
No edit summary
 
(2 intermediate revisions by the same user not shown)
Line 1: Line 1:
[[File:(RS)-Ketamine-Structural Formulae V2.svg|thumb|300px|Ketamine]]
'''Ketamine''' is a [[dissociative]] [[anesthetic]] widely used in [[medicine]] and [[veterinary medicine]] for [[anesthesia]], [[pain management]], and [[sedation]]. It is also known for its [[psychedelic]] effects and has gained attention for its potential as an [[antidepressant]]. Despite its medical applications, ketamine is also used recreationally for its hallucinogenic properties, leading to concerns about [[abuse]] and [[addiction]].
{{Infobox drug
| Watchedfields = changed
| verifiedrevid = 477168837
| image = Ketamine2DCSD.svg
| image_class = skin-invert-image
| width = 150
| alt =
| image2 = S-ketamine-from-HCl-xtal-3D-balls.png
| width2 = 175
| alt2 = (''S'')-Ketamine ball-and-stick model


<!--Clinical data-->
[[File:Ketamine2DCSD.svg|thumb|300px|Ketamine chemical structure]]
| tradename = Ketalar, others
[[File:S-ketamine-from-HCl-xtal-3D-balls.png|thumb|300px|S-Ketamine 3D molecular structure]]
| Drugs.com = {{drugs.com|monograph|ketamine-hydrochloride}}
| DailyMedID = Ketamine
| pregnancy_AU = B3
| pregnancy_AU_comment = <ref name="Drugs.com pregnancy">{{cite web | title=Ketamine (Ketalar) Use During Pregnancy | website=Drugs.com | date=22 November 2019 | url=https://www.drugs.com/pregnancy/ketamine.html | access-date=18 May 2020 | archive-date=26 June 2020 | archive-url=https://web.archive.org/web/20200626125239/https://www.drugs.com/pregnancy/ketamine.html | url-status=live }}</ref>
| addiction_liability = Moderate–high<ref>{{cite web |title=Drug Scheduling |url=https://www.dea.gov/drug-information/drug-scheduling |publisher=U.S. [[Drug Enforcement Administration]] |access-date=29 December 2023 |archive-date=8 April 2024 |archive-url=https://web.archive.org/web/20240408102758/https://www.dea.gov/drug-information/drug-scheduling |url-status=live }} Ketamine is listed in Schedule III.</ref><ref>Huang, MC., Lin, SK. (2020). "Ketamine Abuse: Past and Present". In: Hashimoto, K., Ide, S., Ikeda, K. (eds.) ''Ketamine''. Springer, Singapore. {{doi|10.1007/978-981-15-2902-3_1}}.</ref>
| routes_of_administration = Any<ref>{{cite journal | vauthors = Bell RF, Eccleston C, Kalso EA | title = Ketamine as an adjuvant to opioids for cancer pain | journal = The Cochrane Database of Systematic Reviews | volume = 6 | pages = CD003351 | date = June 2017 | issue = 9 | pmid = 28657160 | pmc = 6481583 | doi = 10.1002/14651858.CD003351.pub3 | url = http://opus.bath.ac.uk/57535/1/Published_Version.pdf | access-date = 10 September 2018 | archive-date = 12 January 2024 | archive-url = https://web.archive.org/web/20240112122726/http://opus.bath.ac.uk/57535/1/Published_Version.pdf | url-status = live }}</ref><ref>{{cite journal | vauthors = Moyse DW, Kaye AD, Diaz JH, Qadri MY, Lindsay D, Pyati S | title = Perioperative Ketamine Administration for Thoracotomy Pain | journal = Pain Physician | volume = 20 | issue = 3 | pages = 173–184 | date = March 2017 | pmid = 28339431 }}</ref><ref name="MathewZarate2016">{{cite book | vauthors = Mathew SJ, Zarate Jr CA |title=Ketamine for Treatment-Resistant Depression: The First Decade of Progress |url=https://books.google.com/books?id=QDOgDQAAQBAJ&pg=PA22|date=25 November 2016 |publisher=Springer |isbn=978-3-319-42925-0 |pages=8–10, 14–22 |url-status=live |archive-url=https://web.archive.org/web/20170908185726/https://books.google.com/books?id=QDOgDQAAQBAJ&pg=PA22 |archive-date=8 September 2017 }}</ref><ref name="MD">{{cite web|title=Ketamine Hydrochloride: Martindale: The Complete Drug Reference|date=9 January 2017|access-date=24 August 2017|veditors=Brayfield A|publisher=Pharmaceutical Press|website=MedicinesComplete|url=https://www.medicinescomplete.com/mc/martindale/current/ms-3114-h.htm|location=London, UK|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828134205/https://about.medicinescomplete.com/wp-content/themes/mc-marketing/assets/images/favicons-tiles/favicon.ico|url-status=live}}</ref>
| class = [[NMDA receptor antagonist]]; [[general anesthetic]]; [[dissociative hallucinogen]]; [[analgesic]]; [[antidepressant]]
| ATC_prefix = N01
| ATC_suffix = AX03


| legal_AU = S8
== Medical Uses ==
| legal_BR = C1
Ketamine is used in various medical settings, including hospitals, emergency rooms, and veterinary clinics. Some of its primary applications include:
| legal_CA = Schedule I
| legal_DE = Anlage III
| legal_UK = Class B
| legal_US = Schedule III
| legal_UN = Unscheduled
| legal_status = In general Rx-only


<!--Pharmacokinetic data-->
=== Anesthesia ===
| bioavailability = * [[Intravenous therapy|Intravenous]]: 100%<ref name="MathewZarate2016" />
Ketamine is used as an [[anesthetic]] for surgeries and medical procedures, particularly in situations where maintaining [[airway reflexes]] is critical. Unlike other anesthetics, ketamine does not significantly suppress [[respiration]], making it valuable in emergency settings.
* [[Intramuscular injection|Intramuscular]]: 93%<ref name="MathewZarate2016" />
* [[Epidural administration|Epidural]]: 77%<ref name="Kintz2014">{{cite book | vauthors = Kintz P |title=Toxicological Aspects of Drug-Facilitated Crimes |url=https://books.google.com/books?id=YgnUAgAAQBAJ&pg=PA87|date=22 March 2014 |publisher=Elsevier Science |isbn=978-0-12-416969-2 |pages=87– |url-status=live |archive-url=https://web.archive.org/web/20170908185726/https://books.google.com/books?id=YgnUAgAAQBAJ&pg=PA87 |archive-date=8 September 2017 }}</ref>
* [[Intranasal administration|Intranasal]]: 45–50%<ref name="MathewZarate2016" /><ref name="pmid23521979">{{cite journal |vauthors=Marland S, Ellerton J, Andolfatto G, Strapazzon G, Thomassen O, Brandner B, Weatherall A, Paal P |title=Ketamine: use in anesthesia |journal=CNS Neurosci Ther |volume=19 |issue=6 |pages=381–9 |date=June 2013 |pmid=23521979 |pmc=6493613 |doi=10.1111/cns.12072 }}</ref>
* [[Sublingual administration|Sublingual]]: 24–30%<ref name="MathewZarate2016" /><ref name="Hashimoto2019">{{cite journal | vauthors = Hashimoto K | title = Rapid-acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective | journal = Psychiatry and Clinical Neurosciences | volume = 73 | issue = 10 | pages = 613–627 | date = October 2019 | pmid = 31215725 | pmc = 6851782 | doi = 10.1111/pcn.12902 }}</ref>
* [[Rectal administration|Rectal]]: 25–30%<ref name="pmid23521979"/>
* [[Oral administration|By mouth]]: 16–20%<ref name="MathewZarate2016" /><ref name="pmid23521979"/>
| protein_bound = 23–47%<ref name="pmid6884418">{{cite journal |vauthors=Dayton PG, Stiller RL, Cook DR, Perel JM |title=The binding of ketamine to plasma proteins: emphasis on human plasma |journal=Eur J Clin Pharmacol |volume=24 |issue=6 |pages=825–31 |date=1983 |pmid=6884418 |doi=10.1007/BF00607095 |s2cid=807011 }}</ref>
| metabolism = [[Liver]], [[intestine]] (oral):
* Major: [[CYP3A4]], [[CYP2B6]]<ref name="MathewZarate2016" /><ref>{{cite journal | vauthors = Hijazi Y, Boulieu R | title = Contribution of CYP3A4, CYP2B6, and CYP2C9 isoforms to N-demethylation of ketamine in human liver microsomes | journal = Drug Metabolism and Disposition | volume = 30 | issue = 7 | pages = 853–8 | date = July 2002 | pmid = 12065445 | doi = 10.1124/dmd.30.7.853 | s2cid = 15787750 }}</ref>
* Intramuscular: 1–5 min
* Subcutaneous: 15–30 min
* Insufflation: 5–10 min
* By mouth: 15–30 min
| elimination_half-life = * Ketamine: 2.5–3 hours
* Norketamine: 12 hours
| duration_of_action = * Intramuscular: 0.5–2 hours
* Insufflation: 45–60 min
* By mouth: 1–6+ hours
| excretion = * [[Urine]]: 91%
* [[Feces]]: 3%


<!--Identifiers-->
=== Pain Management ===
| index2_label = HCl
Ketamine is administered for [[chronic pain]] conditions, such as:
| IUPHAR_ligand = 4233
* [[Neuropathic pain]]
| CAS_number_Ref = {{cascite|correct|??}}
* [[Cancer pain]]
| CAS_number = 6740-88-1
* [[Complex regional pain syndrome (CRPS)]]
| CAS_number2_Ref = {{cascite|correct|??}}
* Post-surgical pain management
| CAS_number2 = 1867-66-9
| CAS_supplemental = {{plainlist|
* 33643-46-8 ([[esketamine]])
* 33643-49-1 ([[arketamine]])
}}
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 6121
| PubChem = 3821
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB01221
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 3689
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 690G0D6V8H
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D08098
| KEGG2_Ref = {{keggcite|correct|kegg}}
| KEGG2 = D00711
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 742
| synonyms = CI-581; CL-369; CM-52372-2<ref name="MortonHall2012">{{cite book | vauthors = Morton IK, Hall JM |title=Concise Dictionary of Pharmacological Agents: Properties and Synonyms |url=https://books.google.com/books?id=tsjrCAAAQBAJ&pg=PA159|date=6 December 2012 |publisher=Springer Science & Business Media |isbn=978-94-011-4439-1 |pages=159– |url-status=live |archive-url=https://web.archive.org/web/20170411144623/https://books.google.com/books?id=tsjrCAAAQBAJ&pg=PA159 |archive-date=11 April 2017 }}</ref>


<!-- Chemical and physical data -->
Low-dose ketamine infusions have been increasingly used as an adjunct to traditional [[opioid]] therapies, helping to reduce opioid dependence.
| IUPAC_name = (''RS'')-2-(2-Chlorophenyl)-2-(methylamino)cyclohexanone
 
| C = 13
=== Treatment-Resistant Depression ===
| H = 16
Recent studies suggest that ketamine has rapid and significant [[antidepressant]] effects, especially in individuals with treatment-resistant depression. A single dose can provide relief from depressive symptoms within hours, with effects lasting up to a week.
| Cl = 1
 
| N = 1
Ketamine is also being researched for its potential to treat:
| O = 1
* [[Post-traumatic stress disorder (PTSD)]]
| chirality = [[Racemic mixture]]:<ref name="sinner" />
* [[Obsessive-compulsive disorder (OCD)]]
* [[Esketamine]] (''S''(+)-isomer)
* [[Suicidal ideation]]
* [[Arketamine]] (''R''(−)-isomer)
* [[Anxiety disorders]]
| SMILES = Clc1ccccc1C2(NC)CCCCC2=O
 
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
=== Emergency Medicine ===
| StdInChI = 1S/C13H16ClNO/c1-15-13(9-5-4-8-12(13)16)10-6-2-3-7-11(10)14/h2-3,6-7,15H,4-5,8-9H2,1H3
Ketamine is used in emergency settings due to its rapid onset and safety profile. It is useful for:
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
* Trauma patients – Provides anesthesia and sedation without causing significant drops in blood pressure.
| StdInChIKey = YQEZLKZALYSWHR-UHFFFAOYSA-N
* Severe asthma attacks – Functions as a bronchodilator to improve breathing.
| density =
* Agitation and sedation – Used in psychiatric emergencies for acute agitation or violent behavior.
| density_notes =
| melting_point = 92 <ref>{{cite book |vauthors=Sass W, Fusari S |date=1977 |chapter=Ketamine |title=Analytical Profiles of Drug Substances |volume=6 |publisher=Academic Press |pages=297–322 |doi=10.1016/S0099-5428(08)60347-0 |isbn=9780122608063 }}</ref>
| melting_high =
| melting_notes =
| boiling_point =
| boiling_notes =
| solubility =
| sol_units =
| specific_rotation =
}}
'''Ketamine''' is a [[dissociative]] [[anesthetic]]. It is a type of drug a doctor might give to put someone to sleep for an operation. Ketamine can also be used as a [[painkiller]] and a bronchodilator (which makes it easier for air to get into your [[lungs]]).<ref>{{Cite book |last1=Peck |first1=T. E. |last2=Hill |first2=S. A. |last3=Williams |first3=M. |year=2008 |page=111 |title=Pharmacology for anaesthesia and intensive care (3rd edition) |publisher=Cambridge University Press |location=Cambridge |isbn=978-0-521-70463-2}}</ref>
Sometimes it can lead to a special type of [[hallucination]] which makes you feel detached from yourself and the things around you<ref>{{Cite journal |last=Bergman |first=S. A. |title=Ketamine: review of its pharmacology and its use in pediatric anesthesia |journal=Anesthesia Progress |volume=46 |issue=1 |pages=10–20 |year=1999 |pmid=10551055 |pmc=2148883}}</ref> which is why some people use it as a recreational drug. As it can have severe side effects, it is usually not available as an over-the-counter drug.


==Medical use==
=== Pediatric and Veterinary Use ===
In medicine, ketamine is normally injected into a [[vein]] or [[muscle]].<ref name="lankenau">{{Cite journal|author=Lankenau SE, Sanders B, Bloom JJ, ''et al.'' |title=First injection of ketamine among young injection drug users (IDUs) in three U.S. cities |journal=Drug and Alcohol Dependence |volume=87 |issue=2–3 |pages=183–93 |date=March 2007 |pmid=16979848 |pmc=1852477 |doi=10.1016/j.drugalcdep.2006.08.015}}</ref>
Ketamine is commonly used in pediatric anesthesia because of its safety in maintaining respiration and circulation.
Ketamine is not the first anaesthetic a doctor would think of using in most situations because of the hallucinations it causes. On the other hand, while most anaesthetics suppress your breathing, resulting in the need for a machine to help you breathe, ketamine does not.<ref name="heshmati">{{Cite journal|author=Heshmati F, Zeinali MB, Noroozinia H, Abbacivash R, Mahoori A |title=Use of ketamine in severe status asthmaticus in intensive care unit |journal=Iranian Journal of Allergy, Asthma, and Immunology |volume=2 |issue=4 |pages=175–80 |date=December 2003 |pmid=17301376 |doi=}}</ref>
This can make it a useful anaesthetic when you don't have any equipment available, for example, in a war zone.{{Citation needed|reason=This claim needs a reliable source|date=December 2013}}
==Side effects==
===Short term===
Short term side effects happen in about 40% of people and include:<ref name ="Quibell">{{Cite journal|author = Quibell R, Prommer EE, Mihalyo M, ''et al.''|title = "Ketamine*"|journal = Journal of Pain and Symptom Management |volume = 41| issue = 3|pages = 640-649|date=March 2011|pmid = 21419322|doi=10.1016/j.jpainsymman.2011.01.001}}</ref>
* [[Dizziness]]
* [[Double vision]]
* [[Euphoria]]
* [[Blurred vision]]
* Finding it hard to express [[emotions]], not being very emotionally reactive
* [[High blood pressure]]
* [[Tachycardia|Fast heart beat]]
* [[Nausea|Feeling sick]] and [[vomiting]]
* Having trouble understanding or producing [[speech]]
* [[Nightmares]]
* [[Illusions]]
* [[Hallucinations]]
* Changed [[body image]]
* [[Impaired memory]] and [[attention]].


===Long term===
In veterinary medicine, ketamine is widely used for sedation and anesthesia in cats, dogs, horses, and other animals.


In the medical setting, ketamine is only given a few times so most long term effects mentioned below are found in recreational ketamine users and animal models.<ref name=morgan11>{{cite journal|last=Morgan|first=Celia J. A.|coauthors=Curran, H. Valerie|title=Ketamine use: a review|journal=Addiction|date=1 January 2012|volume=107|issue=1|pages=27–38|doi=10.1111/j.1360-0443.2011.03576.x|pmid=21777321}}</ref>
== Mechanism of Action ==
Ketamine primarily acts as an NMDA receptor antagonist in the [[central nervous system]] (CNS). By blocking these receptors, it inhibits excessive excitatory neurotransmission, leading to its anesthetic and analgesic effects.


====Urinary tract effects====
Additionally, ketamine affects:
There are 110 reports of people with problems in their urinary tract due to using ketamine.<ref name=middela>{{cite journal|last=Middela|first=S.|coauthors=Pearce, I.|title=Ketamine-induced vesicopathy: a literature review|journal=International Journal of Clinical Practice|date=1 January 2011|volume=65|issue=1|pages=27–30|doi=10.1111/j.1742-1241.2010.02502.x|pmid=21155941}}</ref>
* Opioid receptors – contributing to its pain-relief properties.
* Dopamine system – leading to potential antidepressant effects.
* Sigma receptors – involved in dissociative and hallucinogenic experiences.


Symptoms include:
== Pharmacokinetics ==
* Urgently needing to urinate.
{| class="wikitable" style="width:100%; text-align:center;"
* Finding it painful to urinate and having [[blood]] in your [[urine]].
! Route of Administration !! Bioavailability !! Onset of Action !! Duration of Effects
* Not being able to hold as much urine in your [[bladder]]
|-
* These urinary tract problems are most common in people who have abused ketamine daily for a long time.<ref name =morgan11 />
| [[Intravenous therapy|Intravenous (IV)]] || 100% || 30 sec – 1 min || 10 – 15 min
|-
| [[Intramuscular injection|Intramuscular (IM)]] || 93% || 2 – 4 min || 30 – 60 min
|-
| [[Intranasal administration|Intranasal]] || 45 – 50% || 5 – 10 min || 60 min
|-
| [[Sublingual administration|Sublingual]] || 24 – 30% || 15 – 30 min || 1 – 2 hours
|-
| [[Oral administration|Oral]] || 16 – 20% || 30 – 40 min || 2 – 6+ hours
|}


====Neurological effects====
== Side Effects ==
While ketamine is a valuable medical drug, it also carries risks, particularly when misused.


People who abuse ketamine a lot (more than 4 times a week) have been found to have impaired memory and increased depression when compared to people who don't abuse ketamine. Those who use ketamine less frequently (1-4 times per week) and those who had stopped taking ketamine showed no difference in the aforementioned parameters. This suggests that these problems with memory and mood do not affect infrequent users and might be reversible once ketamine use is stopped.<ref name="Addiction Users Study">{{Cite journal|doi=10.1111/j.1360-0443.2009.02761.x |pmid=19919593 |title=Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1-year longitudinal study |year=2009 |last1=Morgan |first1=Celia J. A. |last2=Muetzelfeldt |first2=Leslie |last3=Curran |first3=H. Valerie |journal=Addiction |volume=105 |issue=1 |pages=121–33}}</ref>
=== Short-Term Side Effects ===
Common side effects include:
* Dizziness
* Nausea and vomiting
* Increased blood pressure and heart rate
* Blurred vision
* Confusion and disorientation
* Hallucinations and dissociation (often described as a "K-hole")
* Difficulty speaking and moving


One study has recently been done using monkeys as a model to see if ketamine is toxic to the brain.<ref name="Cynomolgus monkey neurotoxiciy">{{cite journal|last=Sun|first=Lin|coauthors=Qi Li, Qing Li, Yuzhe Zhang, Dexiang Liu, Hong Jiang, Fang Pan, David T. Yew|title=Chronic ketamine exposure induces permanent impairment of brain functions in adolescent cynomolgus monkeys|journal=Addiction Biology|date=November 2012|doi=10.1111/adb.12004|pmid=23145560|url=http://onlinelibrary.wiley.com/doi/10.1111/adb.12004/abstract}}</ref>
=== Long-Term Side Effects ===
The study found that injecting the monkeys every day for 6 months with ketamine caused more cells to die in the [[pre-frontal cortex|front]] of their brain and also caused a decrease in activity in the areas of the brain which control movement.
Prolonged or heavy ketamine use can lead to:
* Cognitive impairment – Memory loss, trouble concentrating.
* Ketamine bladder syndrome – Severe inflammation, pain, and potential bladder dysfunction.
* Liver and kidney damage – Due to chronic exposure.
* Psychological dependence – Leading to addiction and withdrawal symptoms.


==Mechanism of action==
== Recreational Use ==
Ketamine is an NMDA antagonist in the CNS. By inhibiting NMDA receptors in inhibitory neurons in the brain, it causes increased CNS activity and sympathomimetic effects. As a result, there is not only an anaesthetic effect, but also activation of the CNS unlike other anaesthetics. This is beneficial in surgical settings because it maintains blood pressure, airway reflexes, bronchioles remain dilated, and airways patent. Making this a particularly useful drug in shock and surgery patients because of blood pressure maintained with ketamine use, unlike typical anaesthetics which cause decreased BP and respiratory suppression.
Ketamine is widely used as a club drug due to its hallucinogenic and dissociative effects. Users often seek a sensation of detachment from reality, which can range from mild to profound.


==Research==
Common Forms of Recreational Use:
* Snorted (Insufflation) – Most common, with effects lasting 30 – 60 minutes.
* Injected (IM or IV) – Produces stronger effects with a rapid onset.
* Oral Consumption – Effects last longer but are less intense.


===Treating addiction===
The "K-Hole" Experience:
One study by Evgeny Krupitsky has found that using ketamine along with psychotherapy and group therapy was a lot more effective at treating alcohol addiction than the traditional treatment.<ref>{{cite web|url=http://www.eleusis.us/resource-center/references/acamethod.php|title=The Combination of Psychedelic and Aversive Approaches in Alcoholism Treatment - Eleusis<!-- Bot generated title -->|publisher=}}</ref>
At high doses, users report entering a "K-hole", described as:
The same scientist found that ketamine might also be useful for treating heroin addiction. Patients who had been treated for their addiction with multiple sessions of ketamine fared much better than those who had only had one session of ketamine, with abstinence rates of 50% and 22.2% respectively.<ref>http://www.eleusis.us/resource-center/references/ketamine-psychotherapy-heroin.pdf</ref>
* Out-of-body sensations
* Ego dissolution
* Time distortion
* Vivid hallucinations


===As an antidepressant===
Long-term recreational use is associated with serious bladder damage, memory impairment, and psychological dependence.
Some small studies have been done which found that a single dose of ketamine was able to improve treatment-resistant depression after just a few hours, with the effects lasting for one week.<ref>[http://www.nih.gov/news/pr/aug2006/nimh-07b.htm NIH. "Experimental Medication Kicks Depression in Hours Instead of Weeks"] ''NIH News'', 7 August 2006</ref><ref>Khamsi, R. [https://www.newscientist.com/channel/health/dn9696.html "Ketamine relieves depression within hours"] ''[[New Scientist]]'', 8 August 2006.</ref> The rapid antidepressant effects of ketamine may prove to be a useful alternative compared to current antidepressants, which can take several weeks to have their effects.<ref name=pmid8788498>{{Cite journal|author=Eison AS, Mullins UL |title=Regulation of central 5-HT<sub>2A</sub> receptors: a review of in vivo studies |journal=Behavioural Brain Research |volume=73 |issue=1–2 |pages=177–81 |year=1996 |pmid=8788498 |doi=10.1016/0166-4328(96)00092-7}}</ref>


===Complex regional pain syndrome===
== Legal Status ==
CRPS is a disease that causes severe pain and swelling, getting worse over time.<ref>{{cite web|url=https://www.marksandharrison.com/firm-news-announcements/complex-regional-pain-syndrome-crps/|title=Complex Regional Pain Syndrome (CRPS)|publisher=Marks & Harrison}}</ref> Some researchers have been investigating the use of ketamine to treat this condition. In some cases, low-dose ketamine infusions have shown promising results in reducing pain levels, even in patients who have not responded to other treatments.<ref>{{Cite journal|author=Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M|title=Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study|journal=Pain|volume=147|issue=1–3|pages=107–15|year=2009|pmid=19836135|doi=10.1016/j.pain.2009.08.015}}</ref>
Ketamine is classified differently across countries:


===Post-traumatic stress disorder (PTSD)===
{| class="wikitable" style="width:100%; text-align:center;"
Ketamine has been studied for its potential use in treating post-traumatic stress disorder (PTSD). Some early studies suggest that ketamine may be effective in rapidly reducing the severity of PTSD symptoms, and its effects may last for several weeks following a single treatment.<ref>{{Cite journal|author=Feder A, Parides MK, Murrough JW, et al.|title=Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder: A Randomized Clinical Trial|journal=JAMA Psychiatry|volume=71|issue=6|pages=681–688|year=2014|pmid=24740528|doi=10.1001/jamapsychiatry.2014.62}}</ref> More research is needed to determine the safety and efficacy of ketamine for treating PTSD in the long term.
! Country !! Legal Status
|-
| United States || Schedule III (Controlled, but used medically)
|-
| United Kingdom || Class B (Illegal without prescription)
|-
| Canada || Schedule I (Highly restricted)
|-
| Australia || Schedule 8 (Controlled substance)
|-
| Germany || Anlage III (Requires special prescription)
|}


==Recreational use==
== Research and Future Applications ==
Ketamine is sometimes used recreationally, typically at sub-anesthetic doses. Users often report feelings of dissociation, hallucinations, and a sense of detachment from their body or reality. This experience is sometimes referred to as entering the "K-hole."<ref>{{cite web|url=https://www.vice.com/en/article/59zj5z/what-is-a-k-hole-ketamine|title=What Is a K-Hole and What Does It Feel Like?|publisher=VICE|author=Max Daly}}</ref> However, frequent or high-dose recreational use can lead to a variety of negative health consequences, including bladder damage, cognitive impairment, and addiction.<ref>{{Cite journal|author=Morgan CJ, Curran HV |title=Acute and chronic effects of ketamine upon human memory: a review |journal=Psychopharmacology |volume=188 |issue=4 |pages=408–24 |year=2006 |pmid=17019667 |doi=10.1007/s00213-006-0572-3}}</ref>
Antidepressant Research
Ongoing research is exploring ketamine’s rapid antidepressant effects, particularly for:
* Treatment-resistant depression
* Bipolar depression
* Postpartum depression
* Suicidal ideation


==Risks and side effects==
Treatment for Addiction
Ketamine can cause various side effects, including nausea, vomiting, dizziness, nystagmus (involuntary eye movements), and increased heart rate and blood pressure. High doses or frequent use of ketamine can lead to more severe side effects, such as bladder damage, cognitive impairment, and addiction.<ref>{{Cite journal|author=Morgan CJ, Curran HV |title=Acute and chronic effects of ketamine upon human memory: a review |journal=Psychopharmacology |volume=188 |issue=4 |pages=408–24 |year=2006 |pmid=17019667 |doi=10.1007/s00213-006-0572-3}}</ref>
Studies suggest ketamine may help treat:
* Alcohol use disorder
* Opioid addiction
* Nicotine dependence


Long-term use of ketamine can lead to a condition called [[ketamine cystitis]], which is characterized by severe inflammation of the bladder, causing symptoms such as frequent and painful urination, blood in the urine, and incontinence.<ref>{{Cite journal|author=Chu PS, Ma WK, Wong SC, et al.|title=The destruction of the lower urinary tract by ketamine abuse: a new syndrome?|journal=BJU International|volume=102|issue=11|pages=1616-1622|year=2008|pmid=19021601|doi=10.1111/j.1464-410X.2008.07917.x}}</ref> Additionally, chronic ketamine use has been associated with cognitive deficits, including impairments in memory, attention, and executive function.<ref>{{Cite journal|author=Morgan CJ, Curran HV |title=Acute and chronic effects of ketamine upon human memory: a review |journal=Psychopharmacology |volume=188 |issue=4 |pages=408–24 |year=2006 |pmid=17019667 |doi=10.1007/s00213-006-0572-3}}</ref>
== Summary ==
Ketamine is a powerful anesthetic, analgesic, and psychedelic drug with widespread medical uses. While its potential for treating depression and chronic pain is promising, its recreational abuse raises concerns over addiction and long-term health effects. The drug remains a valuable tool in medicine but requires careful administration and regulation.


Ketamine can also have psychological side effects, such as feelings of anxiety, agitation, and paranoia. These effects may be more pronounced in individuals with a history of mental health disorders. There is also a risk of developing a psychological dependence on ketamine, especially with frequent use.<ref>{{Cite journal|author=Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJ, Curran HV |title=Journey through the K-hole: phenomenological aspects of ketamine use|journal=Drug and Alcohol Dependence |volume=95 |issue=1-2 |pages=219–29 |year=2008 |pmid=18355990 |doi=10.1016/j.drugalcdep.2008.01.024}}</ref>
== See Also ==
* [[Dissociative anesthetics]]
* [[NMDA receptor antagonists]]
* [[Psychedelic therapy]]
* [[General anesthesia]]
* [[Pain management]]


It is essential to use ketamine under the supervision of a healthcare professional to minimize the risk of side effects and complications. When used medically, ketamine is typically administered in a controlled setting, with appropriate monitoring and management of potential side effects.
==References==
<references/>
{{stub}}
{{stub}}
{{Pharmacology}}
{{Navboxes
{{Navboxes
|title= [[Pharmacodynamics]]
|title= Medical Uses
|titlestyle= background:#ccccff
|list1=
{{Acetylcholine receptor modulators}}
{{Dopamine receptor modulators}}
{{Ion channel modulators}}
{{Ionotropic glutamate receptor modulators}}
{{Monoamine reuptake inhibitors}}
{{Opioid receptor modulators}}
{{Sigma receptor modulators}}
}}
{{Navboxes
|title= [[Medicine|Medical uses]]
|titlestyle= background:#ccccff
|list1=
|list1=
{{General anesthetics}}
{{General anesthetics}}
Line 207: Line 150:
}}
}}
{{Navboxes
{{Navboxes
|title= [[Recreational drug use|Recreational uses]]
|title= Recreational Use
|titlestyle= background:#ccccff
|list1=
|list1=
{{Drug use}}
{{Hallucinogens}}
{{Hallucinogens}}
{{Euphoriants}}
}}
}}
{{Portal bar|Medicine}}
{{Portal bar|Medicine|Psychiatry}}
{{Authority control}}
{{stub}}
 
[[Category:Anesthetics]]
[[Category:Psychedelics]]
[[Category:Dissociative drugs]]
[[Category:Analgesics]]
[[Category:Analgesics]]
[[Category:Antidepressants]]
[[Category:Arylcyclohexylamines]]
[[Category:Chemical substances for emergency medicine]]
[[Category:Chloroarenes]]
[[Category:D2-receptor agonists]]
[[Category:Dissociative drugs]]
[[Category:Drugs with unknown mechanisms of action]]
[[Category:Euphoriants]]
[[Category:General anesthetics]]
[[Category:Ketones]]
[[Category:Muscarinic antagonists]]
[[Category:NMDA receptor antagonists]]
[[Category:NMDA receptor antagonists]]
[[Category:Nicotinic antagonists]]
[[Category:Controlled substances]]
[[Category:Opioid modulators]]
[[Category:Veterinary drugs]]
[[Category:Sedatives]]
[[Category:Sigma agonists]]
[[Category:World Health Organization essential medicines]]
 
[[Category:Veterinary medicine]]
[[Category:Equine medications]]
[[Category:Drug-facilitated sexual assault]]
[[Category:Drugs]]

Latest revision as of 21:13, 19 March 2025

Ketamine is a dissociative anesthetic widely used in medicine and veterinary medicine for anesthesia, pain management, and sedation. It is also known for its psychedelic effects and has gained attention for its potential as an antidepressant. Despite its medical applications, ketamine is also used recreationally for its hallucinogenic properties, leading to concerns about abuse and addiction.

File:Ketamine2DCSD.svg
Ketamine chemical structure
File:S-ketamine-from-HCl-xtal-3D-balls.png
S-Ketamine 3D molecular structure

Medical Uses[edit]

Ketamine is used in various medical settings, including hospitals, emergency rooms, and veterinary clinics. Some of its primary applications include:

Anesthesia[edit]

Ketamine is used as an anesthetic for surgeries and medical procedures, particularly in situations where maintaining airway reflexes is critical. Unlike other anesthetics, ketamine does not significantly suppress respiration, making it valuable in emergency settings.

Pain Management[edit]

Ketamine is administered for chronic pain conditions, such as:

Low-dose ketamine infusions have been increasingly used as an adjunct to traditional opioid therapies, helping to reduce opioid dependence.

Treatment-Resistant Depression[edit]

Recent studies suggest that ketamine has rapid and significant antidepressant effects, especially in individuals with treatment-resistant depression. A single dose can provide relief from depressive symptoms within hours, with effects lasting up to a week.

Ketamine is also being researched for its potential to treat:

Emergency Medicine[edit]

Ketamine is used in emergency settings due to its rapid onset and safety profile. It is useful for:

  • Trauma patients – Provides anesthesia and sedation without causing significant drops in blood pressure.
  • Severe asthma attacks – Functions as a bronchodilator to improve breathing.
  • Agitation and sedation – Used in psychiatric emergencies for acute agitation or violent behavior.

Pediatric and Veterinary Use[edit]

Ketamine is commonly used in pediatric anesthesia because of its safety in maintaining respiration and circulation.

In veterinary medicine, ketamine is widely used for sedation and anesthesia in cats, dogs, horses, and other animals.

Mechanism of Action[edit]

Ketamine primarily acts as an NMDA receptor antagonist in the central nervous system (CNS). By blocking these receptors, it inhibits excessive excitatory neurotransmission, leading to its anesthetic and analgesic effects.

Additionally, ketamine affects:

  • Opioid receptors – contributing to its pain-relief properties.
  • Dopamine system – leading to potential antidepressant effects.
  • Sigma receptors – involved in dissociative and hallucinogenic experiences.

Pharmacokinetics[edit]

Route of Administration Bioavailability Onset of Action Duration of Effects
Intravenous (IV) 100% 30 sec – 1 min 10 – 15 min
Intramuscular (IM) 93% 2 – 4 min 30 – 60 min
Intranasal 45 – 50% 5 – 10 min 60 min
Sublingual 24 – 30% 15 – 30 min 1 – 2 hours
Oral 16 – 20% 30 – 40 min 2 – 6+ hours

Side Effects[edit]

While ketamine is a valuable medical drug, it also carries risks, particularly when misused.

Short-Term Side Effects[edit]

Common side effects include:

  • Dizziness
  • Nausea and vomiting
  • Increased blood pressure and heart rate
  • Blurred vision
  • Confusion and disorientation
  • Hallucinations and dissociation (often described as a "K-hole")
  • Difficulty speaking and moving

Long-Term Side Effects[edit]

Prolonged or heavy ketamine use can lead to:

  • Cognitive impairment – Memory loss, trouble concentrating.
  • Ketamine bladder syndrome – Severe inflammation, pain, and potential bladder dysfunction.
  • Liver and kidney damage – Due to chronic exposure.
  • Psychological dependence – Leading to addiction and withdrawal symptoms.

Recreational Use[edit]

Ketamine is widely used as a club drug due to its hallucinogenic and dissociative effects. Users often seek a sensation of detachment from reality, which can range from mild to profound.

Common Forms of Recreational Use:

  • Snorted (Insufflation) – Most common, with effects lasting 30 – 60 minutes.
  • Injected (IM or IV) – Produces stronger effects with a rapid onset.
  • Oral Consumption – Effects last longer but are less intense.

The "K-Hole" Experience: At high doses, users report entering a "K-hole", described as:

  • Out-of-body sensations
  • Ego dissolution
  • Time distortion
  • Vivid hallucinations

Long-term recreational use is associated with serious bladder damage, memory impairment, and psychological dependence.

Legal Status[edit]

Ketamine is classified differently across countries:

Country Legal Status
United States Schedule III (Controlled, but used medically)
United Kingdom Class B (Illegal without prescription)
Canada Schedule I (Highly restricted)
Australia Schedule 8 (Controlled substance)
Germany Anlage III (Requires special prescription)

Research and Future Applications[edit]

Antidepressant Research Ongoing research is exploring ketamine’s rapid antidepressant effects, particularly for:

  • Treatment-resistant depression
  • Bipolar depression
  • Postpartum depression
  • Suicidal ideation

Treatment for Addiction Studies suggest ketamine may help treat:

  • Alcohol use disorder
  • Opioid addiction
  • Nicotine dependence

Summary[edit]

Ketamine is a powerful anesthetic, analgesic, and psychedelic drug with widespread medical uses. While its potential for treating depression and chronic pain is promising, its recreational abuse raises concerns over addiction and long-term health effects. The drug remains a valuable tool in medicine but requires careful administration and regulation.

See Also[edit]

This article is a medical stub. You can help WikiMD by expanding it!
PubMed
Wikipedia


Pharmacology
Ligand (biochemistry)
Pharmacodynamics
Pharmacokinetics
Related
fields
Other


Medical Uses
General anesthetics (N01A)
Inhalational
Injection


The following are antidepressant subclasses and drugs

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone


Recreational Use
Hallucinogens
Psychedelics
(5-HT2A
agonists)
Benzofurans
Lyserg‐
amides
Phenethyl‐
amines
2C-x
* 2C-B


25x-NBx
25x-NMx
N-(2C)-fentanyl
3C-x
4C-x
DOx
Piperazines
Tryptamines
Dissociatives
(NMDAR
antagonists)
Deliriants
(mAChR
antagonists)
Others
Cannabinoids
(CB1 agonists)
Natural
Synthetic
AM-x
CP x
HU-x
JWH-x
Misc. designer cannabinoids
D2 agonists
GABAA
enhancers
Inhalants
(Mixed MOA)
κOR agonists


This article is a medical stub. You can help WikiMD by expanding it!
PubMed
Wikipedia
Retrieved from "https://wikimd.com/index.php?title=Ketamine&oldid=6531963"