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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 with 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 with 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 with 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 with 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 with 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 with 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 with 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 with 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 with 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 with 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 with 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 with 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 with 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
Avoid/Use Alternative
Monitor/Modify Tx
Caution Advised
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)
- biliary obstruction (repeat use)
- sclerosing cholangitis (long-term use)
- hydronephrosis (long-term use)
- ureteral obstruction (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, especially 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, including 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: for ketamine: liver; CYP450: 2B6 (primary), 2C9, 3A4; Info: active metabolite
Excretion: for ketamine: 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
for ketamine: 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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