Oral Ketamine

What is ketamine and why have I been prescribed it?

Ketamine is an anaesthetic medication which is sometimes used to help control pain which has not responded to standard treatment.
Ketamine also has a reputation for being used illegally as a street drug.

At The Walton Centre, Ketamine is used to help with reduction of your opioid medication.

At very rare occasion Ketamine will be used for a short time where no other treatment has been successful. This is often to explore if a rotation to low dose methadone would be indicated.

How does ketamine work?

Ketamine works by blocking the action of a particular receptor in the spinal cord, which in turn reduces the amplification of pain messages sent to the brain.
Unfortunately, Ketamine does not always help to reduce pain. Some people find it does not work. If you find it does not work you should discuss this with your pain doctor or nurse so it can be stopped safely.

How do I take ketamine?

Ketamine will be provided as a liquid to be taken by mouth, usually four to six times a day Your doctor or nurse will tell you how much you should take. Initially this will be a low dose and you may be asked to increase over a period. The maximum dose should not be higher than 200mg per day.

You should continue to take your other medications, unless advised otherwise by your pain doctor or nurse.

Tell your doctor or nurse if you are taking anything which is not prescribed, i.e.. anything you buy yourself, over the counter or herbal treatments.
If you miss a dose, do not double up or try to make up for the dose you have missed. Wait until your next dose is due and skip the dose you have missed.

How should I store my ketamine?

You should store your Ketamine securely, in a cool place, out of direct sunlight and away from children or vulnerable adults.
Any unused Ketamine should be returned to the hospital pharmacy for safe disposal.

Are there any side effects from taking Ketamine?

No two people are the same and when taking Ketamine, people will often report different side effects.

These side effects typically include;

Commonly
• Tiredness
• Feeling unhappy or unwell
• Vivid dreams or nightmares
• Mood swings
• Hallucinations (seeing or hearing things that are not actually there)
• Increases in certain liver enzymes which can indicate liver damage (this often resolves when Ketamine is stopped).

Less commonly
• Increased blood pressure and a fast pulse
• Memory problems (with longer term use)
• Permanent bladder problems know as Ketamine Bladder

A blood test will be performed to check your liver function before starting Ketamine.
This will then be repeated after 2-4 weeks and then 3-monthly thereafter.
You may be asked to stop taking ketamine if you develop side effects or your blood results are not within normal range.
You should be able to stop taking Ketamine at any time, without needing to undertake weaning.

If you develop the following symptoms:;
• Pain on passing urine
• Blood in your urine
• Needing to pass urine more frequently

Please call your GP, or the pain clinic on 0151 556 3686 Monday to Friday 9.00am to 4.30pm.
For evenings, weekends and Bank Holidays call NHS 111.

How long can I take ketamine for?

At The Walton Centre, we use Ketamine to assist patients to reduce their opioid intake.

If you are not actively reducing your opioids you will not be prescribed Ketamine or you may be asked to stop using Ketamine.

We aim to continue Ketamine for no longer than 6 consecutive months; this is to reduce your risks of side effects.

How do I get another prescription of ketamine?

You will need to call Dr Frank’s secretary on 0151 556 3392. It is vital that you allow 5 working days for us to process your request.
You will need to come to the Out Patient department for a blood test if due and then collect your next prescription from the pharmacy.
One of the nurses may need to contact you to discuss your request before a prescription is issued.

Can I drink Alcohol?

It is not advised that you drink alcohol whilst using Ketamine. This can be hazardous as Ketamine can increase the effects of alcohol.

Can I drive?

Taking Ketamine does not automatically mean that you cannot drive, although you should use your common sense as it is your responsibility to ensure you are fit to drive.

The Drug Driving Law introduced in March 2015 states that you could be committing a driving offence driving with Ketamine in your system. unless you are;:
• Taking the medication as prescribed by your doctor or nurse
• AND your driving and judgement is not affected by your medication.

We can measure the blood level of ketamine which should be below 20mcg/l

Who should I contact if I have problems with my ketamine?

Monday to Friday 9am to 4.30pm contact the pain clinic on 0151 556 3686
Evenings, weekends and Bank Holidays please contact NHS111
or in an emergency please call 999.