ketamine

Adult Dosing .

Dosage forms:  INJ

general anesthesia induction

[IV route]

Dose: 1-4.5 mg/kg/dose IV x1; Info: onset 30sec, duration 5-10min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics

[IM route]

Dose: 6.5-13 mg/kg/dose IM x1; Info: onset 3-4min, duration 12-25min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics

general anesthesia maintenance

[0.1-0.5 mg/min IV]

Alt: 0.5-4.5 mg/kg/dose IV prn; 3.25-13 mg/kg/dose IM prn; Info: give adjuvant benzodiazepine prn; decr. usual dose if given w/ other anesthetics

sedation, procedural (off-label)

[IV route]

Dose: 1-2 mg/kg/dose IV x1; Info: onset 30sec, duration 5-10min; may give additional 0.5 mg/kg/dose IV q5-15min prn; consider adjuvant benzodiazepine; decr. usual dose if given w/ other anesthetics

[IM route]

Dose: 4-5 mg/kg/dose IM x1; Info: onset 3-4min, duration 12-25min; may give additional 2-4 mg/kg/dose IM x1 after 10min; consider adjuvant benzodiazepine; decr. usual dose if given w/ other anesthetics; IV route preferred

rapid sequence intubation (off-label)

[1-2 mg/kg/dose IV x1]

Start: 3min after premedications; Info: see Rapid Sequence Intubation (RSI), Adult table

pain, mod-severe acute (off-label)

[IV route]

Dose: 0.1-0.35 mg/kg/dose IV x1; Alt: 0.1-1 mg/kg/h IV prn; Info: refer to institution protocols

[intranasal route]

Dose: 0.5-1 mg/kg/dose intranasally x1, may repeat 0.25-0.5 mg/kg/dose intranasally x1 after 10-15min if no response; Info: refer to institution protocols; use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril

pain, mod-severe chronic (off-label)

[IV route]

Dose: 0.5-2 mg/kg/h IV; Alt: 0.1-0.35 mg/kg/dose IV x1; Info: duration, frequency varies, refer to institution protocols; consider test dose 80 mg IV x1 over 2h

[intranasal route]

Dose: 10 mg intranasally q90sec prn up to 50 mg total dose; Alt: 25 mg intranasally q6h prn; Info: refer to institution protocols; use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril

major depressive disorder, tx-resistant (off-label)

[0.5 mg/kg/dose IV x1]

Alt: 0.5 mg/kg/dose IV 2-3x/wk for up to 8 doses

renal dosing

[see below]

renal impairment: no adjustment

HD/PD: not defined

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised

Peds Dosing .

Dosage forms:  INJ

general anesthesia induction

[IV route, 3 mo-15 yo (off-label)]

Dose: 1-3 mg/kg/dose IV x1

[IV route, 16 yo and older]

Dose: 1-4.5 mg/kg/dose IV x1; Info: onset 30sec, duration 5-10min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics

[IM route, 3 mo-15 yo (off-label)]

Dose: 5-10 mg/kg/dose IM x1

[IM route, 16 yo and older]

Dose: 6.5-13 mg/kg/dose IM x1; Info: onset 3-4min, duration 12-25min; give adjuvant antisialagogue and benzodiazepine; decr. usual dose if given w/ other anesthetics

general anesthesia maintenance

[3 mo-15 yo (off-label)]

Dose: 0.5-3 mg/kg/dose IV prn; Alt: 1-5 mg/kg/h IV

[16 yo and older]

Dose: 0.1-0.5 mg/min IV; Alt: 0.5-4.5 mg/kg/dose IV prn; 3.25-13 mg/kg/dose IM prn; Info: give adjuvant benzodiazepine prn; decr. usual dose if given w/ other anesthetics

sedation, procedural (off-label)

[IV route, 3 mo and older]

Dose: 1.5-2 mg/kg/dose IV x1; Info: onset 0.5-2min, duration 5-60min; may give additional 0.5-1 mg/kg/dose IV q5-15min prn; decr. usual dose if given w/ other anesthetics

[IM route, 3 mo and older]

Dose: 4-5 mg/kg/dose IM x1; Info: onset 3-10min, duration 15-90min; may give additional 2-4 mg/kg/dose IM x1 after 10min; decr. usual dose if given w/ other anesthetics; IV route preferred

[intranasal route, 3 mo and older]

Dose: 3-6 mg/kg/dose intranasally x1; Start: 5-20min before procedure; Info: use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril

[PO route, 3 mo and older]

Dose: 5-6 mg/kg/dose PO x1; Info: mix injectable form in beverage; onset 15-45min, duration 30-120min; IV route preferred

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised