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WHAT IS KETAMINE

Ketamine is a dissociative anesthetic that has some hallucinogenic effects. It distorts perceptions of sight and sound and makes the user feel disconnected and not in control. It is an injectable, short-acting anesthetic for use in humans and animals. It is referred to as a “dissociative anesthetic” because it makes patients feel detached from their pain and environment. Ketamine can induce a state of sedation (feeling calm and relaxed), immobility, relief from pain, and amnesia (no memory of events while under the influence of the drug). It is abused for its ability to produce dissociative sensations and hallucinations. Ketamine has also been used to facilitate sexual assault.

Therapeutic uses

The FDA has approved ketamine for general anesthesia only, but the drug has some off-label uses. Details are below.

Inducing general anesthesia

Doctors use ketamine to induce general anesthesia alone or with other general anesthetics, such as nitrous oxide. They use it in the emergency department setting to produce short-term sedation whenTrusted Source:

  • reducing fractures
  • treating joint dislocations
  • repairing wounds in uncooperative individuals, such as children

Treating pain

Practitioners use low doses that do not produce dissociation to relieve severe pain from the followingTrusted Source conditions:

  • trauma
  • fractures
  • abdominal pain
  • arm or leg pain
  • low back pain

Treating status epilepticus

Status epilepticus is when a person has a seizure that lasts longer than 5 minutes or has more than one seizure within 5 minutes.

Refractory status epilepticus (RSE) is a form of status epilepticus that does not respond to standard antiseizure drugs. It is a severe disease that can cause brain damage and death.

A 2015 study found that ketamine may effectively treat RSE. However, further research is necessary to verify the study findings and prove the safety of using ketamine to treat this condition.

Treating depression

Research in 2017Trusted Source notes that some studies indicate ketamine can quickly relieve depression in people who do not respond well to other treatment.

Despite these positive results, the authors warn that data on the use of ketamine for this condition are limited, so practitioners should consider the risks of the drug before prescribing it.

A 2016 studyTrusted Source cautions that the inappropriate use of ketamine is a worldwide health problem due to its hallucinogenic properties. With this in mind, they urge doctors to prescribe standard antidepressants before trying ketamine for depression.

Treating anxiety

Research on the use of ketamine for anxiety is scarce. However, one study suggests that it may help people with social anxiety disorder (SAD). This condition involves a marked fear of social situations.

The 2017 clinical trialTrusted Source tested the drug on 18 participants and concluded that it might effectively treat SAD.

Because several other trials indicate ketamine may have significant anti anxiety effects, the authors encouraged future studies to explore this possible benefit more fully.

Why Proper Ketamine Storage Matters

Hopeful psychonauts worldwide are venturing out to experience ‘special k’ and what it has to offer. With mainstream support, psychedelic substances are becoming a more common tool for various treatment-resistant mental health ailments. While most psychedelics are still not federally legal, there are ways individuals can acquire certain substances like ketamine. To get the most out of it, it’s important to know how to store ketamine the right way.

Best Ways to Store Ketamine

The concern regarding temperature and climate controls with medication storage is a breakdown and/or decomposition of the drug and its active components or functional abilities. Extreme temperatures can cause significant degradation of medications from chemical reactions such as oxygenation (air) and hydrolysis (moisture).

It’s crucial to properly store ketamine because it is a synthesis of multiple active chemical compounds that naturally react and change with extreme elements. When one of the compounds shifts, it affects the entire makeup of the drug, resulting in the inaccuracy and consistency of the drug functions. If left stored in an uncontrolled environment, the damage is irreversible. So, what are the best conditions to avoid this? 

Intranasal and intravenous infusion are the two most common types of ketamine, and will be the ones we address regarding ketamine storage. 

Intranasal Ketamine

Ketamine consumers often do the intranasal route in both recreational and medical settings for racemic ketamine and Spravato, respectively. Recreationally, powdered ketamine is insufflated at a common dose of ketamine ranging from 30–75 mg. On the other hand, individuals administer Spravato as a nasal spray in medical settings in a fixed dosage of either 54 or 84 mg. This corresponds to two or three insufflations, given intermittently in two-hour visits, one to two times per week.

In regards to intranasal, the main environmental factors that impact storage include temperature, light, humidity. Generally, ketamine is best stored at a controlled room temperature, which will be in the range of 68 and 77 degrees Fahrenheit. Extreme temperatures can cause medications to spontaneously decompose, reassemble, or react with air, contaminants, or a drug’s otherwise inactive ingredients.

Intravenous Ketamine Infusion

The most common consumption method of ketamine is via an intravenous infusion in the treatment of severe depression. It’s been known to produce potent antidepressant effects within hours, which can endure for several weeks. For depression, health practitioners typically administer racemic ketamine intravenously at a dose of 0.5mg/kg over approximately 45 minutes. Typically, IV ketamine therapy consists of six ketamine infusions, spaced out over two to three weeks.

In regards to intravenous infusion, Creighton College did a study on the expiration date and the proper storage temperatures of a ketamine infusion, or in their words, a cocktail—since this typically includes a variety of other medications, like lidocaine and magnesium. The study, however, was tried on mice so their concoction included veterinary substances, such as xylazine. 

The stability of ketamine in biological samples stored at negative 20 degrees Celsius was better than that at room temperature. The samples suspected containing ketamine should be stored at negative 20 degrees Celsius and should be tested as soon as possible.

Best Ketamine Storage Conditions

The best practices for how to store ketamine and other synthesized powdered drugs include: 

  • Little to no light transmission
  • Little to no moisture 
  • Controlled temperature (68 and 77 degrees Fahrenheit) 
  • Sterile container 

Just as extreme temperatures can cause spontaneous decomposition, so can extreme light conditions. Light — especially natural light — can significantly modify chemical compounds.

An average, solid, airtight pill bottle would meet the above requirements. For instance, a generic ibuprofen bottle from the drug store will do. Keep this bottle in a controlled room in your home. A common example of an uncontrolled temperature is an unattended car. The extreme temperature shifts that occur in a car are a sure fire way of altering the chemical makeup of your medicine.

However, if ketamine is not exposed to excessive heat or frost for a period longer than 24 hours, it may be salvageable. Exposure any longer than 24 hours will negatively affect ketamine resulting in uncertain drug potency and effects. 

Short-Term vs. Long-Term Ketamine Storage

All drugs in a pharmacy have a shelf life and expiration date, and ketamine is no different. For those partaking in the intranasal method, ketamine is designed for short-term, immediate consumption, especially when in an uncontrolled temperature. For short-term use, best practices are to keep ketamine in a clean, dark, air-tight container. Those who like to store in a little plastic pinch bag, should take extra care and double up by putting the bag in an air-tight container. 

Thanks to the festival scene, people get creative with their storage when using ketamine recreational purposes. It’s common to see people getting creative with their clean, dark, airtight containers. It’s not recommended to keep your K in a wallet, or in similar conditions, due to the friction in such a place. 

Even under careful conditions, ketamine’s chemical effects aren’t designed to last forever. By following the storage rules, ketamine should last long-term for up to six months when storing for intranasal use such as powder or nasal spray. After six months, ketamine will begin to expire and lose potency and some of its healing qualities. 

It’s recommended, similar to the short term, to keep your ketamine in a clean, dark, air-tight container. Once inside a container, ketamine can live in a medicine cabinet. As mentioned above, ketamine is best stored between 20 to 25 degrees Celsius and away from too much natural light. 

 

 What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

  • head injury
  • heart disease
  • high blood pressure
  • an unusual or allergic reaction to ketamine, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

How should I use this medication?

This drug is injected into a vein or muscle. It is given by a health care provider in a hospital or clinic setting.

Talk to your health care provider about the use of this drug in children. While this drug may be prescribed for children as young as 16 years for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply. This drug is not for regular use.

What may interact with this medication?

This medicine may interact with the following medications:

  • aminophylline
  • antihistamines for allergy, cough, and cold
  • certain medicines for anxiety or sleep
  • certain medicines for blood pressure, heart disease, irregular heartbeat
  • certain medicines for depression like amitriptyline, fluoxetine, sertraline
  • certain medicines for seizures like phenobarbital, primidone
  • medicines that relax muscles for surgery
  • narcotic medicines for pain
  • other general anesthetics like isoflurane, propofol
  • phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine
  • theophylline

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Your condition will be monitored carefully while you are receiving this drug. You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you. Do not stand up or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effects of this drug. Avoid alcoholic drinks.

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How To Take Ketamine

Ketamine should only be taken in a healthcare provider’s office, under the direct supervision of a trained nurse or doctor. When considering where to get ketamine, it’s important to consider the routes of administration offered by your local ketamine clinic because how ketamine is administered greatly affects the strength of the antidepressant effects. At Advanced Brain and Body Clinic in Minneapolis, we offer the three main routes of ketamine administration, including intranasal, intravenous infusions, or intramuscular injections, allowing you and your provider the flexibility to choose which works best for you.

1. Ketamine IV Infusion

When ketamine is given intravenously through an IV, patients will absorb much higher levels of the medication (roughly 99%) compared to intranasal infusions. Since the medication is directly inserted into the bloodstream, some patients may experience a sudden lift of their depression after just one dose. 

During an IV infusion, ketamine is administered at a steady rate over roughly 40 minutes. IV infusions give the greatest amount of flexibility, allowing your provider to adjust your dosage and rate of administration based on your weight, response, and any side effects you may experience during your treatment session. 

While the exact number of ketamine infusions you receive will depend on your unique case, we typically begin with six infusions over 2-3 weeks. After the first two weeks, doses may be spaced out a few weeks apart. Many patients require maintenance treatments at a reduced frequency. Maintenance treatments may be given weekly, monthly, or less. Typically, maintenance treatments are given every 4-6 weeks to start and taper off over time.

Most studies have been done on this infusion route, which is the most commonly chosen route of ketamine administration. 

2. Ketamine Shot

Ketamine may be administered intramuscularly through an injection in the arm. Treatments are quick but may require multiple injections for a single treatment session. Roughly 93% of the medication is absorbed when administered through an injection. 

Compared to an IV infusion, there is less control over the dosage. However, the dosage may be adjusted in subsequent treatment sessions based on the patient’s weight, response, and side effects. 

Intramuscular injections follow a similar cadence to IV infusions. Patients typically receive six injections over the first 2-3 weeks, followed by one injection every few weeks as needed.

3. Ketamine Nasal Spray

Both ketamine and esketamine (Spravato) are offered intranasally as a nasal spray that comes in two strengths. When administered intranasally, roughly 20-30% of the medication is absorbed, so more frequent treatments are required to have the same effect as intramuscular or intravenous infusions.

Patients typically receive two treatments per week for the first four weeks, followed by one treatment a week for an additional five weeks.

Work with a Psychiatrist

There are a lot of clinics that can administer ketamine. However, specializing in a particular drug, versus a medical discipline (such as mental health or cardiology) is a relatively new and concerning development. When the focus is on the drug rather than the patient’s symptoms, it can be easy to miss additional conditions that need to be treated or the underlying cause altogether. For example, ketamine alone can worsen bipolar disorder or psychosis, so it is best to be seen by a psychiatrist who can treat all the conditions you may be experiencing. At Advanced Brain and Body Clinic, many of our ketamine patients are also being treated for other psychiatric problems at the same time.

Ketamine dosing information

Usual Adult Ketamine Dose for Anesthesia:

Intravenous injection (IV)
Induction: 1 to 4.5 mg/kg IV; alternatively, 1 to 2 mg/kg IV at a rate of 0.5 mg/kg/min; (2 mg/kg dose provides 5 to 10 minutes of surgical anesthesia within 30 seconds)
Maintenance: The maintenance dose should be adjusted according to the patient’s anesthetic needs and whether an additional anesthetic is employed. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia.

Intramuscular injection (IM)
Induction: 6.5 to 13 mg/kg IM; (9 to 13 mg/kg IM provides 12 to 25 minutes of surgical anesthesia)
Maintenance: The maintenance dose should be adjusted according to the patient’s anesthetic needs and whether an additional anesthetic is employed. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia.

Comments: This drug should be administered slowly over a period of 60 seconds (more rapid administration may result in respiratory depression and enhanced pressor response).
The larger the total dose, the longer the complete recovery will be.
Because of rapid induction following the initial IV injection, the patient should be in a supported position during administration.

 

 

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