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Precautions and Warnings With Ketamine

People who have certain allergies or a condition in which a large increase in blood pressure would be especially dangerous should not receive ketamine. Other warnings and precautions with this anesthetic involve potential drug interactions and complications this product may cause. Ketamine does have a potential for abuse and may not be the best choice for people with a history of drug or alcohol problems.

What Should I Tell My Healthcare Provider Before Receiving Ketamine?

You should talk with your healthcare provider prior to receiving ketamine hydrochloride (Ketalar®) if you have:
  • High blood pressure (hypertension)
  • Heart problems, such as congestive heart failure
  • A history of alcohol or drug abuse problems, or currently use illicit drugs
  • A history of head trauma or a head injury
  • Intracranial hypertension or increased cerebrospinal fluid pressure (increased pressure of the fluid around the brain)
  • Bleeding in the brain
  • A mental health condition
  • Any allergies, including to foods, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Breastfeeding
  • Pregnant or thinking of becoming pregnant.
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Specific Ketamine Precautions and Warnings

Some warnings and precautions to be aware of prior to receiving this anesthetic include the following:
  • Ketamine may cause psychological reactions, such as a dream-like state, confusion, and hallucinations. Some people may experience unpleasant dreams, excitement, or irrational behavior. While these reactions normally go away within a few hours, they may persist for up to 24 hours after your medical procedure.
  • This medication should only be used under the supervision of a healthcare provider who is experienced in administering general anesthesia and in maintaining and controlling breathing during anesthesia. There are specific instructions for administering ketamine to avoid certain potentially dangerous side effects.
  • Make sure your healthcare provider knows your complete medical history, including any history of alcohol use, before your procedure. Some people may be more sensitive to the effects of ketamine, including those who have:
    • Uncontrolled hypertension (high blood pressure)
    • Heart problems
    • Increased cerebrospinal fluid pressure (increased pressure of the fluid around the brain)
    • Chronic alcohol problems.
  • With a potential for abuse, ketamine may be used illicitly because it produces an altered state of consciousness. Using ketamine in this manner can be extremely dangerous. People who abuse this drug can become psychologically dependent on it. Abuse can also cause tolerance, which means higher doses may be needed to produce the same effects. If you believe you may have a problem with ketamine abuse, please talk to your healthcare provider.
  • This drug may cause drowsiness, sometimes for 24 hours or longer. Do not drive, operate heavy machinery, or do anything else that requires you to be alert for at least 24 hours after your medical procedure.
  • It is unknown if ketamine passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to receiving the anesthetic (see Ketamine and Breastfeeding).
  • Ketamine is a pregnancy Category B medication. This means that it is probably safe for use during pregnancy, although the full risks are currently unknown (see Ketamine and Pregnancy).
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