Use of Ketamine and Esketamine in the Pediatric Population: Current Evidence and Clinical Applications.
Focus (American Psychiatric Publishing) April 1, 2026 Thomas Kun Pak, Stephen Kimatian, Graham Emslie et al.
This review summarizes the pharmacodynamics, pharmacokinetics, adverse effects, contraindications, and clinical applications of ketamine and esketamine in adults and children. Ketamine, used clinically since the 1960s, is gaining recognition for treating chronic pain, refractory status epilepticus, major depressive disorder, and suicidality. Its bioavailability varies by route: intravenous 100%, intramuscular 64%-93% in adults and 41% in pediatric populations, intranasal 43%-48% in adults and 50% in pediatric populations, sublingual 29%-32%, rectal 25%-30%, epidural 77%, and oral 17%-18%, due to extensive first-pass hepatic metabolism. Dosing differences produce distinct clinical effects. Pediatric use is complicated by developmental stage, pharmacokinetics, and neurodevelopmental factors.