Hello,
This is Dr Justin Yanuck MD and I’ve given myself 10 minutes to answer this patient question. This week’s question centers on how ketamine can help with chronic pain
Question: “What are the side-effects of ketamine?”
This is by far the most common question I get. It’s absolutely a fair question. Anytime you take a medicine you should know the possible side-effects. The unique thing with ketamine though, is it is a very dose dependent medicine, so at high doses it is used for anesthesia, and lower doses for mental health. While the side-effects aren’t intrinsically linked to dose, clinically they appear most often to manifest that way. So, with that said, I will speak to the common side-effects I see in the ketamine clinic. In my years running Renew Ketamine Infusion the most common side-effect I see is nausea.
The nausea tends to be quite mild, but for those with predisposition to nausea, or for those who get motion sickness easily, it tends to be more notable. With that said, we give everyone anti-nausea medicine before each treatment (whether it is IV ketamine or nasal spray ketamine-Spravato) and after the first treatment if they have no nausea, we will hold off on the anti-nausea medicine for next time. We use odansetron (Zofran), it has a side-effect of constipation, which is another side-effect of ketamine, but I suspect most of the constipation we see with ketamine is secondary to the Zofran used with each treatment, rather than the ketamine itself. It is quite rare to see severe constipation, and it is almost always in those with a history of constipation and those who are getting Zofran with the ketamine.
It is VERY RARE for the nausea to be limiting, most patients have no nausea, and when they do, it is often quite mild. If it is severe, we have other medicines we can give, and we encourage patients to come into the clinic well hydrated, to get a meal in (4-hours before treatment), as dehydration and hunger can increase nausea independently. Lastly, we encourage patients to keep their eye mask on until the very end if they are feeling nauseous. This is because there is a disconnect between what we see and what our head is feeling while under ketamine and this disconnect can heighten the nausea. This trick of keeping the eye mask on for a few more minutes has saved many patients from vomiting. We have maybe had 2 patients ever throw up in our clinic…just for perspective how mild it usually is.
The next most common side-effect we see is headache. It’s less than 10% of patients, only lasts that day, and responds very well to Tylenol. Of course, if the headache is the worst headache of your life, sudden in onset, or neuro symptoms such as weakness or vision changes we recommend seeking medical care immediately, but that has never been the case to date. It’s a mild transient headache and goes away with Tylenol. For those with migraines, it doesn’t tend to make them worse, but something to watch out for and prepare for.
Next up we see “brain-fog.” Patients will often report feeling slower in their processing speeds for talking or thinking. This makes sense mechanistically as our brains which are optimized by these fixed neural tracts to say and think the same thing and respond quickly, all of a sudden have this massive expansion of neural networks (which is how this medicine works!!) but also can lead temporarily, a day at most, to slower recall and processing. This is rarely impactful for people. We have professionals working the day after treatments just fine, but we recommend that on the day of treatment, to have little to no work obligations after the treatment is done. Many people do not notice this, but those that do often get concerned it will be like this forever. It won’t, and it’s also a good sign your brain is responding to this medicine!
Bladder pain (inflammatory interstitial cystitis). It’s rare, VERY rare, and something we have only seen twice, and both times it’s unclear if the ketamine was the cause. A metabolite of ketamine can irritate the bladder as it’s eliminated from the body. This is typically only seen with recreational ketamine use, daily, high doses, or with very high dose IV for days (in the hospital). In the outpatient setting, such as at the Renew Ketamine Infusion clinic, the doses are just so low and so infrequent, at most twice weekly, that we don’t see this. For those with bladder problems to begin with, we encourage hydrating well both before and after treatment and focusing on eliminating urine multiple times the few hours after treatment so the metabolite of ketamine is not sitting in the bladder, rather it’s immediately eliminated.
Ok these are the side-effects we have seen. Now there are many more side-effects that are outlier cases, and our job during the intake is to ensure that the risk of these outlier cases is mitigated. For example, ketamine has some transient properties where it can increase the heart rate and blood pressure. For those with underlying cardiac disease, we just need to be extra careful to mitigate that risk with premedication’s if needed, but also cardiologist clearance, or possibly not to proceed with ketamine therapy at all if too high risk. Our job is to reduce the risk of these outlier side-effects to near zero. A majority of that risk reduction comes with careful pre-screening to make sure you are safe to enter our clinic and receive treatment, and this is done via an extensive consultation where we ask a series of questions to assess these risk factors.
Ok, my 10 minutes are up. Hope that was helpful, as always, reach out anytime with questions, I’m happy to answer all questions regarding ketamine. You can reach me at info@renewketamineinfusion.com or book a free consultation at renewketamineinfusion.com
Cheers,
Dr. Justin Yanuck, MD
Renew Ketamine Infusion
Tustin, San Juan Capistrano, Seal Beach
