Ketamine Guide: Pharmacology, Indications, Dosing Guidelines and Adverse Effects
July 11, 2025 DOI: 10.64239/pi-bg012 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Practical guide or manual |
|---|---|
| Interventions | Ketamine Esketamine |
| Dose | 0.5-0.75 mg/kg IV over 40 minutes |
| Topics | Esketamine Ketamine |
| Key points | The activity proposes that clinicians optimize ketamine treatment for treatment-resistant depression by understanding its NMDA, AMPA, opioid, and neuroplasticity mechanisms; choosing between ketamine and esketamine based on speed of response, cost, monitoring needs, and contraindications; and following evidence-based protocols using 0.5-0.75 mg/kg IV over 40 minutes with monitoring for dissociation and blood pressure elevation and screening for CYP3A4/2B6 and benzodiazepine interactions. |
Abstract
After completing this activity, participants should be able to: Analyze the pharmacodynamic mechanisms of ketamine, including its primary action as an NMDA receptor antagonist and secondary effects on AMPA receptors, opioid systems, and neuroplasticity pathways, to optimize treatment selection for patients with treatment-resistant depression. Evaluate clinical scenarios to determine when ketamine versus esketamine is most appropriate, considering factors such as speed of response needed, cost constraints, available monitoring resources, and patient-specific contraindications including cardiovascular disease, substance use history, and concurrent medications. Design safe and effective ketamine treatment protocols by applying evidence-based dosing strategies (0.5-0.75 mg/kg IV over 40 minutes), monitoring parameters for common adverse effects (dissociation, blood pressure elevation), and implementing appropriate screening for contraindications and drug interactions, particularly with CYP3A4/2B6 modulators and benzodiazepines.