Ketamine, while promising for treating depression and pain, has specific contraindications. We review the medical conditions and circumstances that may preclude ketamine use. Learn about the safety considerations and potential risks associated with ketamine therapy.
NOTE: The information provided in this blog post is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding ketamine treatment or any medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this article.
Ketamine has gained significant attention in recent years for its potential in treating depression, chronic pain, and other conditions. However, like any powerful medication, it’s not suitable for everyone. Understanding the contraindications for ketamine use is crucial for patient safety and optimal treatment outcomes.
Absolute Contraindications
Hypersensitivity to Ketamine
Individuals with a known allergy or hypersensitivity to ketamine or any of its components should not receive the drug. Anaphylaxis and angioedema have been reported in some cases.
Severe Cardiovascular Disease
Ketamine is contraindicated in patients with severe cardiovascular conditions where an increase in blood pressure or heart rate could be dangerous. This includes:
- Uncontrolled hypertension
- Recent myocardial infarction
- Severe coronary artery disease
- Aneurysms
Pregnancy and Breastfeeding
The FDA does not recommend ketamine use during pregnancy or breastfeeding due to potential risks to the fetus or infants.
Relative Contraindications
Psychosis and Schizophrenia
Ketamine should be used with extreme caution or avoided in individuals with a history of psychosis or schizophrenia. The dissociative effects of ketamine may exacerbate these conditions.
Substance Use Disorders
People with a history of substance abuse may be at higher risk for ketamine misuse or addiction, especially when not utilized in-clinic/in-person. Ketamine therapy for alcohol use disorder (AUD) and other addictive behaviors has proven to be effective when administered safely.
Liver Dysfunction
Severe hepatic impairment may affect ketamine metabolism, potentially leading to increased side effects or altered drug efficacy.
Special Populations
Pediatric Patients
Caution is advised when using ketamine in children, particularly those under 3 years old. Extended use (over 3 hours) may lead to cognitive deficits due to potential neurotoxicity.
Elderly Patients
Older adults, especially those with symptoms of dementia, may be more susceptible to ketamine’s side effects (such as dizziness) and require careful monitoring.
Medical Conditions Requiring Caution
Thyroid Disorders
Patients with thyroid abnormalities may experience exaggerated sympathomimetic effects from ketamine.
Glaucoma
While not an absolute contraindication, ketamine may transiently increase intraocular pressure, warranting caution in glaucoma patients.
Porphyria
Ketamine should be used cautiously in patients with porphyria due to potential exacerbation of symptoms.
Drug Interactions
CNS Depressants
Concurrent use of ketamine with other central nervous system depressants (e.g., opioids, benzodiazepines, alcohol) may increase the risk of respiratory depression and profound sedation. It is generally recommended to not use any of these CNS depressants within at least 24 hours of ketamine treatment.
Thyroid Hormones
Ketamine may interact with thyroid hormones, potentially leading to hypertension and tachycardia.
Theophylline
Combining ketamine with theophylline or aminophylline may lower the seizure threshold.
Screen for Safety and Receive Treatment in a Medically Safe & Sound Space!
While ketamine shows promise in treating various conditions, it’s crucial to consider its contraindications and potential risks. Proper patient screening, medical history review, and ongoing monitoring are essential for safe and effective ketamine use. As research continues, our understanding of ketamine’s contraindications may evolve, potentially expanding or refining its use in clinical practice.
