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Ketalar
ketamine
Adult Dosing .
Dosage forms: INJ
general anesthesia induction
- [IV route]
- Dose: 1-4.5 mg/kg/dose IV x1; Info: onset 30sec, duration 5-10min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics
- [IM route]
- Dose: 6.5-13 mg/kg/dose IM x1; Info: onset 3-4min, duration 12-25min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics
general anesthesia maintenance
- [0.1-0.5 mg/min IV]
- Alt: 0.5-4.5 mg/kg/dose IV prn; 3.25-13 mg/kg/dose IM prn; Info: give adjuvant benzodiazepine prn; decr. usual dose if given w/ other anesthetics
sedation, procedural (off-label)
- [IV route]
- Dose: 1-2 mg/kg/dose IV x1; Info: onset 30sec, duration 5-10min; may give additional 0.5 mg/kg/dose IV q5-15min prn; consider adjuvant benzodiazepine; decr. usual dose if given w/ other anesthetics
- [IM route]
- Dose: 4-5 mg/kg/dose IM x1; Info: onset 3-4min, duration 12-25min; may give additional 2-4 mg/kg/dose IM x1 after 10min; consider adjuvant benzodiazepine; decr. usual dose if given w/ other anesthetics; IV route preferred
rapid sequence intubation (off-label)
- [1-2 mg/kg/dose IV x1]
- Start: 3min after premedications; Info: see Rapid Sequence Intubation (RSI), Adult table
pain, moderate-severe acute (off-label)
- [IV route]
- Dose: 0.1-0.35 mg/kg/dose IV x1; Alt: 0.1-1 mg/kg/h IV prn; Info: refer to institution protocols
- [intranasal route]
- Dose: 0.5-1 mg/kg/dose intranasally x1, may repeat 0.25-0.5 mg/kg/dose intranasally x1 after 10-15min if no response; Info: refer to institution protocols; use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril
pain, moderate-severe chronic (off-label)
- [IV route]
- Dose: 0.5-2 mg/kg/h IV; Alt: 0.1-0.35 mg/kg/dose IV x1; Info: duration, frequency varies, refer to institution protocols; consider test dose 80 mg IV x1 over 2h
- [intranasal route]
- Dose: 10 mg intranasally q90sec prn up to 50 mg total dose; Alt: 25 mg intranasally q6h prn; Info: refer to institution protocols; use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril
major depressive disorder, tx-resistant (off-label)
- [0.5 mg/kg/dose IV x1]
- Alt: 0.5 mg/kg/dose IV 2-3x/wk for up to 8 doses
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ
general anesthesia induction
- [IV route, 3 mo-15 yo (off-label)]
- Dose: 1-3 mg/kg/dose IV x1
- [IV route, 16 yo and older]
- Dose: 1-4.5 mg/kg/dose IV x1; Info: onset 30sec, duration 5-10min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics
- [IM route, 3 mo-15 yo (off-label)]
- Dose: 5-10 mg/kg/dose IM x1
- [IM route, 16 yo and older]
- Dose: 6.5-13 mg/kg/dose IM x1; Info: onset 3-4min, duration 12-25min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics
general anesthesia maintenance
- [3 mo-15 yo (off-label)]
- Dose: 0.5-3 mg/kg/dose IV prn; Alt: 1-5 mg/kg/h IV
- [16 yo and older]
- Dose: 0.1-0.5 mg/min IV; Alt: 0.5-4.5 mg/kg/dose IV prn; 3.25-13 mg/kg/dose IM prn; Info: give adjuvant benzodiazepine prn; decr. usual dose if given w/ other anesthetics
sedation, procedural (off-label)
- [IV route, 3 mo and older]
- Dose: 1.5-2 mg/kg/dose IV x1; Info: onset 0.5-2min, duration 5-60min; may give additional 0.5-1 mg/kg/dose IV q5-15min prn; decr. usual dose if given w/ other anesthetics
- [IM route, 3 mo and older]
- Dose: 4-5 mg/kg/dose IM x1; Info: onset 3-10min, duration 15-90min; may give additional 2-4 mg/kg/dose IM x1 after 10min; ; decr. usual dose if given w/ other anesthetics; IV route preferred
- [intranasal route, 3 mo and older]
- Dose: 3-6 mg/kg/dose intranasally x1; Start: 5-20min before procedure; Info: use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril
- [PO route, 3 mo and older]
- Dose: 5-6 mg/kg/dose PO x1; Info: mix injectable form in beverage; onset 15-45min, duration 30-120min; IV route preferred
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- HTN
- stroke
- intracranial mass
- intracranial hemorrhage
- caution: patients <3 yo (repeat administration or >3h use)
- caution: hepatic impairment
- caution: head trauma
- caution: ICP incr.
- caution: IOP incr.
- caution: CAD
- caution: CHF
- caution: thyrotoxicosis
- caution: psychosis
- caution: alcoholism, acute
- caution: alcohol use, chronic
- caution: substance abuse
Drug Interactions .
Overview
ketamine
general anesthetic; NMDA antagonist
- CNS depression
- hypertensive effects
- lowers seizure threshold
- tachycardia
Contraindicated
- isocarboxazid
- tranylcypromine
Avoid/Use Alternative
- aldesleukin
- amifampridine
- aminophylline
- buprenorphine
- butalbital
- butorphanol
- codeine
- diazepam
- dihydrocodeine
- doxylamine
- ephedra
- epinephrine inhaled
- esketamine
- ethanol
- fentanyl
- furosemide
- hydrocodone
- hydromorphone
- iohexol
- kava
- kratom
- landiolol
- meperidine
- metaxalone
- methadone
- metoclopramide
- midodrine
- morphine
- nalbuphine
- oliceridine
- oxybate
- oxymorphone
- pentazocine
- phenelzine
- procarbazine
- promethazine
- ropeginterferon alfa-2b
- tapentadol
- thalidomide
- theophylline
- tramadol
- trimethobenzamide
- zuranolone
Monitor/Modify Tx
- 5-HTP
- abiraterone acetate
- acebutolol
- albuterol
- albuterol inhaled
- alfentanil
- aliskiren
- allopurinol
- almotriptan
- alprazolam
- amantadine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- amphetamine
- angiotensin II
- apomorphine
- apraclonidine ophthalmic
- aprocitentan
- arformoterol inhaled
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- armodafinil
- asciminib
- asenapine
- atenolol
- atogepant
- atomoxetine
- atropine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- baclofen
- baclofen intrathecal
- benazepril
- benzphetamine
- benztropine
- betamethasone
- betaxolol
- bevacizumab
- bismuth subsalicylate
- bisoprolol
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- bromocriptine
- brompheniramine
- budesonide
- bumetanide
- bupropion
- buspirone
- cabozantinib
- caffeine
- caffeine citrate
- candesartan cilexetil
- cannabidiol
- cannabis
- captopril
- carbamazepine
- carbinoxamine
- carfilzomib
- cariprazine
- carisoprodol
- carvedilol
- celecoxib
- cenobamate
- cetirizine
- chamomile, German
- chlophedianol
- chlorcyclizine
- chlordiazepoxide
- chlorothiazide
- chlorpheniramine
- chlorpromazine
- chlorthalidone
- chlorzoxazone
- citalopram
- clemastine
- clevidipine
- clobazam
- clomipramine
- clonazepam
- clonidine
- clorazepate
- clozapine
- cocaine
- copanlisib
- corticotropin
- cortisone
- cyclobenzaprine
- cyclosporine
- cyproheptadine
- danazol
- dantrolene
- darbepoetin alfa
- daridorexant
- darifenacin
- deflazacort
- desflurane
- desipramine
- desmopressin
- desvenlafaxine
- deutetrabenazine
- dexamethasone
- dexbrompheniramine
- dexchlorpheniramine
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- diclofenac
- diclofenac topical
- dicyclomine
- diethylpropion
- difelikefalin
- difenoxin
- diflunisal
- dihydroergotamine
- diltiazem
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- dobutamine
- domperidone
- dopamine
- doxapram
- doxazosin
- doxepin
- doxepin topical
- dronabinol
- droperidol
- droxidopa
- duloxetine
- efavirenz
- eletriptan
- elinzanetant
- enalapril
- enalaprilat
- entacapone
- entrectinib
- enzalutamide
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- escitalopram
- eslicarbazepine acetate
- esmolol
- estazolam
- estetrol (contraceptive)
- estradiol (contraceptive)
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- ethinyl estradiol (contraceptive)
- ethosuximide
- etodolac
- etomidate
- etrasimod
- felbamate
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fesoterodine
- fingolimod
- flibanserin
- fludrocortisone
- fluoxetine
- fluphenazine
- flurazepam
- flurbiprofen
- fluvoxamine
- formoterol inhaled
- fosinopril
- foslevodopa
- fosphenytoin
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- gabapentin
- gabapentin enacarbil
- galcanezumab
- ganaxolone
- glofitamab
- glycopyrrolate
- guanfacine
- haloperidol
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- hydroxyzine
- hyoscyamine
- ibrutinib
- ibuprofen
- ifosfamide
- iloperidone
- imipramine
- indapamide
- indomethacin
- iopamidol
- irbesartan
- isoflurane
- isoproterenol
- isradipine
- ketoprofen
- ketorolac
- labetalol
- lacosamide
- lamotrigine
- lanreotide
- lasmiditan
- leflunomide
- lemborexant
- lenvatinib
- levalbuterol inhaled
- levetiracetam
- levocetirizine
- levodopa
- levomilnacipran
- levorphanol
- levothyroxine
- licorice
- lifileucel
- linezolid
- linvoseltamab
- liothyronine
- liraglutide
- lisdexamfetamine
- lisinopril
- lofexidine
- lorazepam
- lorlatinib
- losartan
- loxapine
- lumacaftor/ivacaftor
- lumateperone
- lurasidone
- luspatercept
- magnesium salicylate
- meclizine
- meclofenamate
- mefenamic acid
- melatonin
- meloxicam
- meprobamate
- methamphetamine
- methocarbamol
- methohexital
- methoxy polyethylene glycol-epoetin beta
- methscopolamine
- methsuximide
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metolazone
- metoprolol
- metyrapone
- metyrosine
- midazolam
- milnacipran
- minoxidil
- mirabegron
- mirtazapine
- mitotane
- modafinil
- moexipril
- molindone
- mosunetuzumab
- mycophenolate mofetil
- nabumetone
- nadolol
- naltrexone
- naproxen
- naratriptan
- naxitamab
- nebivolol
- nefazodone
- nelarabine
- nicardipine
- nifedipine
- nimodipine
- niraparib
- nisoldipine
- norepinephrine
- nortriptyline
- obinutuzumab
- olanzapine
- olmesartan medoxomil
- olodaterol inhaled
- opicapone
- opium
- orphenadrine
- osilodrostat
- oxaprozin
- oxazepam
- oxcarbazepine
- oxybutynin
- oxycodone
- oxymetazoline nasal
- oxytocin
- ozanimod
- paliperidone
- paroxetine
- passion flower
- pazopanib
- pentobarbital
- perampanel
- perindopril
- perphenazine
- pexidartinib
- phendimetrazine
- pheniramine
- phenobarbital
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- phenytoin
- pimozide
- pindolol
- piroxicam
- ponatinib
- ponesimod
- pralsetinib
- pramipexole
- prazosin
- prednisolone
- prednisone
- pregabalin
- primidone
- prochlorperazine
- propofol
- propranolol
- protriptyline
- pseudoephedrine
- pyrilamine
- quazepam
- quetiapine
- quinapril
- ramelteon
- ramipril
- ramucirumab
- rasagiline
- regorafenib
- remifentanil
- remimazolam
- repotrectinib
- rimegepant
- ripretinib
- risperidone
- rizatriptan
- ropinirole
- rotigotine transdermal
- rufinamide
- safinamide
- salmeterol inhaled
- salsalate
- scopolamine
- selegiline
- selegiline transdermal
- selinexor
- selpercatinib
- sertraline
- sevoflurane
- siponimod
- solifenacin
- solriamfetol
- sorafenib
- spironolactone
- stiripentol
- sufentanil
- sulindac
- sumatriptan
- sunitinib
- suvorexant
- tacrolimus
- tagraxofusp
- tasimelteon
- telmisartan
- temazepam
- terazosin
- terbutaline
- teriflunomide
- testosterone
- tetrabenazine
- thioridazine
- thiotepa
- thiothixene
- thyroid
- tiagabine
- timolol
- tivozanib
- tizanidine
- tolcapone
- tolmetin
- tolterodine
- topiramate
- torsemide
- trametinib
- trandolapril
- trazodone
- triamcinolone
- triamterene
- triazolam
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- trospium
- ubrogepant
- vadadustat
- valbenazine
- valerian
- valproic acid
- valsartan
- vamorolone
- vandetanib
- vasopressin
- venlafaxine
- verapamil
- vigabatrin
- vilanterol inhaled
- vilazodone
- viloxazine
- voclosporin
- yohimbe
- zaleplon
- zavegepant
- ziconotide
- ziprasidone
- ziv-aflibercept
- zolmitriptan
- zolpidem
- zonisamide
Caution Advised
- acetazolamide
- busulfan
- chlorambucil
- hydroxychloroquine
- magnesium citrate
- memantine
- polyethylene glycol
- polyethylene glycol/electrolytes
- sodium picosulfate
- sulfate bowel prep
- treosulfan
Adverse Reactions .
Serious Reactions
- respiratory depression
- laryngospasm
- ICP incr.
- IOP incr.
- hypotension, severe
- bradycardia, severe
- arrhythmia
- emergence delirium
- tonic clonic movements
- anaphylaxis
- abuse
- dependency (prolonged high-dose use)
- withdrawal symptoms (long-term use)
- hepatobiliary dysfunction (repeat use)
- hydronephrosis (long-term use)
- hematuria (long-term use)
- hemorrhagic cystitis (long-term use)
- behavioral changes or cognitive deficits (>3h use in patients <3 yo)
- behavioral changes or cognitive deficits (repeat administration in patients <3 yo)
Common Reactions
- sialorrhea
- anorexia
- nausea
- vomiting
- BP elevated
- HR elevated
- diplopia
- nystagmus
- lacrimation
- fasciculations
- depressed reflexes
- emergence delirium
- bradycardia
- hypotension
- cystitis
Safety/Monitoring .
Monitoring Parameters
ECG, vital signs continuously; LFTs at baseline if repeat administration, then periodically
Look/Sound-Alike Drug Names
Ketalar confused with: Kenalog
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, esp. in 3rd trimester if prolonged (>3h) or repeated administration; possible dose-dependent risk of incr. uterine tone and contraction frequency and intensity based on conflicting human data; dose-dependent risk of neonatal adverse effects, incl. depression, excessive muscle tone, and apnea, based on limited human data; possible risk of adverse neurodevelopmental outcomes based on animal data
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding, especially for non-anesthesia use; inadequate human data available to assess risk of infant harm, though drug excreted into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 2B6 (primary), 2C9, 3A4; Info: active metabolite
Excretion: urine primarily (4% unchanged), feces <5%; Half-life: 2.5h
Subclass: Analgesics, Centrally-acting Nonopioid ; Anesthetics, General ; N-Methyl-D-Aspartate (NMDA) Receptor Antagonists, Psychiatric ; Sedation
Mechanism of Action
antagonizes N-methyl-D-aspart (NMDA) receptors in the CNS, producing dissociative analgesia and sedation
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Par Health
DEA/FDA: Schedule III
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
injectable solution:
- 50 mg/mL (1 vial, 10 mL): $11.00
injectable solution:
- 100 mg/mL (13 vial, 5 mL): $186.00
injectable solution:
- 10 mg/mL (1 vial, 20 mL): $24.00
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