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09/05/2024 | Press release | Distributed by Public on 09/05/2024 09:30

Can You Overdose on Ketamine or Spravato

Key takeaways:

  • Ketamine (Ketalar) is an injectable medication that is FDA approved for use as a surgical anesthetic. It's also prescribed off-label for hard-to-treat depression. Ketamine is a generally safe medication. But it should be given only under close medical supervision.

  • Ketamine is a controlled substance. It has a risk of misuse and dependence. Ketamine overdose is rare but still possible.

  • Overdosing on ketamine is more likely when it's used at home. It's also more likely if you combine ketamine with sedating substances, like opioids, benzodiazepines, or alcohol. Having heart or lung disease also increases your risk of overdose.

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Injectable ketamine (Ketalar) has been used as an anesthesia medication for more than 60 years. More recently, ketamine has gained attention for its use in treatment-resistant depression. This is an off-label use of injectable ketamine. But in 2019, the FDA approved a ketamine-based intranasal spray - Spravato (esketamine) - for hard-to-treat depression, including treatment-resistant depression.

Ketamine can be an effective anesthetic and depression medication. But it's a dangerous substance when used incorrectly. This is especially true when ketamine is misused for its psychedelic effects. Here, we'll discuss these risks, including whether it's possible to overdose on ketamine, how to avoid this, and how to manage this dangerous situation if it occurs.

What is ketamine?

Ketamine is available as an injectable medication and a nasal spray. Injectable ketamine is FDA approved as an anesthesia medication. It can be used before surgical procedures to put you to sleep, which prevents you from feeling pain.

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  • How does ketamine work for depression? Though ketamine was created as an anesthetic, it has gained attention for its use in depression.

  • IV ketamine versus Spravato for depression? These two forms of ketamine have several differences to know about when it comes to using them for depression.

  • How do you manage treatment-resistant depression (TRD)? Ketamine is one of several options for TRD.

Spravato is an intranasal form of ketamine that's FDA approved to treat severe or treatment-resistant depression. It's a nasal spray that must be administered with medical supervision. A healthcare professional will monitor you for at least 2 hours after a dose.

How does ketamine work?

Injectable ketamine and Spravato are N-methyl-D-aspartate antagonists (blockers). They work by affecting the brain in various ways. This includes changing the balance of certain brain chemicals. It also affects how the brain responds to different stimuli.

When ketamine is used for anesthesia, it causes sedation or loss of consciousness. It also causes dissociation - a trance-like state that may feel like an out-of-body experience. It can also cause drowsiness, dizziness, and other symptoms.

When injectable ketamine is used for depression, it's used at a lower dose than what's used for anesthesia. This lower dose shouldn't cause a loss of consciousness. But dissociation from Spravato is still possible. So are other risks such as drowsiness and dizziness.

Can you overdose on ketamine?

When used under medical supervision, ketamine doses for depression or anesthesia are unlikely to cause an overdose. But when ketamine is used incorrectly, overdoses are more likely. Your risk is highest under certain circumstances, including:

If you're prescribed ketamine, what should you do with this information? In short, if you're using ketamine exactly as prescribed under medical supervision, your risk of overdose is low. But keep in mind that other ketamine-related side effects and risks are possible. There are also Spravato side effects to be aware of. For example, injectable ketamine and Spravato can cause:

  • Coordination, balance, and vision problems

  • Nausea or vomiting

  • Suicidal thoughts or behavior (although this is rare)

  • Increased blood pressure

  • Dependence and misuse (which is why ketamine products are controlled substances)

What are the risk factors for ketamine overdose?

Ketamine is a safe treatment when administered in medical settings. But certain situations can make ketamine overdose more likely, including:

  • Using ketamine at home. The biggest risk factor for ketamine overdose is when it's used outside a medical setting. So if you are prescribed injectable ketamine or Spravato, don't use ketamine without medical supervision.

  • Using non-FDA-approved ketamine. Ketamine from sources other than pharmacists or healthcare professionals may be contaminated with lethal substances such as fentanyl. The FDA has warned against non-FDA-approved ketamine products, such as compounded nasal sprays and oral ketamine. These aren't regulated, so you can't be sure what's in them.

  • Combining ketamine with other substances. Ketamine is more likely to lead to overdose if it's combined with other substances that cause sedation. These include alcohol, opioids, or benzodiazepines. Recreational drugs, like GHB, can also increase your risk of overdose when combined with ketamine.

  • Having a history of substance misuse. Ketamine misuse can increase the risk of overdose. If you have a history of substance misuse or substance use disorder, your risk of ketamine misuse, and overdose, may be higher.

Symptoms of a ketamine overdose

Ketamine overdose symptoms may include mild ketamine side effects, like dizziness, drowsiness, and feeling "loopy." Nausea and vomiting are also possible. Ketamine can also cause a spike in blood pressure. With overdose, side effects are more likely to be severe and life-threatening. Overdose symptoms may include:

  • Detachment from reality (known as a K-hole)

  • Slow heart rate

  • Low blood pressure

  • Nausea and vomiting

  • Heart attack

  • Hallucinations

  • Slowed breathing

  • Seizures

  • Loss of consciousness or coma

How to respond to a ketamine overdose

Any drug overdose is an emergency. Even if you don't have symptoms right away, they can develop quickly and be life-threatening. So if you have used ketamine differently than how it's prescribed to you, especially if you've taken other substances that can cause an overdose, seek emergency care right away. Call 911 or have someone take you to the ER.

If you've witnessed an overdose, but you aren't sure what the cause is, it's a good idea to administer the opioid overdose antidote called Narcan (naloxone). Although Narcan doesn't work for a ketamine overdose, it can help if opioids are also contributing to the overdose. Still, after administering Narcan, the person who overdosed needs emergency care. Narcan works for only a short amount of time (and repeat doses are often needed).

If you or someone you know struggles with substance use, help is available. Call the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357 to learn about resources in your area.

Treatment for ketamine overdose

Treating a ketamine overdose involves treating symptoms that present. We don't have a specific ketamine antidote that can reverse the effects of ketamine. Still, ketamine overdose symptoms can be managed and treated.

If you experience a ketamine overdose, you should be closely monitored by a healthcare team for several hours. If symptoms present, healthcare professionals may prescribe medications to manage them. For example, if your blood pressure drops too low, you'll be prescribed medications to increase it. And if you're having trouble breathing, you may need to be intubated. Additionally, you may need medications if you're experiencing agitation or psychosis symptoms.

The bottom line

Ketamine (Ketalar) is an anesthetic medication used before surgeries to cause sedation and prevent feelings of pain. More recently, it's been used off-label for hard-to-treat depression. Spravato (esketamine) is another ketamine-based medication that's FDA approved for hard-to-treat depression.

It's possible to overdose on either form of ketamine, but it's rare if these products are used correctly under medical supervision. Overdose is more likely when ketamine is used differently than how it's prescribed, such as taking it in large amounts or using it along with other substances that can cause overdose such as opioids or illegal drugs.

Symptoms of a ketamine overdose include detachment from reality (known as a K-hole), slowed breathing, and low blood pressure and heart rate. Coma and seizures can also occur. A ketamine overdose is a medical emergency, even if no symptoms are present. Call 911 or have someone take you to the ER if you think you've overdosed on ketamine.

References

Chaves, T. V., et al. (2023). Overdoses and deaths related to the use of ketamine and its analogues. American Journal of Drug and Alcohol Abuse.

Hospira. (2024). Ketamine hydrochloride- ketamine hydrochloride injection, solution, concentrate.

View All References (8)
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Kowalczyk, M., et al. (2021). Ketamine-new possibilities in the treatment of depression: A narrative review. Life (Basel).

Li, L., et al. (2016). Ketamine: 50 years of modulating the mind. Frontiers in Human Neuroscience.

Muetzelfeldt, L., et al. (2008). Journey through the K-hole: Phenomenological aspects of ketamine use. Drug and Alcohol Dependence.

National Institute on Drug Abuse. (2023). Psychedelic and dissociative drugs. National Institutes of Health.

Orhurhu, V. J., et al. (2023). Ketamine toxicity. StatPearls.

Palamar, J. J., et al. (2022). Characteristics of poisonings involving ketamine in the United States, 2019-2021. Journal of Psychopharmacology.

U.S. Food and Drug Administration. (2022). FDA alerts health care professionals of potential risks associated with compounded ketamine nasal spray.

U.S. Food and Drug Administration. (2023). FDA warns patients and health care providers about potential risks associated with compounded ketamine products, including oral formulations, for the treatment of psychiatric disorders.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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