ketamine

Therapeutic Classification: general anesthetics

High Alert

Induction and maintenance of general anesthesia.

Unlabeled Use:

Provides sedation, analgesia, and anxiolytic effects.

Blocks afferent impulses of pain perception.
Suppresses spinal cord activity.
Affects CNS transmitter systems.

Therapeutic effects:

Anesthesia with profound analgesia, minimal respiratory depression, and minimal skeletal muscle relaxation.

Absorption: Rapidly absorbed after IM administration. IV administration results in complete bioavailability.

Distribution: Rapidly distributed. Enters the CNS.

Metabolism/Excretion: Mostly metabolized by the liver. Some conversion to another active compound.

Half-Life: 2.5 hr.

(anesthesia)

ROUTE	ONSET	PEAK	DURATION
IV	30 sec	unknown	5–10 min
IM	3–4 min	unknown	12–25 min

Contraindicated in:

Hypersensitivity;
Psychiatric disturbances;
Uncontrolled hypertension;
↑intracranial pressure;
OB: May affect child's brain development when used during 3rd trimester;
Lactation: Lactation.

Use Cautiously in:

Cardiovascular disease;
Procedures involving larynx, pharynx, or bronchial tree (muscle relaxants required);
Gastroesophageal reflux;
History of alcohol abuse;
Cerebral trauma;
Intracerebral mass or hemorrhage;
Hyperthyroidism;
History of psychiatric problems;
↑intraocular pressure;
Severe eye trauma;
Hepatic impairment;
Pedi: Children <3 yr (may affect brain development).

CV: hypertension, tachycardia, arrhythmias, bradycardia, hypotension

Derm: erythema, rash

EENT: ↑intraocular pressure, diplopia, nystagmus

GI: excessive salivation, hepatotoxicity, nausea, vomiting

GU: cystitis

Local: pain at injection site

MS: ↑skeletal muscle tone

Neuro: emergence reactions, ↑intracranial pressure

Resp: laryngospasm, respiratory depression and apnea (rapid IV administration of large doses)

Drug-drug:

Barbiturates, hydroxyzine or opioid analgesics may result in prolonged recovery time.
Halothane may result in ↓ BP, cardiac output, and HR.
Nondepolarizing neuromuscular blocking agents may result in prolonged respiratory depression.
Levothyroxine may ↑ risk of tachycardia and hypertension.
Diazepam may ↓ incidence of emergence reaction.
Atropine may ↑ incidence of unpleasant dreams.
Aminophylline or theophylline may ↑ risk of seizures; consider using alternative to ketamine.
Vasopressin or sympathomimetics may ↑ ketamine's sympathomimetic effects.

General Anesthesia

IV (Adults ): Induction: 1–2 mg/kg (range 1–4.5 mg/kg) produces 5–10 min of surgical anesthesia or 1–2 mg/kg as a single injection or infused at 0.5 mg/min. May be used with concurrent diazepam. Maintenance: Increments of ½ to the full induction dose may be repeated as needed. If given with concurrent diazepam, an infusion of 0.1–0.5 mg/min may be used, augmented by 2–5 mg doses of diazepam.
IV (Children ): 0.5–2 mg/kg, use smaller doses (0.5–1 mg/kg) for minor procedures.
IM (Adults ): 3–8 mg/kg (10 mg/kg produces 12–25 min of surgical anesthesia).
IM (Children ): 3–7 mg/kg.
PO (Children ): 6–10 mg/kg for 1 dose (mix in cola or other beverage) 30 min prior to procedure.

Sedation/Analgesia (Unlabeled)

IV (Adults ): 0.2–0.75 mg/kg over 2–3 min initially, followed by 0.005–0.02 mg/kg/min as an infusion.
IV (Children ): 0.005–0.02 mg/kg/min as an infusion.
IM (Adults ): 2–4 mg/kg initially, then 0.005–0.02 mg/kg/min as an IV infusion.

(Generic available)

Solution for injection: 10 mg/mL; 50 mg/mL; 100 mg/mL

Assess level of consciousness frequently throughout therapy. Ketamine produces a dissociative state. The patient does not appear to be asleep and experiences a feeling of dissociation from the environment.
Monitor for development of emergence delirium, which may result in confusion or agitation during the recovery period.
Monitor BP, ECG, and respiratory status frequently during therapy. May cause hypertension and tachycardia. May ↑ cerebrospinal fluid pressure and intraocular pressure.

Lab Test Considerations:

Monitor baseline liver function tests (alkaline phosphatase, gamma glutamyl transferase) in patients receiving recurrent doses of ketamine.

Toxicity and Overdose:

Respiratory depression or apnea may be treated with mechanical ventilation.

Do not confuse Ketalar with ketorolac. Do not confuse ketamine with ketorolac.
May be administered concurrently with a drying agent (atropine, scopolamine); ketamine ↑ salivary and tracheobronchial mucous gland secretions. Atropine may ↑ the incidence of unpleasant dreams.
- Patients may experience a state of confusion (emergence delirium) during recovery from ketamine. Administering a benzodiazepine and minimizing verbal, tactile, and visual stimulation may prevent emergence delirium. Severe emergence delirium may be treated with short- or ultra-short-acting barbiturates.
PO: Administer on an empty stomach to prevent vomiting and aspiration. Use 100 mg/mL IV solution and mix appropriate dose in 0.2–0.3 mL/kg of cola or other beverage.

IV Administration:

Y-Site Compatibility:
- acetaminophen
- albumin
- alprostadil
- amikacin
- amiodarone
- arsenic trioxide
- atropine
- caffeine citrate
- calcium gluconate
- cefazolin
- cefepime
- cefotaxime
- ceftazidime
- cefuroxime
- chlorpromazine
- clindamycin
- clonidine
- digoxin
- dimenhydrinate
- diphenhydramine
- dobutamine
- dopamine
- epinephrine
- gentamicin
- haloperidol
- hydrocortisone
- magnesium sulfate
- meperidine
- metoclopramide
- metronidazole
- midazolam
- milrinone
- morphine
- multivitamins
- naloxone
- oxytocin
- penicillin G
- piperacillin/tazobactam
- potassium chloride
- promethazine
- propofol
- sufentanil
- tobramycin
Y-Site Incompatibility:
- acyclovir
- ampicillin
- cisatracurium
- dexmedetomidine
- furosemide
- heparin
- insulin, regular
- meropenem
- phenytoin
- potassium phosphates
- rocuronium
- sodium bicarbonate
- trimethoprim/sulfamethoxazole

Explain purpose and side effects of ketamine to patient.
Psychomotor impairment may last for 24 hr after anesthesia. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to avoid alcohol or other CNS depressants for 24 hr after anesthesia.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected. Ketamine is not recommended for use during pregnancy or delivery.

Anesthesia with profound analgesia, minimal respiratory depression, and minimal skeletal muscle relaxation.

NDC Code

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9508- Ketamine Hydrochloride
  - 0143-9508-10- 10 VIAL in 1 BOX (0143-9508-10) / 10 mL in 1 VIAL (0143-9508-01)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9509- Ketamine Hydrochloride
  - 0143-9509-10- 10 VIAL in 1 BOX (0143-9509-10) / 5 mL in 1 VIAL (0143-9509-01)

0404- Henry Schein, Inc
- 0404-9880- KETALAR
  - 0404-9880-20- 1 VIAL in 1 BAG (0404-9880-20) / 20 mL in 1 VIAL

0404- Henry Schein, Inc.
- 0404-9881- KETAMINE HYDROCHLORIDE
  - 0404-9881-05- 1 VIAL, MULTI-DOSE in 1 BAG (0404-9881-05) / 5 mL in 1 VIAL, MULTI-DOSE

0404- Henry Schein, Inc.
- 0404-9882- KETAMINE HYDROCHLORIDE
  - 0404-9882-10- 1 VIAL in 1 BAG (0404-9882-10) / 10 mL in 1 VIAL

0409- Hospira, Inc.
- 0409-0040- Ketamine Hydrochloride
  - 0409-0040-10- 10 VIAL, MULTI-DOSE in 1 CARTON (0409-0040-10) / 5 mL in 1 VIAL, MULTI-DOSE (0409-0040-05)

0409- Hospira, Inc.
- 0409-2051- Ketamine Hydrochloride
  - 0409-2051-05- 10 VIAL, MULTI-DOSE in 1 BOX (0409-2051-05) / 5 mL in 1 VIAL, MULTI-DOSE (0409-2051-15)

0409- Hospira, Inc.
- 0409-2053- Ketamine Hydrochloride
  - 0409-2053-10- 10 VIAL, MULTI-DOSE in 1 BOX (0409-2053-10) / 10 mL in 1 VIAL, MULTI-DOSE (0409-2053-20)

10920- Arevipharma GmbH
- 10920-597-
  - 10920-597-05- 1 BAG in 1 DRUM (10920-597-05) / 10 kg in 1 BAG

10920- Arevipharma GmbH
- 10920-597-
  - 10920-597-06- 1 BAG in 1 DRUM (10920-597-06) / 20 kg in 1 BAG

10920- Arevipharma GmbH
- 10920-597-
  - 10920-597-07- 1 BAG in 1 DRUM (10920-597-07) / 1 BAG in 1 BAG / 10 kg in 1 BAG

10920- Arevipharma GmbH
- 10920-597-
  10920-597-08- 1 BAG in 1 DRUM (10920-597-08) / 1 BAG in 1 BAG / 20 kg in 1 BAG

25021- Sagent Pharmaceuticals
- 25021-682- Ketamine Hydrochloride
  25021-682-20- 10 VIAL in 1 CARTON (25021-682-20) / 20 mL in 1 VIAL

25021- Sagent Pharmaceuticals
- 25021-683- Ketamine Hydrochloride
  - 25021-683-10- 10 VIAL in 1 CARTON (25021-683-10) / 10 mL in 1 VIAL

25021- Sagent Pharmaceuticals
- 25021-684- Ketamine Hydrochloride
  - 25021-684-05- 10 VIAL in 1 CARTON (25021-684-05) / 5 mL in 1 VIAL

38779- Medisca Inc.
- 38779-1754-
  - 38779-1754-1- 2500 g in 1 CONTAINER (38779-1754-1)

38779- Medisca Inc.
- 38779-1754-
  38779-1754-2- 15 g in 1 VIAL (38779-1754-2)

38779- Medisca Inc.
- 38779-1754-
  38779-1754-3- 5 g in 1 VIAL (38779-1754-3)

38779- Medisca Inc.
- 38779-1754-
  38779-1754-4- 25 g in 1 VIAL (38779-1754-4)

38779- Medisca Inc.
- 38779-1754-
  38779-1754-5- 100 g in 1 VIAL (38779-1754-5)

38779- Medisca Inc.
- 38779-1754-
  38779-1754-7- 250 g in 1 VIAL (38779-1754-7)

38779- Medisca Inc.
- 38779-1754-
  38779-1754-8- 500 g in 1 JAR (38779-1754-8)

38779- Medisca Inc.
- 38779-1754-
  38779-1754-9- 1000 g in 1 JAR (38779-1754-9)

42023- Par Health USA, LLC
- 42023-113- Ketalar
  42023-113-10- 10 VIAL in 1 CARTON (42023-113-10) / 20 mL in 1 VIAL

42023- Par Health USA, LLC
- 42023-114- Ketalar
  - 42023-114-10- 10 VIAL in 1 CARTON (42023-114-10) / 10 mL in 1 VIAL

42023- Par Health USA, LLC
- 42023-115- Ketalar
  - 42023-115-10- 10 VIAL in 1 CARTON (42023-115-10) / 5 mL in 1 VIAL

43066- Baxter Healthcare Corporation
- 43066-177- KETAMINE HYDROCHLORIDE
  - 43066-177-05- 5 CARTON in 1 CARTON (43066-177-05) / 1 SYRINGE, PLASTIC in 1 CARTON (43066-177-01) / 10 mL in 1 SYRINGE, PLASTIC

49169- PCAS
- 49169-1041-
  - 49169-1041-0- 1 BAG in 1 DRUM (49169-1041-0) / 25 kg in 1 BAG

49452- Spectrum Laboratory Products, Inc.
- 49452-3912-
  49452-3912-1- 5 g in 1 BOTTLE, GLASS (49452-3912-1)

49452- Spectrum Laboratory Products, Inc.
- 49452-3912-
  49452-3912-2- 25 g in 1 CONTAINER (49452-3912-2)

49452- Spectrum Laboratory Products, Inc.
- 49452-3912-
  49452-3912-3- 100 g in 1 CONTAINER (49452-3912-3)

49452- Spectrum Laboratory Products, Inc.
- 49452-3912-
  49452-3912-4- 1000 g in 1 CONTAINER (49452-3912-4)

49452- Spectrum Laboratory Products, Inc.
- 49452-3912-
  49452-3912-5- 1 g in 1 BOTTLE, GLASS (49452-3912-5)

49452- Spectrum Laboratory Products, Inc.
- 49452-3912-
  49452-3912-6- 5000 g in 1 PAIL (49452-3912-6)

49452- Spectrum Laboratory Products, Inc.
- 49452-3912-
  49452-3912-7- 500 g in 1 CONTAINER (49452-3912-7)

51552- Fagron Inc
- 51552-0697-
  51552-0697-2- 5 g in 1 CONTAINER (51552-0697-2)

51552- Fagron Inc
- 51552-0697-
  51552-0697-4- 25 g in 1 CONTAINER (51552-0697-4)

51552- Fagron Inc
- 51552-0697-
  51552-0697-5- 100 g in 1 CONTAINER (51552-0697-5)

51552- Fagron Inc
- 51552-0697-
  51552-0697-6- 500 g in 1 CONTAINER (51552-0697-6)

51552- Fagron Inc
- 51552-0697-
  51552-0697-7- 1000 g in 1 CONTAINER (51552-0697-7)

51552- Fagron Inc
- 51552-0697-
  51552-0697-8- 25000 g in 1 CONTAINER (51552-0697-8)

51927- Professional Compounding Centers of America
- 51927-0120-
  51927-0120-0- 1 kg in 1 BOTTLE (51927-0120-0)

51927- Professional Compounding Centers of America dba PCCA
- 51927-0292-
  51927-0292-0- 1 kg in 1 CONTAINER (51927-0292-0)

54382- CU Chemie Uetikon GmbH
- 54382-114-
  54382-114-01- 25 kg in 1 DRUM (54382-114-01)

54382- CU Chemie Uetikon GmbH (340717289)
- 54382-128-
  54382-128-01- 25 kg in 1 DRUM (54382-128-01)

55150- Eugia US LLC
- 55150-438- KETAMINE HYDROCHLORIDE
  55150-438-10- 10 VIAL, MULTI-DOSE in 1 CARTON (55150-438-10) / 20 mL in 1 VIAL, MULTI-DOSE

55150- Eugia US LLC
- 55150-439- KETAMINE HYDROCHLORIDE
  - 55150-439-10- 10 VIAL, MULTI-DOSE in 1 CARTON (55150-439-10) / 10 mL in 1 VIAL, MULTI-DOSE

55150- Eugia US LLC
- 55150-440- KETAMINE HYDROCHLORIDE
  - 55150-440-10- 10 VIAL, MULTI-DOSE in 1 CARTON (55150-440-10) / 10 mL in 1 VIAL, MULTI-DOSE

56087- NORCHIM
- 56087-5442-
  - 56087-5442-4- 25 kg in 1 BAG (56087-5442-4)

60592- Kalchem International inc
- 60592-401-
  60592-401-10- 1000 g in 1 BOTTLE (60592-401-10)

61281- Supriya Lifescience Limited
- 61281-8000-
  61281-8000-1- 25 kg in 1 DRUM (61281-8000-1)

61281- Supriya Lifescience Limited
- 61281-8000-
  61281-8000-2- 1 kg in 1 DRUM (61281-8000-2)

61281- Supriya Lifescience Limited
- 61281-8000-
  61281-8000-3- 5 kg in 1 DRUM (61281-8000-3)

61281- Supriya Lifescience Limited
- 61281-8000-
  61281-8000-4- 10 kg in 1 DRUM (61281-8000-4)

62991- LETCO MEDICAL, LLC
- 62991-1087-
  62991-1087-1- 25 g in 1 JAR (62991-1087-1)

62991- LETCO MEDICAL, LLC
- 62991-1087-
  62991-1087-2- 100 g in 1 JAR (62991-1087-2)

62991- LETCO MEDICAL, LLC
- 62991-1087-
  62991-1087-3- 50 g in 1 JAR (62991-1087-3)

62991- LETCO MEDICAL, LLC
- 62991-1087-
  62991-1087-4- 1000 g in 1 JAR (62991-1087-4)

62991- LETCO MEDICAL, LLC
- 62991-1087-
  62991-1087-5- 5 g in 1 JAR (62991-1087-5)

62991- LETCO MEDICAL, LLC
- 62991-1087-
  62991-1087-7- 500 g in 1 JAR (62991-1087-7)

63275- B&B Pharmaceuticals, Inc.
- 63275-9980-
  63275-9980-4- 25 g in 1 BOTTLE, PLASTIC (63275-9980-4)

63275- B&B Pharmaceuticals, Inc.
- 63275-9980-
  63275-9980-5- 100 g in 1 BOTTLE, PLASTIC (63275-9980-5)

63275- B&B Pharmaceuticals, Inc.
- 63275-9980-
  63275-9980-8- 500 g in 1 BOTTLE, PLASTIC (63275-9980-8)

63275- B&B Pharmaceuticals, Inc.
- 63275-9980-
  63275-9980-9- 1000 g in 1 BOTTLE, PLASTIC (63275-9980-9)

65219- Fresenius Kabi USA, LLC
- 65219-184- ketamine hydrochloride
  65219-184-20- 10 VIAL in 1 TRAY (65219-184-20) / 20 mL in 1 VIAL (65219-184-01)

65219- Fresenius Kabi USA, LLC
- 65219-186- ketamine hydrochloride
  - 65219-186-05- 10 VIAL in 1 TRAY (65219-186-05) / 5 mL in 1 VIAL (65219-186-01)

65219- Fresenius Kabi USA, LLC
- 65219-188- ketamine hydrochloride
  - 65219-188-10- 10 VIAL in 1 TRAY (65219-188-10) / 10 mL in 1 VIAL (65219-188-01)

68083- Gland Pharma Limited
- 68083-504- Ketamine Hydrochloride
  - 68083-504-10- 10 VIAL in 1 CARTON (68083-504-10) / 20 mL in 1 VIAL

68083- Gland Pharma Limited
- 68083-505- Ketamine Hydrochloride
  - 68083-505-10- 10 VIAL in 1 CARTON (68083-505-10) / 10 mL in 1 VIAL

68083- Gland Pharma Limited
- 68083-506- Ketamine Hydrochloride
  - 68083-506-10- 10 VIAL in 1 CARTON (68083-506-10) / 5 mL in 1 VIAL

70600- Maithri Drugs Private Limited
- 70600-035-
  - 70600-035-01- 50 kg in 1 DRUM (70600-035-01)

71872- Medical Purchasing Solutions, LLC
- 71872-7258- Ketamine Hydrochloride
  71872-7258-1- 1 VIAL in 1 BAG (71872-7258-1) / 5 mL in 1 VIAL

71872- Medical Purchasing Solutions, LLC
- 71872-7296- Ketamine Hydrochloride
  - 71872-7296-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7296-1) / 5 mL in 1 VIAL, MULTI-DOSE

72572- Civica, Inc.
- 72572-320- Ketamine Hydrochloride
  - 72572-320-10- 10 VIAL in 1 BOX (72572-320-10) / 10 mL in 1 VIAL (72572-320-01)

72572- Civica, Inc.
- 72572-321- Ketamine Hydrochloride
  - 72572-321-10- 10 VIAL in 1 BOX (72572-321-10) / 5 mL in 1 VIAL (72572-321-01)

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Code ⬆