Ketamine
Pronunciation: pronunciation varies by local usage.
- Generic name
- ketamine hydrochloride
- Brand names
- Ketalar, Ketanest, Ketamine Sandoz, Ketlar, Ketamine Hydrochloride Injection
- Drug class
- Dissociative anesthetic (NMDA receptor antagonist)
- Form
- Solution for injection in single-dose or multi-dose vials; strengths vary (e.g., 50 mg/mL, 100 mg/mL, 200 mg/2 mL, 500 mg/10 mL)
- Route
- Intravenous or intramuscular injection
- Legal status
- Controlled substance (schedule varies by country); prescription-only medicine for healthcare professional administration
Supply Rules Vary
Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand
Australia: Ketalar, APO-KETAMINE, KETAMINE INTERPHARMA · Full directory
What ketamine hydrochloride is and how it works
Ketamine is a dissociative anesthetic and analgesic that works primarily by blocking the NMDA receptor. It produces a trance-like state while providing pain relief, sedation, and amnesia. Approved uses include induction and maintenance of general anesthesia, sedation for diagnostic or therapeutic procedures, and—in some regions—analgesia for acute pain. It is administered only by healthcare professionals in a controlled clinical setting. (1) (2) (3) (4) (5)
Ketamine injection is not a self-administered medicine. It is given by an anesthesiologist or trained healthcare provider in a hospital or clinic, with continuous vital-sign monitoring and emergency airway equipment immediately available. It is a controlled substance with potential for abuse and dependence. The exact formulation, dose, and route depend on the procedure, patient age, weight, medical history, and local product information.
Mechanism of action: how ketamine hydrochloride works
Ketamine is a noncompetitive antagonist at the N‑methyl‑D‑aspartate (NMDA) receptor, producing dissociative anesthesia, analgesia, and amnesia. It also interacts with opioid, monoaminergic, cholinergic, and other receptor systems. The dissociative state is characterised by profound analgesia, intact pharyngeal‑laryngeal reflexes, and spontaneous ventilation, often with skeletal muscle hypertonus and nystagmus. (1) (2) (3) (4) (5)
What ketamine hydrochloride is used for
Induction and maintenance of general anesthesia
Ketamine may be used as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. It can also be used to induce anesthesia before administration of other general anesthetics, or as a supplement to other anesthetic agents. Specific applications include short procedures, neurodiagnostic studies, ophthalmological and ENT surgery (with appropriate muscle relaxants if airway reflexes must be suppressed), orthopaedic procedures, and anesthesia for high-risk patients. (1) (2) (3) (4)
Sedation for diagnostic and therapeutic procedures
Ketamine provides sedation and analgesia for minor surgical or diagnostic interventions, such as wound debridement, painful dressing changes, burn care, dental extractions, and certain radiological procedures. It is particularly useful when spontaneous respiration must be maintained. (2) (3) (4) (5)
Analgesia in acute pain (some regions)
In some countries, ketamine is used for analgesia in acute pain settings, such as in emergency departments or postoperative care, often at lower doses than those used for anesthesia. This use is region‑specific and guided by local protocols. (5)
Before taking ketamine hydrochloride
Do not take / not appropriate for
- Ketamine must not be used in patients with uncontrolled or severe hypertension, pre‑eclampsia, eclampsia, or other conditions where a significant rise in blood pressure would pose a serious hazard. (all indications) (1) (2) (3) (5)
- Do not use ketamine in patients with known hypersensitivity to ketamine or any ingredient in the formulation. (all products) (1) (2) (3) (4) (5)
- Avoid ketamine in patients with recent myocardial infarction, unstable angina, severe coronary artery disease, or decompensated heart failure unless the responsible anaesthetist determines otherwise under the local product information. (all indications) (2) (3) (4)
- Do not use ketamine as the sole anaesthetic for surgery of the pharynx, larynx, or bronchial tree without adequate muscle relaxants, because protective airway reflexes may not be reliably suppressed. (surgery of the pharynx/larynx/bronchial tree) (1) (3)
- Avoid use in patients with a recent cerebrovascular accident or cerebral trauma where raised intracranial pressure could be dangerous. (all indications) (2) (3) (4)
- Ketamine is contraindicated in patients with acute porphyria (documented in some labels). (all indications) (5)
Tell your clinician about
- Any history of hypertension, heart disease, chest pain, or stroke.
- Liver or kidney problems, urinary symptoms, or bladder complaints.
- A personal or family history of psychiatric illness, substance abuse, or dependence.
- Any allergies, especially to anaesthetics or other medicines.
- Pregnancy, plans for pregnancy, breastfeeding, or whether you are taking any hormones (e.g., thyroid medication).
- All current medicines, including over‑the‑counter products, herbal supplements, and any CNS depressants (e.g., benzodiazepines, opioids), sympathomimetics, theophylline, or neuromuscular blockers.
- Recent or chronic alcohol use.
- If the procedure is for a child, discuss the specific risks and benefits, particularly the concern about possible effects on brain development with prolonged or repeated use.
How to take ketamine hydrochloride
- Ketamine injection is administered only by an anesthesiologist or trained healthcare professional in a hospital or clinic setting with continuous monitoring of heart rate, blood pressure, breathing, and oxygen levels.
- The dose and route (intravenous or intramuscular) are determined by the procedure, patient factors, and local product information. Never attempt to self‑inject or alter the prescribed dose.
- Pre‑medication with a benzodiazepine or an antisialagogue may be given to reduce emergence reactions and excessive salivation.
- Because significant emergence reactions (dissociation, hallucinations, vivid dreams) can occur during recovery, the environment is kept quiet and stimulation is minimised. You will be monitored until fully recovered and released only when stable, accompanied by a responsible adult if outpatient use is permitted.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)
Missed dose
Ketamine is administered as part of a scheduled procedure or treatment plan. A missed or interrupted dose will be managed by the healthcare team. Do not attempt to administer a replacement dose yourself.
Overdose
Overdose may cause severe respiratory depression, apnea, and cardiovascular changes. Overdose is managed with supportive care, including maintaining a clear airway, assisted ventilation if needed, and cardiac monitoring. Prognosis is generally good with appropriate supportive care. If you suspect an overdose or experience difficulty breathing after receiving ketamine, seek emergency medical attention immediately. (1) (2) (3) (4) (5)
Side effects
Ketamine commonly causes emergence reactions (also called emergence phenomena) as you recover from anaesthesia. These can include a dream‑like state, vivid imagery, hallucinations, confusion, or delirium. They are more common in adults (especially ages 15‑35) and can be reduced by a calm recovery environment and pre‑medication with a benzodiazepine.
Emergence reactions
What to notice: Vivid dreams, floating sensations, hallucinations, confusion, excitement, or irrational behaviour as the anaesthetic wears off. Reactions are usually short‑lived (a few hours) but can occasionally recur up to 24 hours postoperatively.
What to do: These are expected and will be managed by the anaesthesia team. The environment is kept quiet; a benzodiazepine may be given if needed. Tell the team if you feel distressed. (1) (2) (3) (4) (5)
Increased blood pressure and heart rate
What to notice: A temporary rise in blood pressure and pulse rate shortly after injection, which usually returns to normal within 15 minutes.
What to do: This is closely monitored by the anaesthesia team. Report any chest pain, palpitations, or severe headache. (1) (2) (3) (4) (5)
Increased salivation
What to notice: Excessive saliva production during the procedure.
What to do: A medication to reduce saliva may be given before ketamine. If it persists after the procedure, tell the healthcare team. (3) (5)
Nystagmus (uncontrollable eye movements) or blurred vision
What to notice: Rapid, involuntary eye movements or temporary blurring of vision during recovery.
What to do: Usually resolves without treatment. Report if it persists or is bothersome. (1) (2) (3)
Nausea and vomiting
What to notice: Stomach upset after the procedure.
What to do: May be managed with medicines; tell the team if it occurs. (1) (2)
Severe emergence delirium or psychiatric symptoms
What to notice: Intense agitation, frightening hallucinations, severe confusion, or psychotic behaviour that lasts longer than a few hours or recurs after discharge.
What to do: Contact the anaesthesia provider or go to the emergency department for assessment and treatment. (1) (2) (3)
Urinary or bladder problems (with repeated or chronic use)
What to notice: Painful urination, increased urgency or frequency, blood in urine, or difficulty emptying the bladder, especially after multiple treatments.
What to do: Tell your doctor promptly. These symptoms may indicate bladder inflammation (cystitis) that requires investigation. (1) (2) (3) (5)
Signs of liver problems (with repeated or chronic use)
What to notice: Yellowing of skin or eyes, dark urine, severe itching, abdominal pain, or unusual tiredness.
What to do: Seek medical attention promptly, as these may indicate hepatobiliary injury. (1) (2) (3) (5)
Serious warnings
Severe respiratory depression or apnea — emergency
Symptoms: Slow or shallow breathing, turning blue, or complete stoppage of breathing.
Action: This is a medical emergency. The anaesthesia team will intervene immediately with ventilatory support. If it occurs after discharge, call emergency services. (1) (2) (3) (5)
Severe hypertension or cardiovascular instability — emergency
Symptoms: Extremely high blood pressure, chest pain, irregular heartbeats, or sudden severe headache.
Action: Continuous monitoring in the clinical setting allows immediate treatment. If symptoms appear after discharge, seek emergency medical help. (1) (2) (3)
Severe allergic reaction (anaphylaxis) — emergency
Symptoms: Swelling of face, lips, throat, or tongue; difficulty breathing; severe rash; or sudden drop in blood pressure.
Action: Notify the anaesthesia team immediately during administration. If this occurs after leaving the facility, call emergency services and use any prescribed epinephrine autoinjector if available. (2) (3)
Abuse and dependence — serious
Symptoms: Craving, loss of control over use, continued use despite harm, withdrawal symptoms (anxiety, dysphoria, insomnia, psychotic features) after stopping prolonged use.
Action: Ketamine is a controlled substance. Healthcare professionals will minimize risk by limiting access. Report any history of substance abuse to your doctor. (1) (2) (3) (4) (5)
Urinary and bladder toxicity with chronic use — serious
Symptoms: Dysuria, increased frequency, urgency, incontinence, hematuria, and reduced bladder capacity. Severe cases may lead to cystitis, hemorrhagic cystitis, or acute kidney injury.
Action: Ketamine is not indicated for long‑term use. If you require repeated treatments, your doctor will monitor urinary symptoms and may order tests. (1) (2) (3) (5)
Hepatotoxicity (liver injury) — serious
Symptoms: Elevated liver enzymes, jaundice, right upper abdominal pain, fatigue. Can occur with repeated doses or misuse.
Action: Liver function tests are often monitored during repeated use. Report any signs to your prescriber. (1) (2) (3)
Increased intracranial or intraocular pressure — serious
Symptoms: Severe headache, vomiting, visual changes, or altered consciousness in susceptible individuals.
Action: If you have a condition associated with raised intracranial pressure (e.g., recent head injury, brain tumour) or glaucoma, the anaesthesiologist will weigh the risks. Seek immediate help if new symptoms appear. (1) (2) (3) (5)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| CNS depressants (benzodiazepines, opioids, barbiturates, alcohol) | Enhanced sedation, respiratory depression, coma, or death. Recovery time may be prolonged. | Undergo a full medicine review before ketamine administration. In emergency anesthesia, the team will adjust doses and monitor intensively. (1) (2) (3) (4) (5) |
| Theophylline or aminophylline | Co‑administration may lower the seizure threshold and provoke convulsions. | Avoid giving theophylline products concurrently with ketamine. Tell your anesthesiologist if you use any theophylline‑based medications. (1) (2) |
| Sympathomimetics and vasopressin | Potentiation of blood pressure‑ and heart‑rate‑raising effects; risk of exaggerated hypertensive response. | Continuous cardiovascular monitoring is essential. Dose adjustments of ketamine may be necessary. (1) (4) (5) |
| Neuromuscular blocking agents (e.g., atracurium, tubocurarine) | Ketamine may prolong the effect of some non‑depolarizing muscle relaxants. | The anesthesiologist will monitor neuromuscular function and adjust relaxant dosing accordingly. (2) |
| Thyroid hormones and other sympathomimetic agents | Increased risk of hypertension and tachycardia. | Monitor vital signs closely and consider dosage reduction of ketamine if necessary. (2) |
| CYP3A4 inhibitors or inducers | Drugs that affect the CYP3A4 enzyme (e.g., certain antifungals, rifampicin) can alter ketamine clearance, potentially affecting its potency and duration. | Inform the anesthesiologist of all medications. Dose adjustments may be required. (2) |
Pregnancy, breastfeeding, kidney/liver function, age
Children and adolescents
Safety and effectiveness in children below 16 years have not been established in all regions; emerging evidence raises concern about possible long‑term cognitive effects with prolonged or repeated exposure in young children (particularly under 3 years). Doses are weight‑based and titrated to individual response. Use only when benefit clearly outweighs risk, and limit duration of exposure when possible. (1) (2) (3) (4) (5)
Pregnancy and breastfeeding
Safe use during pregnancy has not been established. Ketamine crosses the placenta and may cause neonatal respiratory depression when used during delivery. Use is not recommended unless clearly necessary (e.g., for obstetric anesthesia in selected cases per UK SmPC). For breastfeeding, safe use has not been established; consult your anaesthetist about the need to temporarily discontinue breastfeeding. (1) (2) (3) (4) (5)
Elderly patients
Older patients may be more sensitive to the effects of ketamine and may have decreased hepatic, renal, or cardiac function. Lower initial doses (starting at the low end of the dosing range) and careful titration are recommended. (1) (2) (4) (5)
Patients with hepatic or renal impairment
Ketamine is metabolized by the liver and excreted by the kidneys. Impairment of either organ may prolong drug effects and increase toxicity risk, especially with repeated doses. Use with caution, and consider dose reduction. Liver function tests should be monitored with repeated use. (1) (2) (3) (5)
Patients with a history of substance abuse or psychiatric disorders
Ketamine has a recognised potential for abuse and dependence. Psychological emergence reactions may be more distressing in patients with pre‑existing psychiatric conditions. A thorough risk‑benefit assessment is required, and pre‑medication with a benzodiazepine may be considered to minimise emergence phenomena. (1) (2) (3) (5)
Monitoring
Before starting
- Confirm the indication and select the appropriate route, dose, and formulation per local product labeling.
- Obtain a full medical history, including hypertension, cardiac disease, cerebrovascular events, liver or kidney disease, psychiatric disorders, substance abuse, and any current medications.
- Check pregnancy status in women of child‑bearing potential.
- Assess baseline vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation).
- Have emergency airway equipment, oxygen, and resuscitation drugs immediately available.
- Consider pre‑medication (e.g., benzodiazepine to reduce emergence reactions, antisialagogue to reduce salivation) based on clinical need.
- Perform baseline liver function tests if repeated doses or prolonged use is anticipated.
During treatment
- Continuously monitor electrocardiogram, blood pressure, heart rate, respiratory rate, and oxygen saturation throughout the procedure and until full recovery.
- Observe for signs of respiratory depression or airway obstruction; be prepared to provide ventilatory support.
- Watch for excessive hypertension or tachycardia, and manage according to institutional protocols.
- During recovery, minimise external stimulation to reduce emergence reactions; treat severe reactions with a benzodiazepine or ultrashort‑acting barbiturate if needed.
- Do not discharge the patient until full recovery of consciousness and vital signs, and ensure a responsible adult accompanies them if outpatient use.
- If repeated doses are given, monitor urinary symptoms and liver function tests periodically.
Storage
Storage requirements are product‑specific. In general, ketamine injection should be stored at controlled room temperature, protected from light, and kept in a secure location because of its controlled‑substance status. Refer to the manufacturer’s labelling on the package for exact instructions. [Note: specific storage conditions were not detailed in the research notes; follow local product information and institutional policies.]
Professional information
Clinician‑facing context only. Use the current local indication, dosing table, formulation instructions, and relevant clinical practice guidelines.
All regions
Indication: Ketamine injection for anesthesia or sedation
Dose summary: Dose must be individualised based on indication, route, patient age, weight, clinical status, and concomitant medications. Typical intravenous induction doses range from 1 to 4.5 mg/kg given slowly over 60 seconds; intramuscular induction doses range from 4 to 13 mg/kg. Maintenance with intermittent intravenous boluses or continuous infusion (10–45 micrograms/kg/minute) may be used. Always consult the specific product monograph for precise dosage and administration guidance. [Gap: no single universal dose table exists for all indications.]
Renal context: In patients with renal or hepatic impairment, dose reduction and cautious titration are advised, especially with repeated administration. No standardised adjustment algorithm is available; individual risk‑benefit assessment is required. Monitor hepatic function during prolonged use. (1) (2) (3) (4) (5)
Hepatic guidance
Hepatobiliary dysfunction, including cholestatic and hepatocellular enzyme elevations, biliary ductal dilatations, and hepatic fibrosis, has been reported, particularly with repeated doses or chronic misuse. Baseline and periodic liver function tests are recommended for patients receiving repeated courses of ketamine. Consider treatment discontinuation if significant liver injury develops.
Overdose note
Overdose may produce severe respiratory depression and cardiovascular instability. Management is supportive: maintain airway, provide mechanical ventilation if needed, and monitor cardiac function. Analeptic agents are not recommended. The margin of safety is wide; full recovery has been documented even after unintentional administration of up to 10 times the usual dose. (1) (2) (3) (4) (5)
Frequently asked questions
Is ketamine the same as esketamine (Spravato™)?
No. Ketamine is a generic injectable anaesthetic and analgesic used in hospital and clinic settings. Esketamine is a different product (a nasal spray) authorised for treatment‑resistant depression in some countries, with a separate risk‑management programme. These products are not interchangeable. (6)
Can ketamine be used outside a hospital?
No, this injectable form of ketamine is administered only by healthcare professionals in a controlled medical environment with continuous monitoring. It is not available for self‑administration or home use. (1) (2) (3)
Will I have strange dreams or hallucinations after receiving ketamine?
Many people experience vivid dreams, floating sensations, or hallucinations as the anaesthetic wears off. This is called an emergence reaction. It is usually short‑lived and can be reduced by a quiet recovery room and sometimes a medication given beforehand. The anaesthesia team is prepared to manage these reactions. (1) (2) (3) (4) (5)
What is the mechanism of action of ketamine hydrochloride?
Ketamine is a noncompetitive antagonist at the N‑methyl‑D‑aspartate (NMDA) receptor, producing dissociative anesthesia, analgesia, and amnesia. It also interacts with opioid, monoaminergic, cholinergic, and other receptor systems. The dissociative state is characterised by profound analgesia, intact pharyngeal‑laryngeal reflexes, and spontaneous ventilation, often with skeletal muscle hypertonus and nystagmus. (1) (2) (3) (4) (5)
References
- KETALAR (Ketamine Hydrochloride Injection) prescribing informationU.S. National Library of Medicine DailyMed · United States · accessed 2026-07-30 · source 1
- Ketalar 50 mg/mL Solution for Injection — Summary of Product Characteristicselectronic Medicines Compendium (UK) · United Kingdom · accessed 2026-07-30 · source 2
- Ketalar (Ketamine Hydrochloride Injection USP) Product Monograph, Searchlight Pharma Inc.Health Canada · Canada · dated 2023-05-24 · accessed 2026-07-30 · source 3
- Ketalar 100 mg/mL Solution for Injection Data SheetNew Zealand Medicines and Medical Devices Safety Authority (Medsafe) · New Zealand · accessed 2026-07-30 · source 4
- KETALAR and generic ketamine injection: ARTG entries and Product InformationTherapeutic Goods Administration · Australia · accessed 2026-07-30 · source 5
- Ketamine: list of nationally authorised medicinal products — PSUSA/00001804European Medicines Agency · European Union · dated 2024-12 · accessed 2026-07-30 · source 6
Brand names by country
Single-ingredient ketamine hydrochloride names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Ketalar100 mg/mL, 10 mg/mL, 50 mg/mL · par health usa, llc
United Kingdom
- Ketalarcurrent licensed product · 50 mg/mL · Pfizer
Canada
- KETALAR
- KETAMINE HYDROCHLORIDE INJECTION SDZ
Australia
- Ketalarcurrent register product example · 100 mg/mL (200 mg/2 mL) · Pfizer Australia Pty Ltd
- APO-KETAMINEcurrent register product example · product-dependent · Apotex Pty Ltd
- KETAMINE INTERPHARMAcurrent register product example · multiple strengths · Interpharma Pty Ltd
New Zealand
- Ketalarcurrent regulator label · 100 mg/mL · See current Medsafe data sheet