Adverse Effects

While there are a wide array of adverse effects, the adverse effects depend on the dose level and can vary significantly from person to person.

The adverse effects listed in this section are not an exhaustive list, however they are the most common adverse effects or the adverse effects that cause the greatest concern in a clinical setting.

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Anesthetic Dose

Possible adverse effects of an anesthetic dose of ketamine include:

  • Dissociation

  • Anxiety

  • Dizziness

  • Nausea

  • Headache

  • Vertigo

  • Altered taste

  • Loss of sensation

  • Increase in blood pressure

  • Vomiting

These adverse reactions are generally transient and tend to resolve within several hours (to a day, at most) of ketamine administration (Janssen Inc., 2020). Though rare, these anesthetic doses may also produce seizures and difficulty breathing (Sandoz Canada Inc., 2015).

Psychedelic and Psycholytic Dose

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Vital Signs

Increased pulse and blood pressure are the most commonly reported effects of ketamine, although drops in both pulse and blood pressure are also possible. As a result, medical monitoring is necessary during ketamine administration (Ceban et al., 2021). Loss of consciousness or responsiveness is very uncommon, although also a possible side effect of ketamine administration (Janssen Inc., 2020).

Physical Adverse Effects

Some other physical adverse effects of ketamine administration include:

    • Increased salivation

    • Nausea

    • Vomiting

    • Muscle spasms

    • Headache

    • Blurred vision

    • Seizures

    • Lower urinary tract symptoms (e.g. incontinence, painful hematuria, etc.) (Ceban et al., 2021; Janssen Inc., 2020)

Nausea and vomiting are the most reported adverse effects as a result of ketamine administration; however, nausea tends to be dose dependent and may reduce with repeated treatment. Certain antinausea medications may be used alongside ketamine to reduce these symptoms. These physical adverse effects tend to improve after discontinuation of the medicine (Ceban et al., 2021).

Note

As with any medication, the potential for unexpected allergic reactions exists.

Behavioural Adverse Effects

Ketamine does not typically produce many behavioural adverse effects beyond the desired effects discussed in Module 3. However, some people can experience:

  • Agitation

  • Anxiety

  • Increased suicidality (Ceban et al., 2021; Janssen Inc., 2020)

Despite its anti-anxiety effects, increased anxiety is commonly seen and is one of the most reported adverse events associated with ketamine administration for the treatment of mood disorders (Ceban et al., 2021). In rare cases, ketamine use can increase suicidality, thus requiring careful monitoring during treatment. That being said, ketamine is also known to have rapid anti-suicidal effects in many, which play an important role in its clinical applications (Abbar et al., 2022; Grunebaum et al., 2018; Janssen Inc., 2020; Witt et al., 2020).

Health Professional Tip

What are some ways to help ease client’s agitation, anxiety, or increased suicidality during a Ketamine Medicine Session?

To help ease a client’s agitation, anxiety, or increased suicidality during a Ketamine Medicine Session, there are a few strategies you can try with the client:

  • Look for opportunities to make the setting more relaxing such as ensuring that the client is physically comfortable

  • Encourage the client to move around the room

  • Encourage the client to explore whatever movement feels best for them

  • Conduct an ACE body scan with the client

Learn More

We will learn more about the ACE body scan in the Fundamentals of Psychedelic-Assisted Therapy course if you have not yet registered for it. In the interim, you can learn more about the ACE body scan by watching this video.

Spravato

Spravato is the brand name of esketamine. The most common adverse effects of Spravato include:

  • Dissociation

  • Dizziness

  • Nausea

  • Sedation

  • Vertigo

  • Hypoesthesia

  • Anxiety

  • Lethargy

  • Blood pressure increased

  • Vomiting

  • Feeling drunk (Psychedelic.support, n.d.)

References

Abbar, M., Demattei, C., El-Hage, W., Llorca, P. M., Samalin, L., Demaricourt, P., . . . Jollant, F. (2022). Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ, 376, e067194. https://doi.org/10.1136/bmj-2021-067194

Ceban, F., Rosenblat, J. D., Kratiuk, K., Lee, Y., Rodrigues, N. B., Gill, H., . . . McIntyre, R. S. (2021). Prevention and Management of Common Adverse Effects of Ketamine and Esketamine in Patients with Mood Disorders. CNS Drugs, 35(9), 925-934. https://doi.org/10.1007/s40263-021-00846-5

Grunebaum, M. F., Galfalvy, H. C., Choo, T. H., Keilp, J. G., Moitra, V. K., Parris, M. S., . . . Mann, J. J. (2018). Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam- Controlled Randomized Clinical Trial. Am J Psychiatry, 175(4), 327-335. https://doi.org/10.1176/appi.ajp.2017.17060647

Janssen Inc. (2020). Product Monograph: NSPRAVATO ® Esketamine Nasal Spray. https://www.janssen.com/canada/sites/www_janssen_com_canada/files/prod_files/live/spravato_cpm.pdf

Psychedelic.support (N.d.). Little book of psychedelics. https://psychedelic.support/education/free-courses/

Sandoz Canada Inc. (2015). Product Monograph: Ketamine Hydrochloride Injection USP & Ketamine Hydrochloride Injection SDZ. https://www.sandoz.ca/sites/www.sandoz.ca/files/Ketamine_HCl_PMe_20150506.pdf

Witt, K., Potts, J., Hubers, A., Grunebaum, M. F., Murrough, J. W., Loo, C., . . . Hawton, K. (2020). Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta- analysis of treatment trials. Aust N Z J Psychiatry, 54(1), 29-45. https://doi.org/10.1177/0004867419883341