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 via PubMed
Summary
AI-generated from the abstractHigh-dose ketamine, used for conditions like Complex Regional Pain Syndrome, is linked to several adverse effects. Psychiatric symptoms such as agitation, anxiety, and sleep disturbances occur across oral, intravenous, and intranasal routes. Emesis is common and more frequent at higher doses. Hepatotoxicity is also common, dose-dependent, and usually transient. Uropathy is another potential adverse effect. When properly monitored in a hospital setting, high-dose ketamine appears safe, though practitioners should note that certain adverse effects are likely dose-dependent.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Ketamine |
| Keywords | Adverse effects Emergence reactions Treatment resistant depression Psychiatric symptoms |
| Citations | 3 |
| Key finding | 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.