ketamine (Rx)

Brand and Other Names:Ketalar
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution: Schedule III

  • 10mg/mL
  • 50mg/mL
  • 100mg/mL

Anesthesia Induction

Load

  • IV: 1-4.5 mg/kg slow IV once  
  • Alternatively (off-label): 0.5-2 mg/kg slow IV if adjuvant drugs (eg, midazolam) are used, OR
  • IM: 6.5-13 mg/kg IM once
  • Alternatively (off-label): 4-10 mg/kg IM once if adjuvant drugs (eg, midazolam) are used

Maintenance

  • 50% of IV ketamine induction dose administered PRN, OR
  • 0.1-0.5 mg/min IV continuous infusion

Resistant Depression (Off-label)

Infusion: 0.5 mg/kg IV twice weekly; not to exceet 6 week; therapy >6 week not studied

Dosage Forms & Strengths

injectable solution: Schedule III

  • 10mg/mL
  • 50mg/mL
  • 100mg/mL

Sedation/Analgesia (Off-label)

ACEP recommends as safe in children

3 months or older

IM

  • 4-5 mg/kg IM once, ACEP Clinical Guidelines (Green 2004); may give a repeat dose (range 2-5 mg/kg) if sedation inadequate after 5-10 min or if additional doses are required  

IV

  • Various recommendations
  • 1.5-2 mg/kg over 30-60 sec; may administer incremental doses of 0.5-2 mg/kg IV q5-15min PRN if initial sedation inadequate (Mace et al., Ann Emerg Med, 44: 342-377 [2004]), OR  
  • 0.25-0.5 mg/kg (Harriet Lane)

Oral

  • 6-10 mg/kg PO once; mix with 0.2-0.3 mL/kg of a beverage; give 30 min before procedure

16 years or older

Load

  • IV: 1-4.5 mg/kg slow IV once
  • Alternatively (off-label): 0.5-2 mg/kg slow IV if adjuvant drugs (eg, midazolam) are used, OR
  • IM: 6.5-13 mg/kg IM once
  • Alternatively (off-label): 4-10 mg/kg IM once if adjuvant drugs (eg, midazolam) are used

Maintenance

  • 50% of IV ketamine induction dose administered PRN, OR
  • 0.1-0.5 mg/min IV continuous infusion
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Interactions

Interaction Checker

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              Serious - Use Alternative (36)

              • abametapir

                abametapir will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

                abametapir will increase the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP2B6 substrates. If not feasible, avoid use of abametapir.

              • apalutamide

                apalutamide will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

              • benzhydrocodone/acetaminophen

                benzhydrocodone/acetaminophen, ketamine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).

              • calcium/magnesium/potassium/sodium oxybates

                ketamine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • clarithromycin

                clarithromycin will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • doxapram

                doxapram, ketamine. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

              • ephedrine

                ketamine, ephedrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of ephedrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding).

              • epinephrine

                ketamine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of epinephrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding).

              • epinephrine racemic

                ketamine increases levels of epinephrine racemic by unknown mechanism. Avoid or Use Alternate Drug.

              • fentanyl

                fentanyl, ketamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl intranasal

                fentanyl intranasal, ketamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl transdermal

                fentanyl transdermal, ketamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl transmucosal

                fentanyl transmucosal, ketamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fexinidazole

                fexinidazole will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. Coadministration may decrease plasma concentrations of CYP2B6 substrates owing to fexinidazole inducing CYP2B6.

                fexinidazole will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

              • hydrocodone

                hydrocodone, ketamine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).

              • idelalisib

                idelalisib will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

              • isocarboxazid

                isocarboxazid increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • itraconazole

                itraconazole will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • ivosidenib

                ivosidenib will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

                ivosidenib will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2C9 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

              • memantine

                memantine, ketamine. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • metoclopramide intranasal

                ketamine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • mifepristone

                mifepristone will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • nefazodone

                nefazodone will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • norepinephrine

                ketamine, norepinephrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of norepinephrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding). .

              • phenelzine

                phenelzine increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • phenylephrine PO

                ketamine increases levels of phenylephrine PO by decreasing metabolism. Contraindicated.

              • posaconazole

                posaconazole will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • rasagiline

                rasagiline increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • selegiline

                selegiline increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • sodium oxybate

                ketamine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • sufentanil SL

                sufentanil SL, ketamine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • tranylcypromine

                tranylcypromine increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • tucatinib

                tucatinib will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

              • voriconazole

                voriconazole will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • voxelotor

                voxelotor will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

              Monitor Closely (182)

              • acebutolol

                ketamine, acebutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • alfentanil

                ketamine and alfentanil both increase sedation. Use Caution/Monitor.

              • alpelisib

                alpelisib will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.

              • alprazolam

                ketamine and alprazolam both increase sedation. Use Caution/Monitor.

              • amifampridine

                ketamine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

              • amitriptyline

                ketamine and amitriptyline both increase sedation. Use Caution/Monitor.

              • amobarbital

                ketamine and amobarbital both increase sedation. Use Caution/Monitor.

              • amoxapine

                ketamine and amoxapine both increase sedation. Use Caution/Monitor.

              • apalutamide

                apalutamide will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Coadministration of apalutamide, a weak CYP2C9 inducer, with drugs that are CYP2C9 substrates can result in lower exposure to these medications. Evaluate for loss of therapeutic effect if medication must be coadministered.

              • apomorphine

                ketamine and apomorphine both increase sedation. Use Caution/Monitor.

              • atazanavir

                atazanavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • atenolol

                ketamine, atenolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • baclofen

                ketamine and baclofen both increase sedation. Use Caution/Monitor.

              • belladonna and opium

                ketamine and belladonna and opium both increase sedation. Use Caution/Monitor.

              • belzutifan

                belzutifan will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

              • benperidol

                ketamine and benperidol both increase sedation. Use Caution/Monitor.

              • betaxolol

                ketamine, betaxolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • bisoprolol

                ketamine, bisoprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • brexanolone

                brexanolone, ketamine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • brompheniramine

                ketamine and brompheniramine both increase sedation. Use Caution/Monitor.

              • buprenorphine

                ketamine and buprenorphine both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                ketamine and buprenorphine buccal both increase sedation. Use Caution/Monitor.

              • buprenorphine, long-acting injection

                ketamine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

              • butabarbital

                ketamine and butabarbital both increase sedation. Use Caution/Monitor.

              • butalbital

                ketamine and butalbital both increase sedation. Use Caution/Monitor.

              • butorphanol

                ketamine and butorphanol both increase sedation. Use Caution/Monitor.

              • cannabidiol

                cannabidiol will increase the level or effect of ketamine by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit CYP2C9 activity. Consider reducing the dose when concomitantly using CYP2C9 substrates.

              • carbamazepine

                carbamazepine will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

                carbamazepine will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • carbinoxamine

                ketamine and carbinoxamine both increase sedation. Use Caution/Monitor.

              • carisoprodol

                ketamine and carisoprodol both increase sedation. Use Caution/Monitor.

              • carvedilol

                ketamine, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • celiprolol

                ketamine, celiprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • cenobamate

                cenobamate will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                cenobamate will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

              • chloral hydrate

                ketamine and chloral hydrate both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                ketamine and chlordiazepoxide both increase sedation. Use Caution/Monitor.

              • chlorpheniramine

                ketamine and chlorpheniramine both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                ketamine and chlorpromazine both increase sedation. Use Caution/Monitor.

              • chlorzoxazone

                ketamine and chlorzoxazone both increase sedation. Use Caution/Monitor.

              • cinnarizine

                ketamine and cinnarizine both increase sedation. Use Caution/Monitor.

              • clemastine

                ketamine and clemastine both increase sedation. Use Caution/Monitor.

              • clomipramine

                ketamine and clomipramine both increase sedation. Use Caution/Monitor.

              • clonazepam

                ketamine and clonazepam both increase sedation. Use Caution/Monitor.

              • clorazepate

                ketamine and clorazepate both increase sedation. Use Caution/Monitor.

              • clozapine

                ketamine and clozapine both increase sedation. Use Caution/Monitor.

              • codeine

                ketamine and codeine both increase sedation. Use Caution/Monitor.

              • cyclizine

                ketamine and cyclizine both increase sedation. Use Caution/Monitor.

              • cyclobenzaprine

                ketamine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

              • cyproheptadine

                ketamine and cyproheptadine both increase sedation. Use Caution/Monitor.

              • dabrafenib

                dabrafenib will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • dantrolene

                ketamine and dantrolene both increase sedation. Use Caution/Monitor.

              • darunavir

                darunavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • desflurane

                desflurane and ketamine both increase sedation. Use Caution/Monitor.

              • desipramine

                ketamine and desipramine both increase sedation. Use Caution/Monitor.

              • dexchlorpheniramine

                ketamine and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                ketamine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmedetomidine

                ketamine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • dextromoramide

                ketamine and dextromoramide both increase sedation. Use Caution/Monitor.

              • diamorphine

                ketamine and diamorphine both increase sedation. Use Caution/Monitor.

              • diazepam

                ketamine and diazepam both increase sedation. Use Caution/Monitor.

              • diethylpropion

                ketamine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • difenoxin hcl

                ketamine and difenoxin hcl both increase sedation. Use Caution/Monitor.

              • dimenhydrinate

                ketamine and dimenhydrinate both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                ketamine and diphenhydramine both increase sedation. Use Caution/Monitor.

              • diphenoxylate hcl

                ketamine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

              • dipipanone

                ketamine and dipipanone both increase sedation. Use Caution/Monitor.

              • dopexamine

                ketamine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                ketamine and dosulepin both increase sedation. Use Caution/Monitor.

              • doxepin

                ketamine and doxepin both increase sedation. Use Caution/Monitor.

              • doxylamine

                ketamine and doxylamine both increase sedation. Use Caution/Monitor.

              • duvelisib

                duvelisib will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

              • efavirenz

                efavirenz will increase the level or effect of ketamine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                efavirenz will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • elagolix

                elagolix decreases levels of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF decreases levels of ketamine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Elvitegravir is a moderate CYP2C9 inducer.

              • encorafenib

                encorafenib, ketamine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

              • esketamine intranasal

                esketamine intranasal, ketamine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • esmolol

                ketamine, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • estazolam

                ketamine and estazolam both increase sedation. Use Caution/Monitor.

              • ethanol

                ketamine and ethanol both increase sedation. Use Caution/Monitor.

              • fedratinib

                fedratinib will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

              • fenfluramine

                ketamine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • flurazepam

                ketamine and flurazepam both increase sedation. Use Caution/Monitor.

              • fluvoxamine

                fluvoxamine will increase the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • fosamprenavir

                fosamprenavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • grapefruit

                grapefruit will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • haloperidol

                ketamine and haloperidol both increase sedation. Use Caution/Monitor.

              • hydromorphone

                ketamine and hydromorphone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                ketamine and hydroxyzine both increase sedation. Use Caution/Monitor.

              • iloperidone

                iloperidone increases levels of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

              • imipramine

                ketamine and imipramine both increase sedation. Use Caution/Monitor.

              • indinavir

                indinavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • istradefylline

                istradefylline will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

              • ketotifen, ophthalmic

                ketamine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

              • labetalol

                ketamine, labetalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • lasmiditan

                lasmiditan, ketamine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                lemborexant will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Monitor CYP2B6 substrate for adequate clinical response. Consider increasing the CYP2B6 substrate dose according to specific prescribing recommendations.

                lemborexant, ketamine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • levorphanol

                ketamine and levorphanol both increase sedation. Use Caution/Monitor.

              • levothyroxine

                levothyroxine increases toxicity of ketamine by unspecified interaction mechanism. Use Caution/Monitor. Coadministration may cause marked hypertension and tachycardia.

              • linezolid

                linezolid increases levels of ketamine by pharmacodynamic synergism. Use Caution/Monitor.

              • lofepramine

                ketamine and lofepramine both increase sedation. Use Caution/Monitor.

              • lofexidine

                ketamine and lofexidine both increase sedation. Use Caution/Monitor.

              • lopinavir

                lopinavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • loprazolam

                ketamine and loprazolam both increase sedation. Use Caution/Monitor.

              • lorazepam

                ketamine and lorazepam both increase sedation. Use Caution/Monitor.

              • lormetazepam

                ketamine and lormetazepam both increase sedation. Use Caution/Monitor.

              • loxapine

                ketamine and loxapine both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                ketamine and loxapine inhaled both increase sedation. Use Caution/Monitor.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor, ketamine. affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2B6 substrates. .

                lumacaftor/ivacaftor, ketamine. affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C9 substrates. .

              • maprotiline

                ketamine and maprotiline both increase sedation. Use Caution/Monitor.

              • melatonin

                ketamine and melatonin both increase sedation. Use Caution/Monitor.

              • meperidine

                ketamine and meperidine both increase sedation. Use Caution/Monitor.

              • meprobamate

                ketamine and meprobamate both increase sedation. Use Caution/Monitor.

              • metaxalone

                ketamine and metaxalone both increase sedation. Use Caution/Monitor.

              • methadone

                ketamine and methadone both increase sedation. Use Caution/Monitor.

              • methocarbamol

                ketamine and methocarbamol both increase sedation. Use Caution/Monitor.

              • metoprolol

                ketamine, metoprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • midazolam

                ketamine and midazolam both increase sedation. Use Caution/Monitor.

              • midazolam intranasal

                midazolam intranasal, ketamine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • mifepristone

                mifepristone will increase the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • mirtazapine

                ketamine and mirtazapine both increase sedation. Use Caution/Monitor.

              • mitotane

                mitotane decreases levels of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

              • morphine

                ketamine and morphine both increase sedation. Use Caution/Monitor.

              • moxonidine

                ketamine and moxonidine both increase sedation. Use Caution/Monitor.

              • nabilone

                ketamine and nabilone both increase sedation. Use Caution/Monitor.

              • nadolol

                ketamine, nadolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • nalbuphine

                ketamine and nalbuphine both increase sedation. Use Caution/Monitor.

              • nebivolol

                ketamine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • nelfinavir

                nelfinavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • nevirapine

                nevirapine will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nitisinone

                nitisinone will increase the level or effect of ketamine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Nitisinone inhibits CYP2C9. Caution if CYP2C9 substrate coadministered, particularly those with a narrow therapeutic index.

              • nortriptyline

                ketamine and nortriptyline both increase sedation. Use Caution/Monitor.

              • opium tincture

                ketamine and opium tincture both increase sedation. Use Caution/Monitor.

              • orphenadrine

                ketamine and orphenadrine both increase sedation. Use Caution/Monitor.

              • oxazepam

                ketamine and oxazepam both increase sedation. Use Caution/Monitor.

              • oxycodone

                ketamine and oxycodone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                ketamine and oxymorphone both increase sedation. Use Caution/Monitor.

              • papaveretum

                ketamine and papaveretum both increase sedation. Use Caution/Monitor.

              • papaverine

                ketamine and papaverine both increase sedation. Use Caution/Monitor.

              • penbutolol

                ketamine, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • pentazocine

                ketamine and pentazocine both increase sedation. Use Caution/Monitor.

              • pentobarbital

                ketamine and pentobarbital both increase sedation. Use Caution/Monitor.

              • perphenazine

                ketamine and perphenazine both increase sedation. Use Caution/Monitor.

              • phenobarbital

                ketamine and phenobarbital both increase sedation. Use Caution/Monitor.

              • phenylephrine PO

                ketamine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • pholcodine

                ketamine and pholcodine both increase sedation. Use Caution/Monitor.

              • pindolol

                ketamine, pindolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • primidone

                ketamine and primidone both increase sedation. Use Caution/Monitor.

              • procarbazine

                procarbazine increases levels of ketamine by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension.

              • prochlorperazine

                ketamine and prochlorperazine both increase sedation. Use Caution/Monitor.

              • promethazine

                ketamine and promethazine both increase sedation. Use Caution/Monitor.

              • propofol

                ketamine and propofol both increase sedation. Use Caution/Monitor.

              • propranolol

                ketamine, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • protriptyline

                ketamine and protriptyline both increase sedation. Use Caution/Monitor.

              • quazepam

                ketamine and quazepam both increase sedation. Use Caution/Monitor.

              • ramelteon

                ketamine and ramelteon both increase sedation. Use Caution/Monitor.

              • ribociclib

                ribociclib will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

                rifampin will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ritonavir

                ritonavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • saquinavir

                saquinavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • secobarbital

                ketamine and secobarbital both increase sedation. Use Caution/Monitor.

              • selegiline transdermal

                selegiline transdermal increases levels of ketamine by pharmacodynamic synergism. Use Caution/Monitor.

              • sevoflurane

                ketamine and sevoflurane both increase sedation. Use Caution/Monitor.

              • sotalol

                ketamine, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • stiripentol

                stiripentol, ketamine. affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP2B6 inhibitor and inducer. Monitor CYP2B6 substrates coadministered with stiripentol for increased or decreased effects. CYP2B6 substrates may require dosage adjustment.

                stiripentol, ketamine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

                stiripentol, ketamine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                ketamine and sufentanil both increase sedation. Use Caution/Monitor.

              • tapentadol

                ketamine and tapentadol both increase sedation. Use Caution/Monitor.

              • tazemetostat

                tazemetostat will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tecovirimat

                tecovirimat will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

              • temazepam

                ketamine and temazepam both increase sedation. Use Caution/Monitor.

              • thioridazine

                ketamine and thioridazine both increase sedation. Use Caution/Monitor.

              • thiothixene

                ketamine and thiothixene both increase sedation. Use Caution/Monitor.

              • timolol

                ketamine, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • tipranavir

                tipranavir will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • topiramate

                ketamine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                ketamine and tramadol both increase sedation. Use Caution/Monitor.

              • trazodone

                ketamine and trazodone both increase sedation. Use Caution/Monitor.

              • triazolam

                ketamine and triazolam both increase sedation. Use Caution/Monitor.

              • triclofos

                ketamine and triclofos both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                ketamine and trifluoperazine both increase sedation. Use Caution/Monitor.

              • trimipramine

                ketamine and trimipramine both increase sedation. Use Caution/Monitor.

              • triprolidine

                ketamine and triprolidine both increase sedation. Use Caution/Monitor.

              • ziconotide

                ketamine and ziconotide both increase sedation. Use Caution/Monitor.

              • zotepine

                ketamine and zotepine both increase sedation. Use Caution/Monitor.

              Minor (13)

              • amitriptyline

                ketamine, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • amoxapine

                ketamine, amoxapine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • clomipramine

                ketamine, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • desipramine

                ketamine, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • dosulepin

                ketamine, dosulepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • doxepin

                ketamine, doxepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • imipramine

                ketamine, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • lofepramine

                ketamine, lofepramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • maprotiline

                ketamine, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • nortriptyline

                ketamine, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • protriptyline

                ketamine, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • trazodone

                ketamine, trazodone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • trimipramine

                ketamine, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

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              Adverse Effects

              >10%

              Emergence rxns

              HTN

              Increased cardiac output

              Increased ICP

              Tachycardia

              Tonic-clonic movements

              Visual hallucinations

              Vivid dreams

              1-10%

              Bradycardia

              Diplopia

              Hypotension

              Increased IOP

              Injection-site pain

              Nystagmus

              <1%

              Anaphylaxis

              Cardiac arrhythmia

              Depressed cough reflex

              Fasciculations

              Hypersalivation

              Increased IOP

              Increased metabolic rate

              Hypertonia

              Laryngospasm

              Respiratory depression or apnea with large doses or rapid infusions

              Postmarketing Reports

              Genitourinary: Dysuria, increased urinary frequency, urgency, urge incontinence, and hematuria, cystitis (including cystitis non- infective, cystitis interstitial, cystitis ulcerative, cystitis erosive and cystitis hemorrhagic), hydronephrosis and reduced bladder capacity

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              Warnings

              Contraindications

              Hypersensitivity

              Conditions in which an increase in blood pressure would be hazardous

              Cautions

              Increases ICP (head raising may alleviate); causes hypersalivation (may be controlled with atropine/glycopyrrolate)

              Not for use alone in surgery or diagnostic procedures of the pharynx, or bronchial tree, mechanical stimulation of the pharynx, larynx, or bronchial tree; avoid mechanical stimulation of the pharynx if ketamine used alone

              May cause CNS depression; use caution when operating heavy machinery; do not engage in hazardous activities or operate hazardous machinery for at least 24 hr after anesthesia

              May cause dependence and tolerance with prolonged use; discontinuation of long term use has been associated with a withdrawal syndrome with psychotic features

              Treat CNS abnormalities, CNS masses, or hydrocephalus as a relative contraindication, due to increased intracranial pressure produced by ketamine

              Therapy may increase intraocular pressure, use with caution in patients with increased intraocular pressure; avoid use in patients with eye injury or other ophthalmic disorder

              Glaucoma or acute globe injury may be considered a relative contraindication

              Therapy may enhance sympathomimetic effect; use caution in patients with porphyria or a thyroid disorder; may consider porphyria and thyroid disorder or thyroid therapy a relative contraindication

              Use caution in patients with coronary artery disease, catecholamine depletion, hypertension and tachycardia; monitor cardiac function continuously in patients with increased blood pressure, heart rate, and cardiac output, thereby increasing myocardial oxygen demand

              Use caution in patients with cerebrospinal fluid pressure elevation; increase in cerebrospinal fluid pressure may be associated with use

              Use with caution in chronic alcoholic patients or acutely intoxicated

              Use requires patient monitoring, to be administered only by experienced personnel who are not actively engaged in the procedure or surgery; in nonintubated and/or nonmechanically ventilated patients, appropriate equipment and qualified personnel should be immediately available to use appropriate equipment for rapid institution of respiratory and/or cardiovascular support

              Too rapid administration will cause respiratory depression

              Do NOT put diazepam or barbiturates in same syringe/bag

              Safety for obstetric procedures not established

              Children may require head positioning, supplemental oxygen, occasional bad-valve-mask ventilatory support and measures top address laryngospasm

              Use caution in patients with significant LV dysfunction, as the sympathetic stimulation may not be adequate to overcome the negative inotropic effects, resulting in deterioration

              Therapy is associated with hepatobiliary dysfunction (most often a cholestatic pattern), with recurrent use (e.g., misuse/abuse or medically supervised unapproved indications); obtain baseline LFTs, including alkaline phosphatase and gamma-glutamyl transferase, in patients receiving therapy as part of a treatment plan that utilizes recurrent dosing; monitor those receiving recurrent therapy at periodic intervals during treatment

              Emergence reactions

              • Postanesthetic emergence reactions, manifested as dreamlike state, vivid imagery, hallucinations, and/or delirium reported in ~12%
              • Least common in children younger than 15 yr, elderly older than 65 yr, or when administered IM
              • May occur up to 24 hr postoperatively
              • Occurrence may be decreased by using lower recommended dose in conjunction with a benzodiazepine for anesthesia induction

              General anesthetics and sedation drugs in young children and pregnant women

              • Brain development
                • Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
                • Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
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              Pregnancy & Lactation

              Pregnancy

              There are no adequate and well-controlled studies performed in pregnant women; in animal reproduction studies in rats developmental delays (hypoplasia of skeletal tissues) were noted at 0.3 times the human intramuscular dose of 10 mg/kg; in rabbits, developmental delays and increased fetal resorptions were noted at 0.6 times the human dose; since safe use in pregnancy, including obstetrics (either vaginal or abdominal delivery), has not been established, such use is not recommended

              Lactation

              Not known if excreted in breast milk; effect on nursing infant unknown

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Produces dissociative anesthesia

              Blocks NMDA receptor

              Overdose may lead to panic attacks and aggressive behavior; rarely seizures, increased ICP, and cardiac arrest

              Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic

              Absorption

              Onset: 30 sec (IV); 3-4 min (IM)

              Duration: 5-10 min (IV); 12-25 min (IM): dissociative state may last >20 min

              Peak plasma concentration: 0.75 mcg/mL

              Metabolism

              Liver

              Elimination

              Excretion: Urine (91%), feces (3%)

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              Administration

              IV Incompatibilities

              Additive: Barbiturates, diazepam

              Syringe: Barbiturates, diazepam, doxapram

              IV Compatibilities

              Additive: Morphine sulfate

              Syringe: Bupivacaine with fentanyl, clonidine with tetracaine, lidocaine with morphine sulfate, meperidine, morphine tartrate

              Y-site: Ceftazidime, propofol

              IV Preparation

              IV infusion: Prepare 1 or 2 mg/mL solution by adding 500 mg to 500 mL or to 250 mL, respectively, of D5W or NS

              IV/IM Administration

              Administer IM, OR

              By slow IV injection over at least 60 sec

              Do not give 100 mg/mL preparation undiluted

              Storage

              Store at controlled room temperature

              Colorless to slightly yellow solution; may darken upon prolonged exposure to light but this does not affect potency

              Do not use if precipitate is present

              Protect from light

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Ketalar injection
              -
              100 mg/mL vial
              Ketalar injection
              -
              50 mg/mL vial
              Ketalar injection
              -
              10 mg/mL vial
              ketamine injection
              -
              10 mg/mL vial
              ketamine injection
              -
              100 mg/mL vial
              ketamine injection
              -
              50 mg/mL vial
              ketamine injection
              -
              50 mg/mL vial
              ketamine injection
              -
              100 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              ketamine injection

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
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              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.