Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
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.
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
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
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.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%)
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
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.
Patient Handout
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.
Formulary
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