IV Ketamine Info

Ketamine Infusion Information
Information gathered by Barby Ingle, Power of Pain Foundation and based on her treatments as well as many other patients.

 Pre K-Infusion

1. Testing
   1. Laboratory
   2. Cardiac
   3. Psychological evaluation
2. Even with NO significant adverse events, administering doctors have been extremely cautious in screening patients with concurrent medical problems
3. Most common reason a patient is eliminated is psychiatric history of note (apart from the depression due to chronic pain) and cardiopulmonary disease

Hospital-based infusions – Five-day in-patient stay

1. An intravenous (iv) line is inserted and the patient
   1.  Dosing starts at 20mg of Ketamine per hour, which is increased by 5mg increments to a maximum of 40mg per hour
   2.  Clonidine, 0.1 mg (per FDA)
   3.  Lorazepam (Ativan®), 1-to-2 mg, for any dysphoria or hallucinations
   4.  Other medications are utilized to treat such problems as nausea and vomiting, headache etc.
2. Adverse events that are most common are fatigue, short term hallucinations (disappear within an hour of lowering the dosage.)
3. The accumulated data over three years has heretofore shown no significant lasting adverse events.
4. Dr. Schwartzman and Philip Getson, D.O. have treated more than 100 patients as of 2006. They had one patient with bradycardia in which the 5-day infusion was terminated

Outpatient protocol –10 day outpatient care

1. Alternatively, the patients are given therapy only on an outpatient basis
2. 10 daily treatments initially in two consecutive weeks in an outpatient infusion suite
   1. 70 mg-to-200 mg of Ketamine per day in titrating doses over the 10-day timeframe and then they are placed in the outpatient booster program as described below
   2. Most patients are given 2 mg of midazolam and sleep through the procedure
   3. Other medications are given as needed for side effects such as nausea and headache
3. Again, there have been few adverse events and most of them have been dosage related
4. As before, the most common is fatigue on the day of the infusion
5. There have been NO long term side effects

Booster Protocol

1. Following discharge from the hospital or 10 day outpatient care, patients enroll in an outpatient infusion booster program
   1. The booster program consists of two outpatient treatments a week every other week for one month, then two treatment one month later, then two treatments at three months.
   2. Outpatient visits are then monthly, or at 3-month intervals, depending on the patient.
   3. This protocol is merely a general guideline however and varies at times.

Results

1. The results obtained so far have been promising
   1. Outcomes are measured using pain scales, physical exams, psychological profiles, and activity increase
   2. Rough estimates show approximately 85% of those undergoing the hospital stay protocol have improvement measured by increased activity, reduction of medication, and improved lifestyles.
      1. For example, some have discarded wheelchairs, walkers, and canes, and others have increased activities or have returned to work.
   3. Those beginning with outpatient therapy have similarly improved, but to a lesser degree (approximately 60% to 70%).
2. All patients receive the follow-up outpatient boosters.
3. The one major problem with Ketamine infusion therapy is the inability to “hold” the improvement achieved by the five-day inpatient or 10-day outpatient regimen.
   1. Without the infusion boosters, the patients almost universally return to their pre-treatment state. It is therefore necessary to combine the initial start-up therapy on an inpatient or outpatient basis with follow-up boosters in order to maintain the level of pain relief
4. Virtually all participants in the program have continued the out-patient Ketamine infusions
   1. None of the patients treated by Dr. Schwartzman and Dr. Philip Getson, D.O. have discontinued due to side effects.
5. Studies are currently ongoing to combine other drugs on an outpatient basis with Ketamine to try lifestyle change and dietary adjustment are all being stressed as improvement is noted. The use of nutritional support vitamins, neutriceuticals, and counseling is also under review.
6. Most patients get sustained relief for 4 to 6 months. Some have been fortunate enough to get a longer term benefit.
7. Certainly the drug is not for everyone—approximately 20% of people show little to no improvement. However, some have benefitted dramatically.
8. For now, however, we at least appear to be heading in a positive direction, helping many individuals who, up to this point in time, have received no or little benefit from the more “conventional” treatment modalities.

Resources: Philip Getson, D.O. is a Board Certified Family Practitioner and an Associate Professor of Neurology at the Drexel University College of Medicine in Philadelphia. He can be reached at 856-983-7246 or PGetson@aol.com.