CPG No.

: PH /CPG/021 Issue date: 25 March 2020 Version: 1

Title: Ketamine FOR Depressive episode associated with major depressive

New■ Revised□ Renewal□
disorder (unipolar), treatment refractory (off-label use)

Effective date: 25 March 2020

Applicability: Medical Staff
Expiry date: 24 March 2022

 DOSE IV: 0.5 mg/kg twice weekly as an IV infusion;

 Administration: IV
administer over 40 minutes
According to the manufacturer, more rapid administration may result in respiratory depression and
enhanced pressor response.
administer over 40 minutes (Sanacora 2017).

 DURATION OF treatment:
up to 6 weeks has been studied.

 Preparation for Administration:

Diluent: NS or D5W.

The 50 mg/mL vials may be further diluted in D5W or NS to prepare a maintenance infusion with a
final concentration of 1 mg/mL (or 2 mg/mL in patients with fluid restrictions); mix well.
Do not mix with barbiturates or diazepam (precipitation may occur).

 warning:
High alert medication
Respiratory depression: Rapid IV administration or overdose may cause respiratory depression or
apnea. Resuscitative equipment should be available during use.

 Monitoring Parameters
Heart rate, blood pressure, respiratory rate, transcutaneous O2 saturation, emergence reactions; cardiac
function should be continuously monitored in patients with increased blood pressure or cardiac
decompensation, during infusion period.

 Advanced Practitioners Physical Assessment/Monitoring

Assess patient for history of airway complications, cardiovascular disease, CNS abnormalities, thyroid
disorders, or increased ocular pressure prior to use. Monitor cardio/respiratory status and CNS status
(when used for procedures monitor sedation score); cardiac monitor, pulse oximetry, blood pressure
monitor, and resuscitation equipment required. Monitor for emergence reactions.

 Disease-related concerns:
•Cardiovascular disease: Use with caution in patients with coronary artery disease, catecholamine
depletion, hypertension, and tachycardia.

 REF : (Sanacora 2017; Singh 2016)

Page|1
Ketamine Usage Guideline
 Page|2
Ketamine Usage Guideline