Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Drug reference
Ketamine
NMDA-receptor antagonist dissociative anaesthetic · Analgesic
Also known as Ketamine Hydrochloride, Special K
START
Anaesthesia 1–2 mg/kg IV (or 4–10 mg/kg IM); procedural 0.5–1 mg/kg IV titrated; depression 0.5 mg/kg IV/40 min protocolised
TYPICAL MAX
Titrate to effect; limit repeated/high cumulative dosing (uropathy/cholangiopathy)
STOP IF
Laryngospasm/apnoea, severe hypertensive/ischaemic response, severe emergence psychosis
WATCH
Airway/SpO2 + BP/HR, emergence (quiet recovery ± benzodiazepine), monitored setting, urological/hepatic symptoms with chronic use, abuse potential
CDSCO approvedPsychotropic Substance (NDPS Act)ATC N01AX03
KDIGO 2024 + manufacturer label
- ONSET
- 36s · IV onset (~30 s)
- PEAK
- 1min · IV peak (~1 min)
- t½
- 2.5h · plasma t½
- DURATION
- 12min · IV anaesthesia (~10 min)
EXCRETION
Hepatic CYP3A4/2B6; renal metabolites
route + CYP
INTERACTIONS
9 major
SEVERE in our sources
PREGNANCY
Use only if clearly needed — limited data; neonatal depression if used at delivery; uterine tone effects
FDA category + note
Top interactionssee all 11 →
- DextropropoxypheneSevereDatabaseDDInter
- IsocarboxazidSevereDatabaseDDInter
- Cns DepressantsSevereDatabaseKimi deep-research + Cla
- LevacetylmethadolSevereDatabaseDDInter
Available in India
27 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Non-competitive NMDA-receptor antagonism (also opioid, monoaminergic, cholinergic effects) producing dissociative anaesthesia, profound analgesia and amnesia with relative preservation of airway reflexes/respiration and sympathomimetic cardiovascular stimulation; sub-anaesthetic doses give rapid antidepressant effects.
Indications
Induction/maintenance of anaesthesia (esp. haemodynamically unstable, asthma, field/low-resource)Procedural sedation and analgesiaAcute/chronic refractory and opioid-tolerant pain (sub-anaesthetic)Treatment-resistant depression (esp. esketamine; IV ketamine off-label); status asthmaticus/refractory bronchospasm
Dosing
- Adult
- Anaesthesia induction: 1–2 mg/kg IV or 4–10 mg/kg IM. Procedural sedation: 0.5–1 mg/kg IV titrated. Analgesia (sub-anaesthetic): 0.1–0.3 mg/kg IV or infusion 0.1–0.3 mg/kg/h. Depression: 0.5 mg/kg IV over 40 min (protocolised).
- Pediatric
- IM 4–5 mg/kg or IV 1–2 mg/kg (specialist).
- Renal adjustment
- No specific adjustment (active metabolite norketamine may accumulate in severe impairment — titrate).
- Hepatic adjustment
- Reduce dose / titrate (hepatic metabolism; accumulation, hepatotoxicity with repeated/high exposure).
- Geriatric
- Reduce dose; cardiovascular caution.
- Max dose
- Titrated to effect; repeated/high cumulative dosing limited by hepatobiliary/urological toxicity
Pharmacokinetics
Onset
IV ~30 s; IM 3–5 min
Peak effect
IV ~1 min; IM ~5–15 min
Duration
IV anaesthesia 5–15 min; IM 15–30 min
Half-life
~2–3 h (alpha redistribution minutes)
Bioavailability
IM ~93%; oral ~16–20% (high first-pass; intranasal ~25–50%)
Protein binding
~12–47%
Metabolism
Hepatic CYP3A4/2B6 → active norketamine
Excretion
Renal (metabolites; little unchanged)
Contraindications
- Conditions where a marked rise in blood pressure is hazardous (severe uncontrolled hypertension, aneurysm, recent MI)
- Severe coronary/cardiac decompensation
- Eclampsia/pre-eclampsia (relative)
- Hypersensitivity to ketamine
- Caution: raised intracranial/intraocular pressure, active psychosis
Side effects
Common
Emergence phenomena (vivid dreams, hallucinations, delirium)Hypertension/tachycardiaHypersalivationNystagmus/diplopiaNausea/vomiting
Serious
- Severe emergence reactions/psychosis
- Laryngospasm, apnoea/respiratory depression (rapid IV, with other depressants)
- Severe hypertension/tachyarrhythmia, myocardial ischaemia
- Raised intracranial/intraocular pressure (debated)
- Ketamine-induced uropathy/cystitis and cholangiopathy (chronic/recreational use); dependence/abuse
Pregnancy & lactation
Pregnancy
Use only if clearly needed — limited data; neonatal depression if used at delivery; uterine tone effects
Lactation
Single peri-procedural dose — brief interruption sufficient; avoid repeated dosing (limited data)
Drug interactions
Isocarboxazid
Severe
Database
Clinical effect not specified
Source: DDInter
Cns Depressants
Severe
Database
Additive sedation/respiratory depression; prolonged recovery
Reduce doses; monitor airway/respiration
Source: Kimi deep-research + Cla
Levacetylmethadol
Severe
Database
Clinical effect not specified
Source: DDInter
Phenelzine
Severe
Database
Clinical effect not specified
Source: DDInter
Selegiline
Severe
Database
Clinical effect not specified
Source: DDInter
Sodium Oxybate
Severe
Database
Clinical effect not specified
Source: DDInter
Sympathomimetics
Severe
Database
Additive hypertension/tachyarrhythmia
Monitor BP/ECG; cautious titration
Source: Kimi deep-research + Cla
Tranylcypromine
Severe
Database
Clinical effect not specified
Source: DDInter
Diazepam
Moderate
Database
Prolongs ketamine effect/recovery (also used to reduce emergence reactions)
Dose-adjust; intended for emergence-phenomenon reduction
Source: Kimi deep-research + Cla
Haloperidol
Moderate
Database
QT prolongation
Monitor ECG.
Source: DDInter
1 additional low-confidence interaction hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about Ketamine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Katzung, BNF, Nelson·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19