Formulary
Ketamine: Indications, Dosing, Side Effects and Interactions
Ketamine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Ketamine: Indications, Dosing, Side Effects and Interactions
Ketamine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Induction and maintenance of anaesthesia**
- **Adult** (By Intravenous Infusion): for long procedures Initially 0.5-2 mg/kg, using an infusion solution containing 1 mg/mL; maintenance 10-45 micrograms/kg/minute, adjusted according to response.
**Diagnostic manoeuvres and procedures not involving intense pain**
- **Adult** (By Intramuscular Injection): Initially 4 mg/kg.
**Induction and maintenance of anaesthesia for short procedures for ketamine**
- **Neonate** (By intramuscular injection): 4 mg/kg, adjusted according to response, a dose of 4 mg/kg usually produces 15 minutes of surgical anaesthesia.
- **Child** (By intramuscular injection): 4-13 mg/kg, adjusted according to response, a dose of 4 mg/kg sufficient for some diagnostic procedures, a dose of 10 mg/kg usually produces 12-25 minutes of surgical anaesthesia.
- **Neonate** (By intravenous injection): 1-2 mg/kg, adjusted according to response, to be given over at least 60 seconds, a dose of 1-2 mg/kg produces 5-10 minutes of surgical anaesthesia.
- **Child 1 month-11 years** (By intravenous injection): 1-2 mg/kg, adjusted according to response, to be given over at least 60 seconds, a dose of 1-2 mg/kg produces 5-10 minutes of surgical anaesthesia.
- **Child 12-17 years** (By intravenous injection): 1-4.5 mg/kg, adjusted according to response, to be given over at least 60 seconds, a dose of 2 mg/kg usually produces 5-10 minutes of surgical anaesthesia.
**Induction and maintenance of anaesthesia for long procedures for ketamine**
- **Neonate** (Initially by intravenous injection): Initially 0.5-2 mg/kg, followed by (by continuous intravenous infusion) 8 micrograms/kg/minute, adjusted according to response, doses up to 30 micrograms/kg/minute may be used to produce deep anaesthesia.
- **Child** (Initially by intravenous injection): Initially 0.5-2 mg/kg, followed by (by continuous intravenous infusion) 10-45 micrograms/kg/minute, adjusted according to response.
**Sedation prior to invasive or painful procedures for ketamine**
- **Child** (By intravenous injection): 1-2 mg/kg for 1 dose.
Cautions
Acute circulatory failure (shock); cardiovascular disease; dehydration; elderly; fixed cardiac output; hallucinations; head injury; hypertension; hypovolaemia; increased cerebrospinal fluid pressure; intracranial mass lesions; nightmares; predisposition to seizures; psychotic disorders; raised intra-ocular pressure; respiratory tract infection; thyroid dysfunction
Contraindications
Acute porphyrias ; eclampsia; head trauma; hypertension; pre-eclampsia; raised intracranial pressure; severe cardiac disease; stroke
Side effects
Common or very common Anxiety; behaviour abnormal; confusion; diplopia; hallucination; muscle tone increased; nausea; nystagmus; skin reactions; sleep disorders; tonic clonic movements; vomiting Uncommon Appetite decreased; arrhythmias; hypotension; respiratory disorders Rare or very rare Apnoea; cystitis; cystitis haemorrhagic; delirium; dysphoria; flashback; hypersalivation Frequency not known Drug-induced liver injury Side-effects, further information Incidence of hallucinations can be reduced by premedicaton with a benzodiazepine (such as midazolam).
Interactions
**Severe interactions:**
- Ketamine Co-administration of etomidate and ketamine appears to have no significant effect on the plasma concentrations or pharmacokinetic parameters of ketamine or its principal metabolite,...
**Other interactions (6):**
- The same may be true for ketamine and dextromethorphan (see also section 4.4).
- General anaesthetics Increased risk of convulsions with ketamine; increased risk of arrhythmias with halothane Pancuronium Resistance to neuromuscular block with pancuronium has been reported in...
- General anaesthetics: Isolated reports of marked hypertension and tachycardia have been reported with concurrent ketamine administration.
- These include: Antibacterials Enhanced effects of suxamethonium with Aminoglycosides Clindamycin, polymyxins and vancomycin Piperacillin Antimalarials Quinine and chloroquine - effects of...
- As with all non-depolarising neuromuscular blocking agents, non-depolarising neuromuscular block may be increased and/or extended by interaction with: - antibiotics , including the aminoglycosides,...
- Co-administration with ketamine may cause reduced convulsive threshold; with doxapram may cause increased CNS stimulation.
Pregnancy
May depress neonatal respiration if used during delivery.
Breast feeding
Avoid for at least 12 hours after last dose.
Hepatic impairment
Manufacturer advises caution (risk of prolonged duration of action). Dose adjustments Manufacturer advises consider dose reduction.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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