118 PCN Ketamine Notes

Sub-anesthetic (off-label) uses for pain management

• MNDA channel blockade – involved in central (dorsal horn) sensitization
• Consider for: neuropathic pain
  • opioid-induced hyperalgesia (opioid alternative)
• Continuous IV infusion: 0.05-0.3 mg/kg/hr
• PO Ketamine:
  • liquid – dilute to 50 mg/ml
  • start 10-25 mg tid to qid, titrate in steps of 10-25 mg
  • usual effective dose 100-300 mg/day