Identifying Safety Concerns and Potential Risks
Associated with the Use of Ketamine Products
Megan Ehret, PharmD, MS, BCPP
University of Maryland Baltimore School of Pharmacy
Tolerability & Safety
Psychiatric Side Effects
Dissociation- some literature shows decrease of disocciation over subsequent administrations, peaks within 40 minutes, resolves in 1-2 hours
CLinical Rating scales (CADSS) too challenging to adminsiter
Psycotomimetic - pre-existing vulnerability - (aka psychedelic)
Dizziness, drowsiness, light-headedness - fall risks
Long term exposure? Cellular or lolecular evidence of neurotoxicity - DOn’t know if we have the evidence yet
Hemodynmaic - increase in BP 10-50%, observed in 20-50 minutes of treatment
Resolve in 2-4 hours
with esketamine, we have the REMS that dictate when and what to measure
20-30% have increased BP
Genitourinary - 20-40% of recreatinal users - nocturita, painful hematuria, dysuria, urinary urgency, incontinence - dose-dependent relationsip
Abuse Liability
Increased liking, (cites 2017 and 2008 research)
Esketamine vs ketamine REMS?
Esketamine required to reduce occuraence of severity
esketamine- increased risk of seadation, discoiation, repiratory dewpression after admin
Many providers see REMS as a barrier to esketamine prescription
Ketamine does not have a REMS