The variety of administration routes and dosing protocols make Ketamine useful for analgesia in a palliative care setting. According to Family Practice News, Ketamine seems extremely effective in a variety of difficult pain syndromes that are commonly encountered in Hospice and palliative medicine. Also, the multiple administration methods make Ketamine a valuable weapon in the setting of refractory pain.
Ketamine is most commonly administered intravenously, orally, and subcutaneously, but it can also be administered sublingually, intranasally, and topically. Dr. Eric Prommer, director of palliative care at the Mayo Clinic Hospital in Scottsdale,AZ, said, “Ketamine is both water and lipid soluble. That’s the beauty of Ketamine: It’s what allows multiple routes of administration and generally reliable absorption.”
Ketamine is on the World Health Organization’s essential drug list for refractory cancer pain, but there is no agreement on the best protocol, dose, method of administration for optimal analgesia. At present, Ketamine is prescribed for pain in order to avoid escalation of opioid dosing. Because Ketamine is a NMDA antagonist, it works to reverse opioid tolerance. Unlike methadone, Ketamine has no major drug interactions that could affects its bioavailability.
Ketamine does have various side effects, including altered visuospatial perception, delirium, dizziness, altered hearing, tachycardia, hypertension, nausea, and vomiting. These mostly occurred with higher doses of intravenous administration, but were less frequent with oral doses.
Intravenous and oral doses are effective in controlling regular pain in palliative care, while the other methods are very effective in treating break through pain. Ketamine is currently used widely to tranquilize animals, and it is also a very popular party drug. The possibility for using Ketamine for palliative care shows a lot of promise.