Repeated ketamine infusions do not cause hepatotoxicity reveals study

USA: The repeated infusions of ketamine treatment for pain and migraine does not increase a patient's risk for hepatotoxicity and adverse drug events, reveal results of a recent study presented at the 18th Annual Pain Medicine Meeting.

Ketamine is a common and effective treatment for acute and chronic pain conditions. Some previous research has shown it to be associated with hepatotoxicity and ADEs.

Andrew Mendelson, Thomas Jefferson University Hospital in Philadelphia, PA, and colleagues evaluated the impact of ketamine by designing a multicenter cohort study using patients admitted to Thomas Jefferson University Hospital and UVA Pain Management Center from 2014 through 2018.

For the study, the researchers retrospectively reviewed the records of 114 patients who had undergone either a single admission or multiple admissions for treatment of refractory headache or pain for five-day ketamine infusions, used off-label, at two institutions and compared the incidence of elevated liver function tests (LFTs) and psychomimetic ADEs between initial and repeated ketamine treatments.

Overall, the mean age of the study population was 46 years and 85 of the participants were female. Minimum time spent between ketamine infusion during the study was 8 weeks and the mean time between first and second infusions was 152 days.

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Key findings include:

• The mean maximum ketamine rate during admission was 0.70 mg/kg/h and elevated liver function tests at baseline were reported in 30.7% of total admissions.


• No statistically significant association were noted between elevated liver function tests and admission status (initial vs. repeat).


• No association were observed between the presence of hallucinations and vivid dreams and admission status.


• The patients who underwent repeated infusion had a lower incidence of nausea and vomiting than those undergoing a single admission.


• Patients who underwent repeated infusion also reported less sedation than patients with single admissions.

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“Given the overall high incidence of elevated liver function tests in this population, we recommend baseline and at least one additional set of liver function tests at the end of treatment to monitor for toxicity as well as follow-up for any patient with elevated liver function tests at the end of treatment,” investigators wrote.

This study, “A Multicenter Retrospective Study of Adverse Effects from Ketamine for Refractory Headache and CRPS,” will be presented on November 15, 2019, during the 18th Annual Pain Medicine Meeting in New Orleans, LA.