Q: What are the potential side effects of ketamine? Is it safe?
A: Ketamine is on the World Health Organization’s List of Essential Medicines, which lists the most efficacious, safe and cost-effective medicines for priority conditions, indicating a favorable safety profile. Patients screened for oral KAP must meet a minimum set of safety criteria with clearly-outlined contraindications that preclude treatment.
Before KAP, vital signs are taken by the patient to ensure blood pressure and heart rate are within designated ranges. Vital signs are taken again at the end of their KAP dosing session to monitor any changes. For patient safety, please record patient vitals in the Journey Clinical Portal charting and ensure that they do not proceed with KAP if their blood pressure or heart rate are not within the safety parameters given by their prescriber. Documentation of vitals, even when within the normal range, is important for preventing delays in care so please remember to chart the KAP session once completed.
The most common side effects associated with ketamine are nausea, vomiting, dizziness, diplopia, drowsiness, dysphoria, and confusion. Because ketamine can elicit dissociation, patients are prohibited from driving and are recommended for escort back home following treatment. If using an escort is not possible, the patient must sign a clearance form to leave via walking or taking public transportation.
In order to minimize the chances of nausea and vomiting, it’s best to always encourage patients to avoid swallowing Ketamine. Patients may take tums, or zofran if they're prescribed an antiemetic, before their KAP dosing session if they're concerned about the possibility of nausea or vomiting. Instructions are provided to patients to limit food and caffeine intake prior to their dosing session.
Q: Does Ketamine Cause Urinary Issues or Cystitis?
A: Ketamine cystitis (or ketamine bladder syndrome) is a fairly new reported side effect to Ketamine use, first documented in 2007. This is usually a concern for excessive and prolonged recreational abuse of ketamine. For patients with a current or history of cystitis or other urinary and bladder-related issues, ketamine may worsen symptoms, so the medical team may consider a medical clearance while weighing the risks and benefits of treating these patients.
Q: How can I help a client who experiences nausea or vomiting after or during KAP?
A: The best thing to prevent nausea and vomiting is to instruct and remind patients to avoid swallowing the medication/saliva during swish and spit. Ahead of time, patients are instructed to have light meals before their appointment, and to avoid unnecessary medications or caffeine. Clients may also take Tums before their KAP dosing session if they're prone to nausea or vomiting.
If a client experiences nausea or vomiting during or after a session, we would recommend comfort measures such as following the BRAT diet, staying hydrated with water and electrolytes, and following up with their PCP or urgent care for worsening symptoms. Some clients may be prescribed zofran to have on hand in case nausea or vomiting occurs. The medical team will review the clients' full medication regimen and consider risks/benefits before prescribing. If a client has zofran, they may opt to take one tablet 30 minutes prior to dosing, and have it nearby in case they want to take a second tablet after the consultation if they experience any symptoms. Our protocol is designed to minimize the likelihood of unwanted effects including nausea or vomiting.
Q: What should I do if my client's vitals are higher than the safety parameters listed on their instuctions?
A: If your client's blood pressure or heart rate are out of range before KAP dosing, we recommend instructing them to rest for a few minutes and use breathing and relaxation techniques before asking them to re-take their vitals twice consecutively.
To obtain the most accurate reading, clients should avoid speaking, chewing, or moving while their vitals are being measured. Ensure that the blood pressure cuff is at heart level (they may need to elevate their arm with a pillow) and that their feet are flat on the floor without crossing their legs.
Pre-KAP re-check: On the first re-check, if the results are within a normal range, they should administer one more set of vitals to validate the normal result. If the results remain normal, you may proceed with KAP, and you should document the vitals in the Journey Clinical Portal. If either of the re-checks remains out of range, do not proceed with KAP. We recommend that the client seeks medical attention from their Primary Care Provider or Urgent Care to address their elevated vital signs if they remain elevated. For their safety, if vitals are abnormal clients may not continue with KAP until they consistently have pre-KAP vitals that are under the threshold. Thank you.
Post-KAP re-check: You should instruct the client to relax for several minutes and check the vitals again. If the vitals do not decrease to the recommended range after 60 minutes of rest and they are having symptoms such as headache, flushing, chest pain, shortness of breath, or distress, they should go to Urgent Care or an Emergency Department for medical evaluation.
If they are NOT having symptoms, we ask that they continue to take their vitals at home until they return to lower than the parameters, and relay all of the vitals to you to document in the KAP session notes for the medical team. If their vitals are still not below the parameters after 4 hours of monitoring, we recommend the patient goes to an Urgent Care or Emergency Department for medical evaluation.
If their vitals are elevated for >1 hour WITH symptoms or >4 hours WITHOUT symptoms, we ask that they seek immediate medical attention and refrain from continuing KAP until their Journey Clinical Prescriber has been able to discuss this situation with the client. Please complete the Adverse Events Form in the Help section of the Portal to report this occurence once it's safe to do so. The prescriber may require additional tests or collaboration with the patient's medical team before they can resume KAP for their safety. We appreciate your cooperation and attention to this necessary safety measure.