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Ketamine , sold under the brand name Ketalar among others, is a medication mainly used for starting and maintaining anesthesia. Common side effects include psychological reactions as the medication wears off. Ketamine was discovered in , first tested in humans in , and was approved for use in the United States in Uses as an anesthetic: Since it suppresses breathing much less than most other available anesthetics, \\\\\\\\\\\\\\[30\\\\\\\\\\\\\\] 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. Ketamine is used as a bronchodilator in the treatment of severe asthma. Ketamine may be used for postoperative pain management. Low doses of ketamine may reduce morphine use, nausea, and vomiting after surgery. 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 tested as a rapid-acting antidepressant \\\\\\\\\\\\\\[46\\\\\\\\\\\\\\] for treatment-resistant depression in bipolar disorder , and major depressive disorder. The use of ketamine is cautioned against in cases of: Ketamine is generally safe for those critically ill, when administered by trained medical professionals. 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 corresponds 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. 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: 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: Benzodiazepines may diminish the antidepressant effects of ketamine. Ketamine acts as a selective antagonist of the NMDA receptor , an ionotropic glutamate receptor. 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. Drowsiness , dissociation , and psychosis -like effects e. 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: Ketamine is absorbable by intravenous , intramuscular , oral , and topical routes due to both its water and lipid solubilities. Dehydronorketamine, followed by norketamine, is the most prevalent metabolite detected in urine. In medical settings, ketamine is usually injected intravenously or intramuscularly. Ketamine can be started using the oral route , or people may be changed from a subcutaneous infusion once pain is controlled. 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 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. MDMA due to its anesthetic properties e. Because of its ability to cause confusion and amnesia , ketamine can leave users vulnerable to date rape. Ketamine is primarily sold throughout the world under the brand name Ketalar. Esketamine is sold mainly under the brand names Ketanest and Ketanest-S. While ketamine is legally marketed in many countries worldwide \\\\\\\\\\\\\\[ citation needed \\\\\\\\\\\\\\] , it is also a widely controlled substance throughout the world. 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. 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. After the publication of the NIH-run antidepressant clinical trial, clinics began opening in which the medication is given. Russian doctor Evgeny Krupitsky has claimed to have encouraging results by using ketamine as part of a treatment for alcohol addiction which combines psychedelic and aversive techniques. A review of subjects with suicidal thoughts found that a single dose of ketamine caused a reduction in suicidal thinking that was rapid and lasted up to a week. 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. From Wikipedia, the free encyclopedia. For the functional group referred to as ketimine, see imine. C Risk not ruled out. Skeletal formula of R -ketamine. Ball-and-stick model of R -ketamine. Recreational use of ketamine. Reinforcement and Addictive Disorders'. A Foundation for Clinical Neuroscience 2nd ed. Phencyclidine PCP or angel dust and ketamine also known as special K are structurally related drugs The Cochrane Database of Systematic Reviews. Ketamine for Treatment-Resistant Depression: The First Decade of Progress. Archived from the original on 8 September The Complete Drug Reference'. Retrieved 24 August Hall 6 December Concise Dictionary of Pharmacological Agents: Archived from the original on 11 April Drug Metabolism and Disposition. Toxicological Aspects of Drug-Facilitated Crimes. Handbook of Experimental Pharmacology. Continuous Subcutaneous Infusions in Palliative Care. Pharmacology and Therapeutics for Dentistry - E-Book. Principles of Forensic Toxicology. Archived from the original on 10 December Retrieved 1 December Annals of Emergency Medicine. Center for Substance Abuse Research. Archived from the original on 12 November Retrieved 26 September American Journal of Emergency Medicine. Archived from the original on 18 August Archived PDF from the original on 13 December Retrieved 8 December Archived from the original on 23 August Retrieved 12 January Current applications in anesthesia, pain, and critical care'. Anesthesia, Essays and Researches. Iranian Journal of Allergy, Asthma, and Immunology. Archived from the original on 6 October Life in the Fastlane blog. Archived from the original on 9 February Retrieved 10 April Frequency, duration, and consequences'. Circulatory interactions during total intravenous anesthesia and analgesia-sedation\\\\\\\\\\\\\\]. Der Anaesthesist in German. Expert Review of Respiratory Medicine. Indian Journal of Critical Care Medicine. Archived from the original on 8 August Cochrane Database of Systematic Reviews. Pain, Palliative and Supportive Care Group. Cochrane Database of Systematic Reviews 1: A quantitative systematic review of randomised trials'. A systematic review and synthesis of the literature'. A retrospective analysis of a novel therapeutic approach to complex regional pain syndrome'. Archived from the original on 22 November Archived from the original on 9 August Annual Review of Medicine. Archived from the original on 19 April Therapeutic Advances in Psychopharmacology. Archived from the original on 5 September Retrieved 11 June NIH News Press release. National Institutes of Health ; Dept. National Institute of Mental Health director Thomas Insel said, 'To my knowledge, this is the first report of any medication or other treatment that results in such a pronounced, rapid, prolonged response with a single dose. These were very treatment-resistant patients. Journal of Affective Disorders. Australian Medicines Handbook Pty Ltd. Anderson, Cliff June Archived from the original on 17 December Current Opinion in Anaesthesiology. A 1-year longitudinal study'. Insight into molecular mechanisms and relevance to humans'. Psychotomimetic, perceptual, cognitive, and neuroendocrine responses'. Archives of General Psychiatry. International Journal of Clinical Practice. Current Opinion in Supportive and Palliative Care. Potential Pharmacokinetic and Pharmacodynamic Drug Interactions'. Archived from the original on 14 July Perspectives in Clinical Research. Archived from the original on 5 May Retrieved 14 August D2 basis for schizophrenia'. Its mechanism s of action and unusual clinical uses'. British Journal of Anaesthesia. Archived from the original on 20 October Expert Opinion on Investigational Drugs. Teaching an old drug new tricks'. British Journal of Pharmacology. NIH-funded team finds rapid-acting, non-addicting agent in mouse study'. Archived from the original on 7 May Journal of the European College of Neuropsychopharmacology. Australian Medicines Handbook 12th ed. Int J Psychiatry Clin Pract. A report of two cases'. Trends in Anaesthesia and Critical Care. Reevaluation of an old drug'. Journal of Clinical Pharmacology. An update on licit and illicit ketamine use'. Substance Abuse and Rehabilitation. A review of its pharmacologic properties and use in ambulatory anesthesia'. Drug and Alcohol Dependence. August \\\\\\\\\\\\\\[August \\\\\\\\\\\\\\]. Archived PDF from the original on Anaesthesiologie und Reanimation in German. Journal of Separation Science. Chronic Pain and Addiction. A comprehensive review of the non-medical use of dissociative drugs'. Drug Testing and Analysis. Further pharmacologic studies and first clinical experience with the phencyclidine derivative CI'. Archived from the original on Retrieved 27 July Archived from the original on 19 August Retrieved 19 August Awuonda, M 13 July Gahlinger, PM 1 June Archived from the original on 17 November Jansen, KL 6 March The cultural meaning of ketamine use in Hong Kong'. Tanner-Smith, EE July Results from an online testing service' PDF. Archived PDF from the original on 4 March Copeland, J; Dillon, P International Journal of Drug Policy. Minimising problems and maximising pleasure'. Drugs and Alcohol Today. Centre for Addiction and Mental Health. Elks 14 November The Dictionary of Drugs: Chemical Data, Structures and Bibliographies. Archived from the original on 15 February Archived from the original on 29 August Retrieved 28 August Archived from the original on 19 January Retrieved 6 January Controlled Drugs and Substances Act S. Canada Gazette Part II. Archived PDF from the original on 8 August Retrieved 2 August Canadian Society of Customs Brokers. Archived from the original on 10 August Criminal Law in Hong Kong. The Times of India. Archived from the original on 14 April Archived from the original on 30 December Retrieved 7 May Archived from the original on 9 June Final Rule \\\\\\\\\\\\\\]' PDF. Archived PDF from the original on 5 May Archived from the original on 7 June Retrieved 7 June Archived from the original on 19 June Archived from the original on 24 August American Journal of Therapeutics. Lilly, John Cunningham The Little Book of Ketamine. Alltounian, Howard Sunny; Moore, Marcia Journeys Into the Bright World. Palmer, Cynthia; Horowitz, Michael Sisters of the Extreme: Women Writing on the Drug Experience. The Essential Psychedelic Guide. Multidisciplinary Association for Psychedelic Studies. Archived from the original on 30 March Archived from the original on 25 March A review of the results of ten years of research'. Journal of Psychoactive Drugs. In Winkelman, Michael J. New Evidence for Hallucinogens as Treatments. Treatment of pain--clinical pharmacology'. Journal of Feline Medicine and Surgery. The Veterinary Clinics of North America. Veterinary Medicine, Small Animal Clinician: Veterinary Pharmacology and Therapeutics. Pharmacy and Pharmacology portal. Analgesics N02A , N02B. Meclofenamic acid Mefenamic acid. Cannabidiol Cannabis Nabilone Nabiximols Tetrahydrocannabinol dronabinol. Gabapentin Gabapentin enacarbil Pregabalin Ziconotide. Carbamazepine Lacosamide Local anesthetics e. Tricyclic and tetracyclic antidepressants. Amoxapine Maprotiline Mianserin Mirtazapine Setiptiline. Atypical antipsychotics aripiprazole , brexpiprazole , lurasidone , olanzapine , quetiapine , risperidone Buspirone Lithium lithium carbonate , lithium citrate Thyroid hormones triiodothyronine T 3 , levothyroxine T 4. 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. Muscarinic acetylcholine receptor modulators. Nicotinic acetylcholine receptor modulators. Amantadine Memantine Rimantadine Aminotetralins: KCNQ K v 7 -specific: Ranolazine Antiarrhythmics class I: Conotoxins Neosaxitoxin Saxitoxin Tetrodotoxin Others: Buprenorphine Evenamide Menthol mint Safinamide Tricyclic antidepressants. Atracotoxins Robustoxin , Versutoxin Ciguatoxins Poneratoxin. Ionotropic glutamate receptor modulators. Neomycin Spermidine Spermine ; Other positive allosteric modulators: Selective norepinephrine reuptake inhibitors: Amoxapine Maprotiline Mianserin Oxaprotiline Setiptiline. Selective serotonin reuptake inhibitors: A Amoxapine Antihistamines e. Agonists abridged; see here for a full list: Retrieved from ' https: Views Read Edit View history. In other projects Wikimedia Commons. This page was last edited on 5 November , at By using this site, you agree to the Terms of Use and Privacy Policy. IV , IM , IT , \\\\\\\\\\\\\\[2\\\\\\\\\\\\\\] insufflated , by mouth , epidural , \\\\\\\\\\\\\\[3\\\\\\\\\\\\\\] intraosseous , intranasal , topical , transdermal \\\\\\\\\\\\\\[4\\\\\\\\\\\\\\] \\\\\\\\\\\\\\[5\\\\\\\\\\\\\\]. The smaller the value, the more strongly the drug binds to the site. Wikimedia Commons has media related to Ketamine. Calcium blockers Gabapentin Gabapentin enacarbil Pregabalin Ziconotide. Monoamine oxidase inhibitors Non-selective Irreversible: 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 K ATP -specific: Blockers BK Ca -specific: Blockers Amiloride Benzamil Triamterene. Blockers Glibenclamide Lonidamine Piretanide. TRPs See here instead.

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