Кетамин википедия
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Кетамин википедия
Ketamine is a medication mainly used for starting and maintaining anesthesia. Common side effects include agitation , confusion, or hallucinations as the medication wears off. Ketamine was discovered in , first tested in humans in , and approved for use in the United States in Uses as an anesthetic: \\\\\\\\\\\\[33\\\\\\\\\\\\]. Since it suppresses breathing much less than most other available anesthetics, \\\\\\\\\\\\[36\\\\\\\\\\\\] ketamine is used in medicine as an anesthetic; however, due to the hallucinations it may cause, it is not typically used as a primary anesthetic, although it is the anesthetic of choice when reliable ventilation equipment is not available. Ketamine is frequently used in severely injured people and appears to be safe in this group. The effect of ketamine on the respiratory and circulatory systems is different from that of other anesthetics. When used at anesthetic doses, it will usually stimulate rather than depress the circulatory system. It has been successfully used to prevent postanesthetic shivering. Ketamine is used as a bronchodilator in the treatment of severe asthma. Ketamine is sometimes used in the treatment of status epilepticus that has failed to adequately respond to standard treatments. Ketamine may be used for postoperative pain management. Low doses of ketamine may reduce morphine use, nausea, and vomiting after surgery. Ketamine has similar efficacy to opioids in a hospital emergency department setting for management of acute pain and for control of procedural pain. It may also be used as an intravenous analgesic with opiates to manage otherwise intractable pain, particularly if this pain is neuropathic. It has the added benefit of counteracting spinal sensitization or wind-up phenomena experienced with chronic pain. At these doses, the psychotropic side effects are less apparent and well managed with benzodiazepines. Low-dose ketamine is sometimes used in the treatment of complex regional pain syndrome CRPS. Ketamine has been found to be a rapid-acting antidepressant in depression. Ketamine has not been approved for use as an antidepressant, but its enantiomer , esketamine , was developed as a nasal spray for treatment-resistant depression and was approved for this indication in the United States in March Ketamine is available in the form of solution for intravenous infusion. The use of ketamine is cautioned against in cases of: \\\\\\\\\\\\[67\\\\\\\\\\\\] \\\\\\\\\\\\[5\\\\\\\\\\\\]. When administered by trained medical professionals, ketamine is generally safe for those people who are critically ill. However, the rat brain has significant differences in metabolism from the human brain; therefore such changes may not occur in humans. Current infrequent averaging 3. This suggests the infrequent use of ketamine does not cause cognitive deficits, and that any deficits that might occur may be reversible when ketamine use is discontinued. However, abstinent, frequent, and infrequent users all scored higher than controls on a test of delusional symptoms. These results raise the possibility that chronic exposure to low, subanesthetic concentrations of ketamine, while not affecting cell survival, could still impair neuronal maintenance and development. More recent studies of ketamine-induced neurotoxicity have focused on primates in an attempt to use a more accurate model than rodents. Some neonatal experts do not recommend the use of ketamine as an anesthetic agent in human neonates because of the potential adverse effects it may have on the developing brain. These neurodegenerative changes in early development have been seen with other drugs that share the same mechanism of action of NMDA receptor antagonism as ketamine. The acute effects of ketamine cause cognitive impairment, including reductions in vigilance, verbal fluency, short-term memory, and executive function, as well as schizophrenia-like perceptual changes. A systematic review examined reports of irritative urinary tract symptoms from ketamine recreational use. Bilateral hydronephrosis and renal papillary necrosis have also been reported in some cases. The time of onset of lower urinary tract symptoms varies depending, in part, on the severity and chronicity of ketamine use; however, it is unclear whether the severity and chronicity of ketamine use correspond linearly to the presentation of these symptoms. However, following dose reduction, the symptoms remitted. Management of these symptoms primarily involves ketamine cessation, for which compliance is low. Other treatments have been used, including antibiotics , NSAIDs , steroids , anticholinergics , and cystodistension. Further follow-up is required to fully assess the efficacy of these treatments. In case reports of three people treated with esketamine for relief of chronic pain, liver enzyme abnormalities occurred following repeat treatment with ketamine infusions, with the liver enzyme values returning below the upper reference limit of normal range on cessation of the drug. The result suggests liver enzymes must be monitored during such treatment. The short duration of effects promotes bingeing ; tolerance can develop; and withdrawal symptoms, including anxiety, shaking, and palpitations, may be present in some daily users following cessation of use. Plasma concentrations of ketamine are increased by CYP3A4 inhibitors e. Other drugs which increase blood pressure may interact with ketamine in having an additive effect on blood pressure including: stimulants, SNRI antidepressants, and MAOIs. Increase blood pressure and heart rate, palpitations, and arrhythmias may be potential effects. Ketamine may increase the effects of other sedatives in a dose-dependent manner, including, but not limited to alcohol , \\\\\\\\\\\\[88\\\\\\\\\\\\] benzodiazepines , \\\\\\\\\\\\[89\\\\\\\\\\\\] opioids , \\\\\\\\\\\\[90\\\\\\\\\\\\] quinazolinones , phenothiazines , anticholinergics , and barbiturates. Benzodiazepines may diminish the antidepressant effects of ketamine. In vitro , ketamine acts as an antagonist of the NMDA receptor , an ionotropic glutamate receptor. Besides NMDA receptor antagonism, other actions of ketamine under laboratory research include: \\\\\\\\\\\\[92\\\\\\\\\\\\] \\\\\\\\\\\\[4\\\\\\\\\\\\] \\\\\\\\\\\\[94\\\\\\\\\\\\]. Ketamine has been found to act as a potent partial agonist of the high-affinity state of the human and rat dopamine D 2 receptors in multiple studies. Antagonism of the NMDA receptor is thought to be responsible for the anesthetic, amnesic , dissociative , and hallucinogenic effects of ketamine. Ketamine produces measurable changes in peripheral organ systems, including the cardiovascular , gastrointestinal , and respiratory systems : \\\\\\\\\\\\[\\\\\\\\\\\\]. It has yet to be fully understood how ketamine mediates its robust and rapid-onset antidepressant effects. Esketamine is a more potent NMDA receptor antagonist and dissociative hallucinogen than arketamine , the other enantiomer of ketamine. Drowsiness , dissociation , and psychosis -like effects e. Ketamine can be absorbed by intravenous , intramuscular , oral , and topical routes due to both its water and lipid solubilities. Oral ketamine is easily broken down by bile acids , and hence has a low bioavailability. Often, lozenges or 'gummies' for sublingual or buccal absorption prepared by a compounding pharmacy are used to combat this issue. Some specialists stop the subcutaneous infusion when the first dose of oral ketamine is given. Others gradually reduce the infusion dose as the oral dose is increased. Ketamine is rapidly distributed and, due to its high lipophilicity , rapidly crosses the blood—brain barrier into the central nervous system. When administered orally, ketamine undergoes first-pass metabolism , where it is biotransformed in the liver by CYP3A4 major , CYP2B6 minor , and CYP2C9 minor isoenzymes into norketamine through N - demethylation and ultimately dehydronorketamine. As the major metabolite of ketamine, norketamine is one-third to one-fifth as potent as an anesthetic, and plasma levels of this metabolite are three times higher than ketamine following oral administration. The duration of action of ketamine in a clinical setting is 0. In chemical structure, ketamine is an arylcyclohexylamine derivative. Ketamine is a chiral compound. Most pharmaceutical preparations of ketamine are racemic ; however, some brands reportedly have mostly undocumented differences in their enantiomeric proportions. The more active enantiomer, esketamine S -ketamine , is also available for medical use under the brand name Ketanest S, \\\\\\\\\\\\[\\\\\\\\\\\\] while the less active enantiomer, arketamine R -ketamine , has never been marketed as an enantiopure drug for clinical use. The optical rotation of a given enantiomer of ketamine can vary between its salts and free base form. The difference originates from the conformation of the cyclohexanone ring. In both the free base and the hydrochloride, the cyclohexanone ring adopts a chair conformation , but the orientation of the substituents varies. In the free base, the o -chlorophenyl group adopts an equatorial position and the methylamino group adopts an axial position. Ketamine may be quantitated in blood or plasma to confirm a diagnosis of poisoning in hospitalized patients, provide evidence in an impaired driving arrest or to assist in a medicolegal death investigation. Blood or plasma ketamine concentrations are usually in a range of 0. Urine is often the preferred specimen for routine drug use monitoring purposes. The presence of norketamine, a pharmacologically-active metabolite, is useful for confirmation of ketamine ingestion. Ketamine was first synthesized in by Calvin L. Stevens , a professor of Chemistry at Wayne State University and a Parke-Davis consultant conducting research on alpha-hydroxyimine rearrangements. Nonmedical use of ketamine began on the West Coast of the United States in the early s. Ketamine is primarily sold throughout the world under the brand name Ketalar. Esketamine is sold mainly under the brand names Ketanest and Ketanest-S. After the publication of the NIH-run antidepressant clinical trial, clinics began opening in which the intravenous ketamine is given for depression. While ketamine is legally marketed in many countries worldwide, \\\\\\\\\\\\[\\\\\\\\\\\\] it is also a controlled substance in many countries. In Australia , ketamine is listed as a schedule 8 controlled drug under the Poisons Standard October In Canada , ketamine is classified as a Schedule I narcotic, since By , ketamine was classified as class III in Taiwan ; given the recent rise in prevalence in East Asia, however, rescheduling into class I or II is being considered. In December , the government of India , in response to rising recreational use and the use of ketamine as a date rape drug, has added it to Schedule X of the Drug and Cosmetics Act requiring a special license for sale and maintenance of records of all sales for two years. Recreational use of ketamine was documented in the early s in underground literature e. Consignments of Ecstasy known as 'Strawberry' contained what Saunders described as a 'potentially dangerous combination of ketamine, ephedrine , and selegiline ', as did a consignment of 'Sitting Duck' Ecstasy tablets. The use of ketamine as part of a 'post-clubbing experience' has also been documented. Ketamine use as a recreational drug has been implicated in deaths globally, with more than 90 deaths in England and Wales in the years of — It takes effect within about 10 minutes, \\\\\\\\\\\\[\\\\\\\\\\\\] while its hallucinogenic effects last 60 minutes when insufflated or injected and up to two hours when ingested orally. Lilly , Marcia Moore and D. Turner amongst others have written extensively about their own entheogenic use of, and psychonautic experiences with ketamine. Because of its ability to cause confusion and amnesia , ketamine has been used for date rape. Production for recreational use has been traced to , when it was referred to as 'mean green' and 'rockmesc'. According to the ongoing Monitoring the Future study conducted by University of Michigan , prevalence rates of recreational ketamine use among American secondary school students grades 8, 10, and 12 have varied between 0. In , the U. In China, the small village of Boshe in eastern Guangdong was confirmed as a main production centre when it was raided in Established by the Hong Kong Narcotics Division of the Security Bureau , the Central Registry of Drug Abuse CRDA maintains a database of all the illicit drug users who have come into contact with law enforcement, treatment, health care, and social organizations. The compiled data are confidential under The Dangerous Drugs Ordinance of Hong Kong, and statistics are made freely available online on a quarterly basis. A survey conducted among school-attending Taiwanese adolescents reported prevalence rates of 0. Russian doctor Evgeny Krupitsky has claimed to have obtained encouraging results by using ketamine as part of a treatment for alcohol addiction which combines psychedelic and aversive techniques. In veterinary anesthesia , ketamine is often used for its anesthetic and analgesic effects on cats, \\\\\\\\\\\\[\\\\\\\\\\\\] dogs, \\\\\\\\\\\\[\\\\\\\\\\\\] rabbits , rats , and other small animals. It is an important part of the ' rodent cocktail ', a mixture of drugs used for anesthetizing rodents. Ketamine is used to manage pain among large animals, though it has less effect on bovines. Ketamine appears not to produce sedation or anesthesia in snails. Instead, it appears to have an excitatory effect. From Wikipedia, the free encyclopedia. For the functional group referred to as ketimine, see imine. Dissociative medication. IUPAC name. Interactive image. Phencyclidine PCP or angel dust and ketamine also known as special K are structurally related drugs Cochrane Database of Systematic Reviews. Pain Physician. Mathew; Carlos A. Zarate, Jr. Archived from the original on 8 September London, UK: Pharmaceutical Press. Retrieved 24 August Morton; Judith M. Hall 6 December Archived from the original on 11 April Drug Metabolism and Disposition. Opioid-Induced Hyperalgesia. CRC Press. Toxicological Aspects of Drug-Facilitated Crimes. Elsevier Science. CNS Drugs. Modern Anesthetics. Handbook of Experimental Pharmacology. Psychiatry and Clinical Neurosciences. Schatzberg; Charles B. Nemeroff American Psychiatric Pub. Expert Review of Neurotherapeutics. Oxford University Press. Pharmacology and Therapeutics for Dentistry — E-Book. Elsevier Health Sciences. Principles of Forensic Toxicology. American Association for Clinical Chemistry. March Archived from the original on 10 December Retrieved 1 December Annals of Emergency Medicine. Clujul Medical. International Journal of Psychiatry in Clinical Practice. Center for Substance Abuse Research. University of Maryland. Archived from the original on 12 November Retrieved 26 September American Journal of Emergency Medicine. ACS Chemical Neuroscience. World Health Organization model list of essential medicines: 21st list Geneva: World Health Organization. Archived from the original on 23 August Retrieved 12 January Kurdi; Kaushic A. Theerth; Radhika S. Deva September Anesthesia: Essays and Researches. Biomed Res Int. December Iranian Journal of Allergy, Asthma, and Immunology. Archived from the original on 6 October Life in the Fastlane blog. Critical Care Compendium. Archived from the original on 9 February Retrieved 10 April Archives of Surgery. Acta Anaesthesiologica Scandinavica. Circulatory interactions during total intravenous anesthesia and analgesia-sedation\\\\\\\\\\\\]. Der Anaesthesist in German. Expert Review of Respiratory Medicine. BMC Anesthesiology. Indian Journal of Critical Care Medicine. Airways Group. Acta Medica Portuguesa. Academic Emergency Medicine. Pain Medicine. Pain, Palliative and Supportive Care Group. Annual Review of Medicine. Current Neuropharmacology. Therapeutic Advances in Psychopharmacology. Neurosci Biobehav Rev. Am J Psychiatry. Indian J Psychiatry. Lancet Psychiatry. Expert Opin Investig Drugs. JAMA Psychiatry. July AMH Online. Neurocritical Care. Journal of Anesthesia. Bibcode : Sci Anderson, Cliff June Archived from the original on 17 December Current Opinion in Anesthesiology. Toxicology Letters. May In Ito, U. Brain Edema IX. Acta Neurochirurgica. November Addiction Biology. Toxicological Sciences. Anesthesiology commentary. Psychotomimetic, perceptual, cognitive, and neuroendocrine responses'. Archives of General Psychiatry. International Journal of Clinical Practice. Current Opinion in Supportive and Palliative Care. The Journal of Clinical Psychiatry. Perspectives in Clinical Research. Pediatric Anesthesia. Retrieved 14 August Pharmacological Reviews. Journal of Psychopharmacology. Organic Letters. PLOS One. Bibcode : PLoSO European Neuropsychopharmacology. Journal of Pharmacology and Experimental Therapeutics. Molecular Psychiatry. The International Journal of Neuropsychopharmacology. British Journal of Anaesthesia. Archived from the original on 20 October Biochemical Pharmacology. Neuroscience Letters. Neurotoxicology and Teratology. The Journal of Neuroscience. Canadian Journal of Anaesthesia. Biochem Pharmacol. Drug Discov Today. September British Journal of Pharmacology. Australian Medicines Handbook 12th ed. Bibcode : Natur. European Journal of Pharmacology. Frontiers in Pharmacology. August The Journal of Clinical Pharmacology. Drug Discovery Today. Trends in Anaesthesia and Critical Care. Drug and Alcohol Dependence. Palliative Care Guidelines. August \\\\\\\\\\\\[August \\\\\\\\\\\\]. Archived from the original PDF on 29 October Anesthesia Progress. Emergency Medicine Australasia. Substance Abuse and Rehabilitation. Anaesthesiologie und Reanimation in German. Journal of Separation Science. Acta Crystallographica Section E. Acta Chemica Scandinavica. Drug Testing and Analysis. Development of a gas chromatography-mass spectrometry method for determination of ketamine in plasma and its application to human samples. Drug Monit. Detection of ketamine and its metabolites in urine by ultra high pressure liquid chromatography-tandem mass spectrometry. B —, Chronic Pain and Addiction. Basel, Switzerland: Karger AG. Retrieved 27 July Archived from the original on 19 August Retrieved 19 August The Lancet. Gahlinger, PM 1 June American Family Physician. Archived from the original on 17 November Jansen, KL 6 March Archived PDF from the original on 4 March Copeland, J; Dillon, P International Journal of Drug Policy. London: Free Association Books. Drugs and Alcohol Today. Elks 14 November Archived from the original on 15 February Archived from the original on 29 August Retrieved 28 August Bloomberg BusinessWeek. Archived from the original on 30 March Pharmaceutical Journal. Anesthesiology News. Archived from the original on 25 March Archived from the original on 19 January Retrieved 6 January Controlled Drugs and Substances Act S. Justice Laws Website. Government of Canada. Archived from the original on 22 November Canada Gazette Part II. Archived from the original PDF on 8 August Retrieved 2 August Canadian Society of Customs Brokers. Archived from the original on 10 August Criminal Law in Hong Kong. Kluwer Law International. Taipei Times. Archived from the original on 8 August The Times of India. Archived from the original on 14 April Archived from the original on 30 December BBC News. Archived from the original on 3 September Retrieved 7 May The Daily Telegraph. Archived from the original on 9 June Final Rule \\\\\\\\\\\\]' PDF. Rules and Regulations. Federal Register. Archived PDF from the original on 5 May The Freak Brothers Omnibus. London: Knockabout Comics. Journeys into the Bright World. Rockport, Mass. BMJ Clinical research ed. Dancing on drugs: risk, health and hedonism in the British club scene. London: Free Association. E for Ecstasy. London: N. Archived from the original on 7 June Retrieved 7 June Archived from the original on 19 June Archived from the original on 24 August Knowledge Exchange. Toronto: Centre for Addiction and Mental Health. Archived from the original on 7 April Psychiatric Medicine. American Journal of Therapeutics. Drug Abuse. Los Angeles: Health Information Press. The Scientist: A Metaphysical Autobiography. Berkeley, CA: Ronin. Kelly, Kit The Little Book of Ketamine. Alltounian, Howard Sunny; Moore, Marcia Journeys Into the Bright World. Rockport, MA: Para Research. Palmer, Cynthia; Horowitz, Michael Inner Traditions. Turner, D. The Essential Psychedelic Guide. San Francisco: Panther Press. Ketamine: Dreams and Realities. Multidisciplinary Association for Psychedelic Studies. Retrieved 3 January Retrieved 11 January Archived from the original on 15 December Archived from the original PDF on 26 April Pediatric Annals. UIT Cambridge. The Indian Journal of Medical Research. Monitoring the Future. Retrieved 17 January HHS Publication No. Emerging Health Threats Journal. Psychiatria Polska. CATO Institute. Australian Institute of Health and Welfare. BMC Public Health. Chen 1 October Journal of Adolescent Health. Forensic Science International. Alcoholism Treatment Quarterly. Journal of Psychoactive Drugs. In Winkelman, Michael J. Westport, CT: Praeger. Part 2. Treatment of pain--clinical pharmacology'. Journal of Feline Medicine and Surgery. Veterinary Medicine, Small Animal Clinician. Veterinary Pharmacology and Therapeutics. Medical uses. General anesthetics N01A. Fospropofol Propofol. Hexobarbital Methohexital Narcobarbital Thiopental Thiotetrabarbital. Alfadolone Alfaxalone Hydroxydione. Analgesics N02A , N02B. Meloxicam Piroxicam. Meclofenamic acid Mefenamic acid. Cannabidiol Cannabis Nabilone Nabiximols Tetrahydrocannabinol dronabinol. Carbamazepine Lacosamide Local anesthetics e. Antidepressants N06A. Atomoxetine Reboxetine Viloxazine. Mianserin Mirtazapine Setiptiline. Etoperidone Nefazodone Trazodone. Vilazodone Vortioxetine. Tricyclic and tetracyclic antidepressants. Amoxapine Maprotiline Mianserin Mirtazapine Setiptiline. Monoamine oxidase inhibitors. Irreversible: Selegiline. Adjunctive therapies. Atypical antipsychotics aripiprazole , brexpiprazole , lurasidone , olanzapine , quetiapine , risperidone Buspirone Lithium lithium carbonate , lithium citrate Thyroid hormones triiodothyronine T 3 , levothyroxine T 4. Recreational uses. Recreational drug use. Calea zacatechichi Silene capensis. Coffee break Coffeehouse Latte art Tea house. Abuse Date rape drug Impaired driving Drug harmfulness Effects of cannabis Addiction Dependence Prevention Opioid replacement therapy Rehabilitation Responsible use Drug-related crime Fetal alcohol spectrum disorder Long-term effects of cannabis Neurotoxicity Overdose Passive smoking of tobacco or other substances. Alcohol legality Alcohol consumption Anabolic steroid legality Cannabis legality Annual use Lifetime use Cigarette consumption Cocaine legality Cocaine use Methamphetamine legality Opiates use Psilocybin mushrooms legality Salvia legality. Diphenidine Ephenidine Fluorolintane Methoxphenidine. Dextrallorphan Dextromethorphan Dextrorphan Racemethorphan Racemorphan. Apomorphine Aporphine Bromocriptine Cabergoline Lisuride Memantine Nuciferine Pergolide Phenethylamine Piribedil Pramipexole Ropinirole Rotigotine Salvinorin A Also indirect D 2 agonists, such as dopamine reuptake inhibitors cocaine , methylphenidate , releasing agents amphetamine , methamphetamine , and precursors levodopa. Glaucine Isoaminile Noscapine Pukateine. See also: Recreational drug use. Acetylcholine receptor modulators. Muscarinic acetylcholine receptor modulators. Nicotinic acetylcholine receptor modulators. Dopamine receptor modulators. Ion channel modulators. L-type-selective : Bay K Amiloride Benzamil Triamterene. Glibenclamide Lonidamine Piretanide. See here instead. Ionotropic glutamate receptor modulators. Monoamine reuptake inhibitors. Others: Antihistamines e. Others: A Amoxapine Antihistamines e. Amiodarone Amphetamines e. Opioid receptor modulators. Consumer Drug Information. Low—moderate \\\\\\\\\\\\[1\\\\\\\\\\\\]. Any \\\\\\\\\\\\[2\\\\\\\\\\\\] \\\\\\\\\\\\[3\\\\\\\\\\\\] \\\\\\\\\\\\[4\\\\\\\\\\\\] \\\\\\\\\\\\[5\\\\\\\\\\\\]. Norketamine Dehydronorketamine Hydroxynorketamine Conjugates \\\\\\\\\\\\[17\\\\\\\\\\\\]. Intravenous: seconds \\\\\\\\\\\\[11\\\\\\\\\\\\] Intramuscular: 1—5 min \\\\\\\\\\\\[11\\\\\\\\\\\\] \\\\\\\\\\\\[18\\\\\\\\\\\\] Subcutaneous: 15—30 min \\\\\\\\\\\\[18\\\\\\\\\\\\] Insufflation: 5—10 min \\\\\\\\\\\\[11\\\\\\\\\\\\] By mouth: 15—30 min \\\\\\\\\\\\[11\\\\\\\\\\\\] \\\\\\\\\\\\[18\\\\\\\\\\\\]. Ketamine: 2. Intramuscular: 0. GABA A. MOR 2. D 2 High. PCP 2. The smaller the value, the stronger the interaction with the site. Wikimedia Commons has media related to Ketamine. Phenols Fospropofol Propofol. Adjunctive therapies Atypical antipsychotics aripiprazole , brexpiprazole , lurasidone , olanzapine , quetiapine , risperidone Buspirone Lithium lithium carbonate , lithium citrate Thyroid hormones triiodothyronine T 3 , levothyroxine T 4. Blockers Amiloride Benzamil Triamterene. Blockers Glibenclamide Lonidamine Piretanide. TRPs See here instead.
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Кетамин википедия
Кетамин как наркотик, свойства, действие, эффекты, передозировка
Ketamine is a medication mainly used for starting and maintaining anesthesia. Common side effects include agitation , confusion, or hallucinations as the medication wears off. Ketamine was discovered in , first tested in humans in , and approved for use in the United States in Uses as an anesthetic: \\\\\\\\\\\\\\[33\\\\\\\\\\\\\\]. Since it suppresses breathing much less than most other available anesthetics, \\\\\\\\\\\\\\[36\\\\\\\\\\\\\\] ketamine is used in medicine as an anesthetic; however, due to the hallucinations it may cause, it is not typically used as a primary anesthetic, although it is the anesthetic of choice when reliable ventilation equipment is not available. Ketamine is frequently used in severely injured people and appears to be safe in this group. The effect of ketamine on the respiratory and circulatory systems is different from that of other anesthetics. When used at anesthetic doses, it will usually stimulate rather than depress the circulatory system. It has been successfully used to prevent postanesthetic shivering. Ketamine is used as a bronchodilator in the treatment of severe asthma. Ketamine is sometimes used in the treatment of status epilepticus that has failed to adequately respond to standard treatments. Ketamine may be used for postoperative pain management. Low doses of ketamine may reduce morphine use, nausea, and vomiting after surgery. Ketamine has similar efficacy to opioids in a hospital emergency department setting for management of acute pain and for control of procedural pain. It may also be used as an intravenous analgesic with opiates to manage otherwise intractable pain, particularly if this pain is neuropathic. It has the added benefit of counteracting spinal sensitization or wind-up phenomena experienced with chronic pain. At these doses, the psychotropic side effects are less apparent and well managed with benzodiazepines. Low-dose ketamine is sometimes used in the treatment of complex regional pain syndrome CRPS. Ketamine has been found to be a rapid-acting antidepressant in depression. Ketamine has not been approved for use as an antidepressant, but its enantiomer , esketamine , was developed as a nasal spray for treatment-resistant depression and was approved for this indication in the United States in March Ketamine is available in the form of solution for intravenous infusion. The use of ketamine is cautioned against in cases of: \\\\\\\\\\\\\\[67\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[5\\\\\\\\\\\\\\]. When administered by trained medical professionals, ketamine is generally safe for those people who are critically ill. However, the rat brain has significant differences in metabolism from the human brain; therefore such changes may not occur in humans. Current infrequent averaging 3. This suggests the infrequent use of ketamine does not cause cognitive deficits, and that any deficits that might occur may be reversible when ketamine use is discontinued. However, abstinent, frequent, and infrequent users all scored higher than controls on a test of delusional symptoms. These results raise the possibility that chronic exposure to low, subanesthetic concentrations of ketamine, while not affecting cell survival, could still impair neuronal maintenance and development. More recent studies of ketamine-induced neurotoxicity have focused on primates in an attempt to use a more accurate model than rodents. Some neonatal experts do not recommend the use of ketamine as an anesthetic agent in human neonates because of the potential adverse effects it may have on the developing brain. These neurodegenerative changes in early development have been seen with other drugs that share the same mechanism of action of NMDA receptor antagonism as ketamine. The acute effects of ketamine cause cognitive impairment, including reductions in vigilance, verbal fluency, short-term memory, and executive function, as well as schizophrenia-like perceptual changes. A systematic review examined reports of irritative urinary tract symptoms from ketamine recreational use. Bilateral hydronephrosis and renal papillary necrosis have also been reported in some cases. The time of onset of lower urinary tract symptoms varies depending, in part, on the severity and chronicity of ketamine use; however, it is unclear whether the severity and chronicity of ketamine use correspond linearly to the presentation of these symptoms. However, following dose reduction, the symptoms remitted. Management of these symptoms primarily involves ketamine cessation, for which compliance is low. Other treatments have been used, including antibiotics , NSAIDs , steroids , anticholinergics , and cystodistension. Further follow-up is required to fully assess the efficacy of these treatments. In case reports of three people treated with esketamine for relief of chronic pain, liver enzyme abnormalities occurred following repeat treatment with ketamine infusions, with the liver enzyme values returning below the upper reference limit of normal range on cessation of the drug. The result suggests liver enzymes must be monitored during such treatment. The short duration of effects promotes bingeing ; tolerance can develop; and withdrawal symptoms, including anxiety, shaking, and palpitations, may be present in some daily users following cessation of use. Plasma concentrations of ketamine are increased by CYP3A4 inhibitors e. Other drugs which increase blood pressure may interact with ketamine in having an additive effect on blood pressure including: stimulants, SNRI antidepressants, and MAOIs. Increase blood pressure and heart rate, palpitations, and arrhythmias may be potential effects. Ketamine may increase the effects of other sedatives in a dose-dependent manner, including, but not limited to alcohol , \\\\\\\\\\\\\\[88\\\\\\\\\\\\\\] benzodiazepines , \\\\\\\\\\\\\\[89\\\\\\\\\\\\\\] opioids , \\\\\\\\\\\\\\[90\\\\\\\\\\\\\\] quinazolinones , phenothiazines , anticholinergics , and barbiturates. Benzodiazepines may diminish the antidepressant effects of ketamine. In vitro , ketamine acts as an antagonist of the NMDA receptor , an ionotropic glutamate receptor. Besides NMDA receptor antagonism, other actions of ketamine under laboratory research include: \\\\\\\\\\\\\\[92\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[4\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[94\\\\\\\\\\\\\\]. Ketamine has been found to act as a potent partial agonist of the high-affinity state of the human and rat dopamine D 2 receptors in multiple studies. Antagonism of the NMDA receptor is thought to be responsible for the anesthetic, amnesic , dissociative , and hallucinogenic effects of ketamine. Ketamine produces measurable changes in peripheral organ systems, including the cardiovascular , gastrointestinal , and respiratory systems : \\\\\\\\\\\\\\[\\\\\\\\\\\\\\]. It has yet to be fully understood how ketamine mediates its robust and rapid-onset antidepressant effects. Esketamine is a more potent NMDA receptor antagonist and dissociative hallucinogen than arketamine , the other enantiomer of ketamine. Drowsiness , dissociation , and psychosis -like effects e. Ketamine can be absorbed by intravenous , intramuscular , oral , and topical routes due to both its water and lipid solubilities. Oral ketamine is easily broken down by bile acids , and hence has a low bioavailability. Often, lozenges or 'gummies' for sublingual or buccal absorption prepared by a compounding pharmacy are used to combat this issue. Some specialists stop the subcutaneous infusion when the first dose of oral ketamine is given. Others gradually reduce the infusion dose as the oral dose is increased. Ketamine is rapidly distributed and, due to its high lipophilicity , rapidly crosses the blood—brain barrier into the central nervous system. When administered orally, ketamine undergoes first-pass metabolism , where it is biotransformed in the liver by CYP3A4 major , CYP2B6 minor , and CYP2C9 minor isoenzymes into norketamine through N - demethylation and ultimately dehydronorketamine. As the major metabolite of ketamine, norketamine is one-third to one-fifth as potent as an anesthetic, and plasma levels of this metabolite are three times higher than ketamine following oral administration. The duration of action of ketamine in a clinical setting is 0. In chemical structure, ketamine is an arylcyclohexylamine derivative. Ketamine is a chiral compound. Most pharmaceutical preparations of ketamine are racemic ; however, some brands reportedly have mostly undocumented differences in their enantiomeric proportions. The more active enantiomer, esketamine S -ketamine , is also available for medical use under the brand name Ketanest S, \\\\\\\\\\\\\\[\\\\\\\\\\\\\\] while the less active enantiomer, arketamine R -ketamine , has never been marketed as an enantiopure drug for clinical use. The optical rotation of a given enantiomer of ketamine can vary between its salts and free base form. The difference originates from the conformation of the cyclohexanone ring. In both the free base and the hydrochloride, the cyclohexanone ring adopts a chair conformation , but the orientation of the substituents varies. In the free base, the o -chlorophenyl group adopts an equatorial position and the methylamino group adopts an axial position. Ketamine may be quantitated in blood or plasma to confirm a diagnosis of poisoning in hospitalized patients, provide evidence in an impaired driving arrest or to assist in a medicolegal death investigation. Blood or plasma ketamine concentrations are usually in a range of 0. Urine is often the preferred specimen for routine drug use monitoring purposes. The presence of norketamine, a pharmacologically-active metabolite, is useful for confirmation of ketamine ingestion. Ketamine was first synthesized in by Calvin L. Stevens , a professor of Chemistry at Wayne State University and a Parke-Davis consultant conducting research on alpha-hydroxyimine rearrangements. Nonmedical use of ketamine began on the West Coast of the United States in the early s. Ketamine is primarily sold throughout the world under the brand name Ketalar. Esketamine is sold mainly under the brand names Ketanest and Ketanest-S. After the publication of the NIH-run antidepressant clinical trial, clinics began opening in which the intravenous ketamine is given for depression. While ketamine is legally marketed in many countries worldwide, \\\\\\\\\\\\\\[\\\\\\\\\\\\\\] it is also a controlled substance in many countries. In Australia , ketamine is listed as a schedule 8 controlled drug under the Poisons Standard October In Canada , ketamine is classified as a Schedule I narcotic, since By , ketamine was classified as class III in Taiwan ; given the recent rise in prevalence in East Asia, however, rescheduling into class I or II is being considered. In December , the government of India , in response to rising recreational use and the use of ketamine as a date rape drug, has added it to Schedule X of the Drug and Cosmetics Act requiring a special license for sale and maintenance of records of all sales for two years. Recreational use of ketamine was documented in the early s in underground literature e. Consignments of Ecstasy known as 'Strawberry' contained what Saunders described as a 'potentially dangerous combination of ketamine, ephedrine , and selegiline ', as did a consignment of 'Sitting Duck' Ecstasy tablets. The use of ketamine as part of a 'post-clubbing experience' has also been documented. Ketamine use as a recreational drug has been implicated in deaths globally, with more than 90 deaths in England and Wales in the years of — It takes effect within about 10 minutes, \\\\\\\\\\\\\\[\\\\\\\\\\\\\\] while its hallucinogenic effects last 60 minutes when insufflated or injected and up to two hours when ingested orally. Lilly , Marcia Moore and D. Turner amongst others have written extensively about their own entheogenic use of, and psychonautic experiences with ketamine. Because of its ability to cause confusion and amnesia , ketamine has been used for date rape. Production for recreational use has been traced to , when it was referred to as 'mean green' and 'rockmesc'. According to the ongoing Monitoring the Future study conducted by University of Michigan , prevalence rates of recreational ketamine use among American secondary school students grades 8, 10, and 12 have varied between 0. In , the U. In China, the small village of Boshe in eastern Guangdong was confirmed as a main production centre when it was raided in Established by the Hong Kong Narcotics Division of the Security Bureau , the Central Registry of Drug Abuse CRDA maintains a database of all the illicit drug users who have come into contact with law enforcement, treatment, health care, and social organizations. The compiled data are confidential under The Dangerous Drugs Ordinance of Hong Kong, and statistics are made freely available online on a quarterly basis. A survey conducted among school-attending Taiwanese adolescents reported prevalence rates of 0. Russian doctor Evgeny Krupitsky has claimed to have obtained encouraging results by using ketamine as part of a treatment for alcohol addiction which combines psychedelic and aversive techniques. In veterinary anesthesia , ketamine is often used for its anesthetic and analgesic effects on cats, \\\\\\\\\\\\\\[\\\\\\\\\\\\\\] dogs, \\\\\\\\\\\\\\[\\\\\\\\\\\\\\] rabbits , rats , and other small animals. It is an important part of the ' rodent cocktail ', a mixture of drugs used for anesthetizing rodents. Ketamine is used to manage pain among large animals, though it has less effect on bovines. Ketamine appears not to produce sedation or anesthesia in snails. Instead, it appears to have an excitatory effect. From Wikipedia, the free encyclopedia. For the functional group referred to as ketimine, see imine. Dissociative medication. IUPAC name. Interactive image. Phencyclidine PCP or angel dust and ketamine also known as special K are structurally related drugs Cochrane Database of Systematic Reviews. Pain Physician. Mathew; Carlos A. Zarate, Jr. Archived from the original on 8 September London, UK: Pharmaceutical Press. Retrieved 24 August Morton; Judith M. 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Meclofenamic acid Mefenamic acid. Cannabidiol Cannabis Nabilone Nabiximols Tetrahydrocannabinol dronabinol. Carbamazepine Lacosamide Local anesthetics e. Antidepressants N06A. Atomoxetine Reboxetine Viloxazine. Mianserin Mirtazapine Setiptiline. Etoperidone Nefazodone Trazodone. Vilazodone Vortioxetine. Tricyclic and tetracyclic antidepressants. Amoxapine Maprotiline Mianserin Mirtazapine Setiptiline. Monoamine oxidase inhibitors. Irreversible: Selegiline. Adjunctive therapies. Atypical antipsychotics aripiprazole , brexpiprazole , lurasidone , olanzapine , quetiapine , risperidone Buspirone Lithium lithium carbonate , lithium citrate Thyroid hormones triiodothyronine T 3 , levothyroxine T 4. Recreational uses. Recreational drug use. Calea zacatechichi Silene capensis. Coffee break Coffeehouse Latte art Tea house. 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Apomorphine Aporphine Bromocriptine Cabergoline Lisuride Memantine Nuciferine Pergolide Phenethylamine Piribedil Pramipexole Ropinirole Rotigotine Salvinorin A Also indirect D 2 agonists, such as dopamine reuptake inhibitors cocaine , methylphenidate , releasing agents amphetamine , methamphetamine , and precursors levodopa. Glaucine Isoaminile Noscapine Pukateine. See also: Recreational drug use. Acetylcholine receptor modulators. Muscarinic acetylcholine receptor modulators. Nicotinic acetylcholine receptor modulators. Dopamine receptor modulators. Ion channel modulators. L-type-selective : Bay K Amiloride Benzamil Triamterene. Glibenclamide Lonidamine Piretanide. See here instead. Ionotropic glutamate receptor modulators. Monoamine reuptake inhibitors. Others: Antihistamines e. Others: A Amoxapine Antihistamines e. Amiodarone Amphetamines e. Opioid receptor modulators. Consumer Drug Information. Low—moderate \\\\\\\\\\\\\\[1\\\\\\\\\\\\\\]. Any \\\\\\\\\\\\\\[2\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[3\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[4\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[5\\\\\\\\\\\\\\]. Norketamine Dehydronorketamine Hydroxynorketamine Conjugates \\\\\\\\\\\\\\[17\\\\\\\\\\\\\\]. Intravenous: seconds \\\\\\\\\\\\\\[11\\\\\\\\\\\\\\] Intramuscular: 1—5 min \\\\\\\\\\\\\\[11\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[18\\\\\\\\\\\\\\] Subcutaneous: 15—30 min \\\\\\\\\\\\\\[18\\\\\\\\\\\\\\] Insufflation: 5—10 min \\\\\\\\\\\\\\[11\\\\\\\\\\\\\\] By mouth: 15—30 min \\\\\\\\\\\\\\[11\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[18\\\\\\\\\\\\\\]. Ketamine: 2. Intramuscular: 0. GABA A. MOR 2. D 2 High. PCP 2. The smaller the value, the stronger the interaction with the site. Wikimedia Commons has media related to Ketamine. Phenols Fospropofol Propofol. Adjunctive therapies Atypical antipsychotics aripiprazole , brexpiprazole , lurasidone , olanzapine , quetiapine , risperidone Buspirone Lithium lithium carbonate , lithium citrate Thyroid hormones triiodothyronine T 3 , levothyroxine T 4. Blockers Amiloride Benzamil Triamterene. Blockers Glibenclamide Lonidamine Piretanide. TRPs See here instead.