Optimizing ketamine dosing strategies across diverse clinical applications: a comprehensive review.
Ahmed M Kedwany, Reem Sayad, Nada S Jibril, Eslam A Hawash, Amna M Anis, Nardein John Wadie Danial, Ahmed Saad Elsaeidy, Neveen A Kohaf
Annals of Medicine and Surgery July 18, 2025 DOI: 10.1097/ms9.0000000000003580 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Depression Ketamine Esketamine |
| Keywords | Safety Pain Anesthesia |
| Key findings | Argues that ketamine's clinical utility across anesthesia, pain management, and psychiatric disorders depends on individualized dosing, since therapeutic effects are dose-dependent and infusion rate and administration frequency influence both efficacy and safety. The authors contend that balancing benefits against side effects is paramount and call for further research into long-term effects, alternative administration routes, and personalized, pharmacokinetic-informed protocols. |
Abstract
Ketamine has emerged as a versatile therapeutic agent with applications spanning anesthesia, pain management, and psychiatric disorders. This review examines ketamine's clinical utility across diverse administration routes, including intravenous, intramuscular, intranasal, and oral, emphasizing the need to individualize dosing regimens. We explore factors influencing ketamine dosing, such as patient characteristics (age, weight, comorbidities), concomitant medications, and desired clinical effects, while balancing efficacy and side effects. The impact of dose, infusion rate, and administration frequency on therapeutic outcomes is analyzed to provide a comprehensive understanding of its clinical implications. The review highlights the critical role of individualized dosing regimens tailored to patient-specific factors. The therapeutic effects of ketamine are dose-dependent, with infusion rate and administration frequency significantly influencing both efficacy and safety. Achieving a balance between clinical benefits and potential side effects remains paramount. There are gaps in knowledge, necessitating for further research into long-term effects, alternative administration routes, and personalized approaches informed by pharmacokinetic variability. Developing standardized, evidence-based protocols and exploring alternative strategies will improve ketamine's therapeutic potential while addressing safety, misuse, and availability concerns.
Comparable studies
Other narrative reviews on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| 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: a paradigm shift for depression research and treatment | 2019 | Review | |
| Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective | 2019 | Review | |
| Ketamine: A tale of two enantiomers | 2020 | Review | |
| Molecular mechanisms underlying the antidepressant actions of arketamine: beyond the NMDA receptor | 2021 | Review |
Citations in the library
Cited by 2
- A Blueprint for Implementing Ketamine-Assisted Psychotherapy in Palliative Care: Design, Process, and Treatment Patterns of a Real-World Clinical Program. Journal of Palliative Medicine March 1, 2026
- Psychoactive and Neurobiological Effects of Ketamine in Humans: A Scoping Review of Clinical Evidence. Journal of Clinical Medicine July 29, 2026
Cites 18
- Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) CNS Neuroscience & Therapeutics April 10, 2013
- Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. American Journal of Psychiatry March 29, 2019
- Ketamine: 50 Years of Modulating the Mind Frontiers in Human Neuroscience November 29, 2016
- A Phase 2 Open Label Study of Efficacy, Safety, and Tolerability of SLS-002 (Intranasal Racemic Ketamine) in Adults with MDD at Imminent Risk of Suicide. Psychopharmacology Bulletin March 4, 2024
- Ketamine and rapid antidepressant action: new treatments and novel synaptic signaling mechanisms Neuropsychopharmacology July 24, 2023
and 13 more in the library