Adverse Effects Associated With High-Dose Ketamine Infusions For Refractory Pain And Psychiatric Conditions.
Elika D Javaheri, Christopher Wie, Stephen Covington, Lopa Misra, Scott Pew, Omar Viswanath, John Freeman, Jillian Maloney
Current Pain and Headache Reports June 19, 2025 DOI: 10.1007/s11916-025-01408-w (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Ketamine Esketamine |
| Keywords | Adverse effects Emergence reactions Treatment resistant depression Psychiatric symptoms Agitation Sleep disturbances Emesis Transient hepatotoxicity Safe |
| Citations | 3 |
| Key findings | High-dose ketamine is associated with dose-dependent adverse effects including psychiatric symptoms, emesis, hepatotoxicity, and uropathy, but appears safe when monitored in a hospital setting. |
Abstract
As higher doses of ketamine are being used in numerous medical conditions such as Complex Regional Pain Syndrome (CRPS), it is critical to examine common adverse effects (AEs) explicitly associated with high doses of ketamine (HDK). HDK is often associated with psychiatric symptoms such as agitation, anxiety, and sleep disturbances. Psychiatric effects have been documented in various methods of administration of HDK, including oral, intravenous, and intranasal formulations. Emesis is a common AE of HDK and is more prevalent at higher ketamine doses. Hepatotoxicity is common after HDK, is dose-dependent, and is usually transient. HDK-induced uropathy is another potential AE. When monitored appropriately, HDK administered in a hospital setting appears safe; practitioners should be mindful that certain AEs of HDK are likely dose-dependent.
Comparable studies
Other narrative reviews on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms | 2018 | Review | |
| Mechanisms of Ketamine Action as an Antidepressant | 2018 | Review | |
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) | 2013 | Review | |
| A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders | 2017 | Review and consensus statement |
Citations in the library
Cited by 2
Cites 6
- Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms Pharmacological Reviews June 26, 2018
- NMDA Receptor Activation-Dependent Antidepressant-Relevant Behavioral and Synaptic Actions of Ketamine Journal of Neuroscience January 3, 2023
- Ketamine: Mechanisms and Relevance to Treatment of Depression. Annual Review of Medicine September 20, 2023
- Ketamine Infusion for Complex Regional Pain Syndrome Treatment: A Narrative Review. Current Pain and Headache Reports January 14, 2025
- Involvement of AMPA receptor in both the rapid and sustained antidepressant-like effects of ketamine in animal models of depression. Behavioural Brain Research June 6, 2011
and 1 more in the library