Ketamine
KETALAR
Pronunciation: KET-a-meen
“Cat taller (than) Cat tamer”
What it isNMDA receptor antagonist; anesthesia, procedural sedation, and off label for depression and chronic pain.
Why this oneIt relatively preserves airway reflexes and respiratory drive while supporting blood pressure, useful in shock or a difficult airway.
What limits itEmergence reactions, increased secretions and hypertension can end a trial. Abuse liability; Schedule III.
FDA-approved for
- anesthesia (1970)
Off-label
- treatment-resistant depression
- chronic pain
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Induction of anesthesia | adult | 1-4.5 mg/kg IV slow (over 60 sec), or 1-2 mg/kg IV at 0.5 mg/kg/min | ||
| Induction of anesthesia (IM) | adult | 6.5-13 mg/kg IM | ||
| Maintenance of anesthesia | adult | one-half to full induction dose, repeat PRN |
Renal Undefined
Hepatic Undefined
Instructions
- Administer by/under direction of clinicians experienced in general anesthesia; continuously monitor vital signs; emergency airway equipment immediately available
- Do not give 100 mg/mL concentration IV without proper dilution; use immediately after dilution
Available strengths
- inj 10, 50, 100 mg/mL
Contraindications
- Conditions where a significant elevation of blood pressure would be a serious hazard
Cautions
- Hemodynamic instability (transient BP/HR/cardiac index rise; also hypotension, arrhythmias)
- Emergence reactions/postoperative confusional states
- Respiratory depression with overdose or too-rapid administration
- Reflexes not suppressed—avoid as sole agent for pharynx/larynx/bronchial procedures
- Pediatric neurotoxicity with use >3 hours in children ≤3 yr
- Drug-induced liver injury
Adverse reactions
- Elevated BP/HR/cardiac index
- Emergence reactions (postoperative delirium)
- Nausea, vomiting, anorexia
- Enhanced muscle tone/spasms
- Diplopia, nystagmus, raised intraocular pressure
- Anaphylaxis
Pregnancy Not recommended; animal data show possible fetal harm—avoid in pregnancy, labor, and delivery
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 10 mg/mL | inj | per unit | not offered | |
| 50 mg/mL | inj | per unit | $0.56/mL | not offered |
| 100 mg/mL | inj | per unit | $1.78/mL | not offered |
Generic entryBy 2023
NO BOXED WARNINGS
Principal riskEmergence reactions; abuse liability
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityDissociation, sedation, blood-pressure and heart-rate elevation, emergence reactions and abuse/misuse potential; respiratory depression risk rises with other CNS depressants.
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