Ketamine is a pharmaceutical that is primarily used to start and maintain anesthesia by producing a trance-like state.
Other uses of ketamine treatment include pain relief, sedation and amnesia. At lower doses, it is prescribed for treatment-resistant depression. The drug’s properties allow for its effects while preserving breathing, airway reflexes, stimulated heart function, increased blood pressure, and moderate bronchodilation.
Along with its prescribed purposes, ketamine is also used as a recreational drug for its hallucinogenic and dissociative effects. Ketamine is related to the drug phencyclidine (PCP), however it has a fraction of its potency at less than 10%.
Ketamine is primarily used by anesthetic, medical, and veterinarian professionals. It is on the World Health Organization’s List of Essential Medicines, and is available as a generic medication.
Ketamine blocks HCN1 receptors as a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist. At high doses, it can also bind to sigma and the opioid mu receptors while disrupting the glutamate neurotransmitter – a key neurochemical associated with memory, learning, pain, and emotion. Besides exhibiting sympathomimetic activity (that mimics the sympathetic nervous system’s effect on organs and structures), the use of ketamine can elevate the heart rate and increase blood pressure.
Ketamine Distribution and Half-Life
Ketamine is a lipid-soluble compound with a large and initial rapid distribution. Its half-life is roughly 10-15 minutes which increases to 3 hours once distributed to peripheral tissues. Following distribution, it is then excreted through the urinary process.
Ketamine for Hospitals
Due to its effect on the circulatory and respiratory systems, ketamine is the compound of choice for short-term medical procedures where muscle relaxation is not required. It differs from other anesthetic compounds by reduced suppression of breathing, and when used at high doses it can stimulate the circulatory system while preserving airway reflexes.
Ketamine may cause delirium or delusions that are counteracted by administering propofol and benzodiazepines. It has been supported for use as a sedative in emergency medicine, such as emergency surgeries in war zones and other physically painful procedures. Since low blood pressure is a risk to people with severe head trauma, ketamine is used because it is least likely to lower blood pressure. Its bronchodilating properties make it a preferred choice for anesthesia with patients that have severe reactive airway diseases, asthma, or obstructive airway conditions.
Treatment for Chronic Pain & Complex Regional Pain Syndrome
Ketamine infusions can be used to treat chronic pain, acute pain in emergency situations, and in people suffering from refractory pain at sub-anesthetic doses. It is used frequently in surgical patients where post-operative pain is expected and in patients with tolerance to opioids.
Ketamine’s low risk of respiratory depression makes it a candidate for pre-hospital admittance. It is also used for chronic pain as an intravenous analgesic if the pain is neuropathic, and has an added benefit of counteracting spinal sensitization or a “wind-up” phenomenon that is associated with chronic pain.
Depression is a continuing concern in the medical profession and general public. Recent data suggests that diagnoses of major depression have risen by 33%, including a 47% increase in those ages 18 to 34 since 2013.
It acts fast to relieve symptoms of depression. When administered intravenously, it has been shown to improve mood within 4 hours while reaching a peak level of effect at 24 hours. Studies suggest that ketamine’s antidepressant effects are diminished within seven days, with most patients relapsing within ten days. For a minority of patients, the improvement can last 30 days or more, lending to maintenance protocols that can extend its effects.
Esketamine, a variant of ketamine, is approved as a nasal spray in the United States for treatment-resistant depression. While intravenous infusions of ketamine have not been evaluated in a comparison study with esketamine, a comparative clinical trial meta-analysis has shown that intravenous ketamine is a superior option with a more favourable response that includes lower remission rates and fewer dropouts.
Ketamine has been used in some cases of treatment-resistant status epilepticus (seizures that last longer than five minutes), however there are limited case studies supporting its use.
The use of ketamine is contraindicated in the following conditions:
- Severe cardiovascular disease
- Patients less than three months of age
- Unstable angina
- Poorly controlled hypertension.
- Increased intracranial pressure
- Increased intraocular pressure
- Poorly controlled psychosis
- Severe liver disease such as cirrhosis
- Active substance abuse (in cases of serial ketamine injections)
Side effects of ketamine that require immediate attention include:
- Bloody/cloudy urine
- Blue-hued skin or lips
- Changes in vision
- Burning sensations during urination
- Sudden, frequent urges to urinate
- Chest issues such as discomfort, pain, coughing or tightness
- General confusion (places, times or people)
- Swallowing difficulties
- Issues when suddenly standing from a lying position (dizziness, lightheadedness, or faintness)
- Irregular heartbeats (fast or slow)
- Skin conditions such as itching, hives, or rashes
- Breathing cessation or irregularities (fast, slow or shallow)
- Vision loss
- Swelling/puffiness of eyelids, face, lips, eyes, or tongue
- Delusions (hearing, seeing, or feeling things that are not visible to others)
- Increased sweating
- Unusual behaviour (nervousness, excitement, restlessness, weakness or tiredness)
The use of ketamine can result in dependence caused by feelings of euphoria that have been supported by animal experiments.
Ketamine’s immediate effect induced by nasal administration has increased its use as a recreational drug. After repeated use, high tolerance to the drug can be developed that requires higher doses to achieve similar effects.
Withdrawal effects such as anxiety, shaking, sweating, and palpitations have been observed, in addition to cognitive deficits, delusion and dissociation symptoms.
Good Manufacturing Practice (GMP)
GMPs practices are guidelines recommended by agencies that control licensing and authorization of both the manufacture and sale of cosmetics, food, beverages, dietary supplements, medical equipment and pharmaceutical products. They are put into place and enforced to ensure product quality and consistency among manufacturers.
Medica Pharma partners with GMP manufacturers and specialty labs globally to establish and maintain strong professional relationships. This allows us to source and provide the highest quality chemical products on the market.
Please note that ketamine is controlled in many countries.
Medica Pharma supplies ketamine API to professional companies only that feature all required licences to purchase and import Ketamine API. Ketamine in final dosage form is NOT being supplied by MedicaPharma.