Name of the medicine:

Ketamine 50 mg/5ml oral solution, ketamine injection 50mg/ml, ketamine injection 10 mg/ml

The information given in this leaflet should be read along with any patient information leaflet provided by the manufacturer with your medicine. Click here

What is it for?

Ketamine is normally used as an anaesthetic for short operations, particularly in children, and for major depression.  In much smaller doses it can help to control nerve pain in palliative care. Ketamine may be used when this nerve pain has not responded to other treatments.

Most medicines available in the UK have a licence. The licence describes the conditions the medicine can be used to treat, and how the medicine can be given. The manufacturer of the medicine has to show that the medicine is safe and made to a high standard before the medicine is licenced.

The use of ketamine to help relieve pain by the oral (by mouth) or subcutaneous (by an injection under the skin) route is outside its licence. Medicines used in palliative care are quite often used in this way. There is experience and research to support the use of ketamine in this way. The person who prescribed your medicine will have carefully considered the benefits for you.

The information in this leaflet is not included in the information leaflet supplied with the medicine.

We are giving you this extra leaflet to tell you about the reason(s) why you are taking this medicine and to highlight other information. You should read both leaflets.

What form(s) of this medicine are there and how is it usually taken?

By Mouth

Ketamine is given as a liquid medicine by mouth, usually up to four times a day.

Ketamine can be prescribed as an oral solution in a bottle, but it is a specially made product so your local pharmacy may not be able to get it for you.

If this oral solution is not available, the ketamine injection solution may be used instead, and taken by mouth. You may either swallow it (oral) or place it under your tongue (sublingual).  Ketamine can have an unpleasant bitter taste.  Drinking fruit juice, squash or a similar soft drink after taking the medicine can help to disguise the taste.

By Injection

Ketamine can also be given by injection. If you need an injection this will be given by a doctor or nurse via a needle under your skin. A small device known as a Saf-T (thin plastic tube under the skin) will be placed into your skin. The injection will usually be given using this every time so that you do not feel a needle.

It may be given as injections four times a day, or as a continuous infusion under the skin over 24 hours. This is done using a small portable battery-operated pump known as a syringe pump. The ketamine dose that you need for 24 hours is in a syringe, which is then placed into the pump and is slowly pushed down a tube (called a line), through the Saf-T  and is absorbed into your bloodstream. A nurse will replace the syringe contents every day.

The syringe pump patient leaflet gives more information.

What are the most common side effects I might experience?

The dose of ketamine that you start with may be quite low to try to avoid side effects. The dose may be gradually increased to help relieve your nerve pain. It may take a period of time to get the dose right for your pain.  However, you may experience vivid dreams, nightmares, mood swings, hallucinations or agitation at the start of treatment or when the dose is increased.  If you experience these side effects, they can be helped by adding another medicine for a short period of time.  You should tell your doctor or nurse if you have any of these symptoms.

Ketamine may increase your blood pressure and heart rate.  Your doctor or nurse will monitor your blood pressure and pulse when you start treatment and possibly if the dose is increased. Your doctor may need to alter the dose of ketamine if they are concerned by any changes in your blood pressure or pulse.

Ketamine can sometimes cause problems with your urine. If you notice that you start to have frequent urine infections or have pain in your bladder (where urine is stored in your body), please let your doctor or nurse know.

Ketamine may cause skin irritation if it is given by a subcutaneous injection or pump.  Your nurse will check your skin at the site where the Saf-T (thin tube) is each day and change it if needed. If you notice any problems with the skin around the needle for example, pain, redness, or swelling, please let your doctor or nurse know.

What other information should I know about this medicine?

Please remember to order your repeat prescription with a few days spare, to allow it to be processed.

Ketamine oral solution is not kept in stock by most community pharmacies. It may take a few working days for your local pharmacist to obtain ketamine oral liquid. At least a few days before running out of ketamine, make sure you get a prescription from your GP and ask your local pharmacist to order more for you. This ensures that there are no gaps in you taking your medication. You or your representative may be asked to sign for collecting this medicine at the community pharmacy.

It is important not to order more medication than you need. Even if you return them to the pharmacy in future, they cannot be reused after they have been labelled for your use and must be disposed of.

Your medication needs to be kept in a safe place out of the reach of children.

It is important to store your medication in the original container.

Return ALL unused medication to a pharmacy.

If for any reason a medication is disposed of at home, it is important NOT to flush it down the toilet as this pollutes the water. Medication CAN be disposed of securely and safely in a general waste bin, ensuring that it cannot be accessed by children or animals.

Frequently asked questions

What do I do if I forget to take a regular dose of oral ketamine?

Take the dose as soon as you remember.  Do not take a double dose to make up for the missed one.  If you are sick (vomit) within 30 minutes of taking a dose, repeat the dose as soon as you feel better.  If you miss more than one dose through being unwell, contact your doctor or nurse.

How long will I need to take ketamine?

This will depend on why you were started on ketamine and how your pain responds to the treatment.  The palliative care specialist or your doctor will discuss this with you.

Can ketamine interfere with my other medicines?

You may need to have the dose of your other pain-relieving medicines reduced if the ketamine works well for your pain.  Signs that you may be on too high a dose of other strong painkillers that you may be taking like morphine, oxycodone or fentanyl are:

·       Feeling more sleepy than usual

·       Feeling sick more often

·       Restlessness or jumpiness

·       Agitation (feeling nervous or anxious)

·       Bad dreams.

If this happens contact your doctor or nurse.

Can I drive?

You should not drive after starting ketamine until you have discussed driving with your doctor. For further information, please refer to the information leaflet provided via the link:

https://www.gov.scot/publications/drug-driving-rules-promotional-material

Can I drink alcohol?

It is best to minimise alcohol consumption to avoid drowsiness.

Who should I phone if I need advice urgently about my ketamine?

You may be given a contact number for your local specialist palliative care service. If not, please telephone the hospice who advised you to take ketamine.

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