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[[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
| H = 16
| Cl = 1
| N = 1
| O = 1
| chirality = [[Racemic mixture]]:<ref name="sinner" />
* [[Esketamine]] (''S''(+)-isomer)
* [[Arketamine]] (''R''(−)-isomer)
| SMILES = Clc1ccccc1C2(NC)CCCCC2=O
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| 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
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = YQEZLKZALYSWHR-UHFFFAOYSA-N
| density =
| 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]] that is commonly administered by [[physicians]] to induce [[anesthesia]] during [[surgery]] or [[medical procedures]]. Ketamine can also be used as a [[painkiller]] and as a [[bronchodilator]], which facilitates easier airflow into the [[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>


Occasionally, ketamine use can lead to a specific type of [[hallucination]] that produces feelings of detachment from one's [[body]] and surroundings.<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> This property has made it a popular [[recreational drug]] despite its potentially severe [[side effects]]. For this reason, ketamine is not typically available as an over-the-counter drug.
=== Treatment-Resistant Depression ===
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.


== Medical Use ==
Ketamine is also being researched for its potential to treat:
In clinical settings, ketamine is most commonly administered via [[injection]] into a [[vein]] ([[intravenous]]) or a [[muscle]] ([[intramuscular]]).<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>
* [[Post-traumatic stress disorder (PTSD)]]
* [[Obsessive-compulsive disorder (OCD)]]
* [[Suicidal ideation]]
* [[Anxiety disorders]]


While ketamine is not the preferred [[anesthetic]] in many cases due to its hallucinogenic effects, it offers distinct advantages. Unlike most other anesthetics that suppress [[respiration]] and necessitate the use of mechanical [[ventilation]], ketamine does not significantly inhibit breathing.<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 the Intensive Care Unit |journal=Iranian Journal of Allergy, Asthma, and Immunology |volume=2 |issue=4 |pages=175–80 |date=December 2003 |pmid=17301376}}</ref>
=== Emergency Medicine ===
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 ===
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 ==
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 ==
{| class="wikitable" style="width:100%; text-align:center;"
! Route of Administration !! Bioavailability !! Onset of Action !! Duration of Effects
|-
| [[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
|}


Ketamine is particularly valuable in situations where advanced medical equipment is unavailable, such as in [[war zones]] or emergency [[field medicine]].{{Citation needed|reason=This claim needs a reliable source|date=December 2013}}
== Side Effects ==
== Side Effects ==
While ketamine is a valuable medical drug, it also carries risks, particularly when misused.
=== Short-Term Side Effects ===
=== Short-Term Side Effects ===
Short-term side effects are experienced by approximately 40% of individuals 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>
Common side effects include:
* [[Dizziness]]
* Dizziness
* [[Double vision]]
* Nausea and vomiting
* [[Euphoria]]
* Increased blood pressure and heart rate
* [[Blurred vision]]
* Blurred vision
* Difficulty expressing [[emotions]]
* Confusion and disorientation
* [[Hypertension|High blood pressure]]
* Hallucinations and dissociation (often described as a "K-hole")
* [[Tachycardia]] ([[Fast heart rate]])
* Difficulty speaking and moving
* [[Nausea]] and [[vomiting]]
* Speech difficulties
* [[Nightmares]]
* [[Illusions]]
* [[Hallucinations]]
* Altered [[body image]]
* [[Memory]] and [[attention]] impairments.


=== Long-Term Side Effects ===
=== Long-Term Side Effects ===
Long-term effects of ketamine are mostly observed in [[recreational drug use|recreational users]] or from prolonged exposure in [[animal studies]].<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>
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 ==
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.


==== Urinary Tract Effects ====
== Legal Status ==
Chronic ketamine use has been associated with [[urinary tract]] issues, including:
Ketamine is classified differently across countries:
* Increased urgency to urinate
* Pain during urination with [[hematuria]] ([[blood in urine]])
* Reduced [[bladder]] capacity<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>


==== Neurological Effects ====
{| class="wikitable" style="width:100%; text-align:center;"
Frequent recreational use (more than 4 times a week) has been linked to impaired [[cognitive functions]], including [[memory]] deficits and increased [[depression]].<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>
! 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)
|}


== Mechanism of Action ==
== Research and Future Applications ==
Ketamine functions as an [[NMDA receptor]] antagonist in the [[central nervous system]] ([[CNS]]). By inhibiting these receptors, ketamine prevents excessive [[excitatory neurotransmission]], resulting in an [[anesthetic]] effect. Additionally, it produces [[sympathomimetic]] effects that help maintain [[blood pressure]] and [[airway reflexes]]. These properties make it a critical option for patients with [[shock]] or requiring [[emergency surgery]].
Antidepressant Research
Ongoing research is exploring ketamine’s rapid antidepressant effects, particularly for:
* Treatment-resistant depression
* Bipolar depression
* Postpartum depression
* Suicidal ideation


== Research ==
Treatment for Addiction
=== Treating Addiction ===
Studies suggest ketamine may help treat:
Studies have explored ketamine's role in managing [[alcohol addiction]] and [[opioid use disorder]].<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|publisher=Eleusis}}</ref>
* Alcohol use disorder
* Opioid addiction
* Nicotine dependence


=== Antidepressant Effects ===
== Summary ==
Preliminary studies suggest that a single dose of ketamine can significantly alleviate symptoms of [[treatment-resistant depression]] within hours, with effects lasting up to a week.<ref>[http://www.nih.gov/news/pr/aug2006/nimh-07b.htm NIH: "Experimental Medication Kicks Depression in Hours Instead of Weeks"]</ref>
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.


== Recreational Use ==
== See Also ==
Recreational users typically consume ketamine at [[sub-anesthetic doses]]. The dissociative effects, often referred to as a "K-hole," include [[hallucinations]] and a profound sense of detachment.<ref>{{cite web|url=https://www.vice.com/en/article/59zj5z/what-is-a-k-hole-ketamine|title=What Is a K-Hole?|publisher=VICE}}</ref> Chronic use, however, may lead to serious consequences such as [[bladder damage]], [[cognitive decline]], and [[psychological dependence]].<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}}</ref>
* [[Dissociative anesthetics]]
* [[NMDA receptor antagonists]]
* [[Psychedelic therapy]]
* [[General anesthesia]]
* [[Pain management]]


==References==
<references/>
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{{Pharmacology}}
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|title= [[Pharmacodynamics]]
|title= Medical Uses
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{{Acetylcholine receptor modulators}}
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{{Ionotropic glutamate receptor modulators}}
{{Monoamine reuptake inhibitors}}
{{Opioid receptor modulators}}
{{Sigma receptor modulators}}
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[[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]]
==Ketamine==
<gallery>
File:Ketamine2DCSD.svg|Ketamine 2D Structure
File:S-ketamine-from-HCl-xtal-3D-balls.png|S-Ketamine 3D Structure
</gallery>

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.

Ketamine chemical structure
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


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PubMed
Wikipedia
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