illustration for ketamine dosing

Ketamine Dosing: Low Dose vs. High Dose

Ketamine has different effects at different doses. It is used by doctors for a range of purposes including pain relief, sedation, anesthesia and psychedelic therapy.

Analgesic Dose

Ketamine is an effective analgesic when administered intravenously (IV) at extremely low doses of 0.1-0.3 mg/kg. At this level, ketamine provides powerful pain relief while having minimal effect on the patient’s perception or emotions. In this way, it serves as an alternative to opioids like hydrocodone, oxycodone and morphine.

Sedative or Anesthetic Dose

Ketamine at its highest doses acts as a sedative or an anesthetic, and there is some overlap between the two. Ketamine is frequently used to sedate children during a procedure at doses of 1–1.5 mg/kg via IV.

The usual adult dose for producing dissociative anesthesia is 1-4.5 mg/kg, administered rapidly via IV. In this state, the patient is cut off from all external stimuli, which is the ideal situation for surgery. Patients cannot see, hear or feel anything while being operated on and do not create memories.

Therapeutic Doses

1. Intravenous Infusion (IV)

Ketamine for psychedelic therapy is most commonly administered via IV at doses around 0.5 mg/kg over a period of 40 minutes. There is a range of effective doses and evidence for its efficacy at double that amount. Ketamine when delivered via IV infusion has 100% bioavailability, meaning the entire dose enters the bloodstream.

2. Intramuscular Infusion (IM)

Intramuscular (IM) infusion has 93% bioavailability. A higher dose of ketamine will need to be administered in order to have the same amount in the bloodstream as IV.

3. Orally

When ketamine is taken orally, it is even less bioavailable. When taken nasally, the bioavailability is both lower and less consistent.

Ketamine lozenges have only around 25% to 30% bioavailability. A patient weighing 150 lbs and receiving the standard 0.5 mg/kg dose via IV will receive a total of 34 mg of ketamine delivered into their bloodstream.

The same patient would need a lozenge containing approximately 113-136 mg to achieve a similar effect. Finding the right dose for the patient when using lozenges will usually involve some experimentation.

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