Section 13 · Monograph
Ketamine
Reviewed Nov 2026FDA label
KetalarNMDA antagonist anesthetic
- Forms
- IV/IM: 10, 50, 100mg/mL
- Dose
- Refractory status epilepticus (off-label): 1.5mg/kg IV bolus (may repeat), infusion 0.3-7.5mg/kg/h | Sedation-analgesia: 0.1-0.5mg/kg/h
- MOA
- Noncompetitive NMDA receptor blockade
Indications
- Induction and maintenance of general anesthesiaFDA-labeled
- Sedation and analgesia for proceduresFDA-labeled
Off-Label Uses
- Refractory status epilepticusOff-label
- Analgesic and opioid-sparing infusionsOff-label
Mechanism of Action
- Noncompetitive NMDA receptor antagonist providing dissociative anesthesia, analgesia and anticonvulsant effects with relative preservation of airway reflexes and hemodynamics
Full Dosing
Adult / usual
- Refractory status epilepticus (off-label): 1.5mg/kg IV bolus (may repeat), then infusion 0.3-7.5mg/kg/h titrated to EEG
- Sedation-analgesia: 0.1-0.5mg/kg/h infusion
- Schedule III controlled substance
Contraindications
- Conditions in which a significant elevation of blood pressure would be hazardous
- Known hypersensitivity to ketamine
Drug Interactions
- Additive CNS depression with benzodiazepines and opioids
- Thyroid hormone and sympathomimetics may increase hypertension and tachycardia
Adverse Effects
- Hypertension and tachycardia
- Emergence reactions and hallucinations (reduced by benzodiazepine co-administration)
- Hepatobiliary injury and uropathy (cystitis) with prolonged or repeated use
- Laryngospasm and hypersalivation
Monitoring Parameters
- Blood pressure and heart rate
- Liver enzymes with prolonged infusions
- Neurologic and psychiatric status
Pregnancy & Lactation
- Crosses the placenta; limited data — use if benefit justifies risk
- Present in milk