Ketamine is classified as a dissociative anesthetic, meaning it can create a sense of detachment from one’s surroundings and physical body while maintaining consciousness. It is primarily used for pain relief, sedation during medical procedures, induction in patients with specific medical complications, and an emerging treatment for mental health conditions like treatment-resistant depression.[1][2]
Ketamine is also used recreationally, and taking too much ketamine can lead to sedation, hallucination, confusion, unconsciousness, dangerously slowed breathing, increased heart rate, high blood pressure, and, in extreme cases, respiratory depression, coma, or, in rare cases death.[3]
If someone is experiencing an altered mental state—such as confusion, disorientation, paranoia, slurred speech, trouble walking, reduced consciousness, difficulty breathing, or severe symptoms like seizures, unresponsiveness, or irregular heartbeats—call 911 or go to the nearest emergency room immediately. [3] For additional guidance, you can also contact the poison control center at 1-800-222-1222.
- Ketamine overdose occurs by exceeding therapeutic doses, often when mixed with other substances, leading to respiratory depression, seizures, and cardiac complications.
- Common interactions include alcohol, opioids, benzodiazepines, and stimulants, which amplify respiratory and cardiovascular risks.
- Treatment focuses on airway management, oxygen support, benzodiazepines for seizures, and close monitoring in a medical setting. No antidote is available.
Can you overdose on ketamine?
When ketamine is used or administered in excessive amounts, it can lead to overdose. Ketamine is administered in medical settings under supervision, with dosages calculated based on the patient’s specifics and the intended purpose (e.g., anesthesia or pain management).
However, even in these controlled environments, errors such as miscalculations, improper administration, or failure to account for individual factors (e.g., metabolism, concurrent medications, or pre-existing conditions) can lead to overdose.[4]
When ketamine is used recreationally, the risk of overdose is significantly higher due to unregulated dosing and other adulterants or impurities in the substance.[5] People who use ketamine usually take unregulated doses, sometimes exceeding safe doses to achieve dissociative or euphoric effects, overwhelming the body's ability to process the drug and leading to toxic accumulation in the system.
Also, the lack of medical supervision under these circumstances leads to adverse reactions not being promptly or accurately addressed, increasing the likelihood of severe outcomes because of overdose.[6]
Can you die from ketamine overdose?
Yes, it is possible to die from a ketamine overdose, though such cases are generally rare and involve other contributing factors. Deaths due to ketamine alone are uncommon. In a review of ketamine-related fatalities, most deaths involved multi-drug intoxications, suggesting ketamine's direct toxicity is relatively low compared to other substances.[7]
While rare, acute overdose can result in respiratory depression, cardiovascular collapse, or aspiration pneumonia, leading to death, especially at very high doses or when used with other sedatives.[8]
Many deaths from ketamine overdose involve recreational ketamine use in conjunction with substances like opioids, alcohol, or stimulants.[8]
Ketamine used in controlled medical settings (e.g., for anesthesia or depression treatment) is generally safe, with no reported deaths linked to therapeutic use in recent systematic reviews.[5]
Maximum recommended dose of ketamine
In a clinical setting, the following are the maximum safe dosages for different therapeutic uses:[3]
Anesthesia
- Intravenous (IV) induction: Maximum 4.5 mg/kg (though 2 mg/kg is standard).
- Intramuscular (IM) induction: Maximum 13 mg/kg for deep anesthesia.
Pain Management
- Continuous IV Infusion: Maximum 0.5 mg/kg/hour, adjusted based on response.
Depression Treatment (Resistant)
- IV Infusion: Maximum 1 mg/kg over 40 minutes.
These represent the upper limits for safe and effective use. Exceeding these doses increases the risk of severe adverse effects, including dissociation, cardiovascular (heart) instability, and respiratory(breathing) issues.
Ketamine overdose symptoms
The signs and symptoms of a ketamine overdose depend on how much ketamine someone uses, whether they’ve used any other drugs, and if the ketamine contains any adulterants.[3]
Symptoms of ketamine overdose include:
- Marked sedation and decreased level of consciousness
- Respiratory depression
- Apnea (periods where someone stops breathing)
- Excessive salivation
- Hypotension (low blood pressure)
- Bradycardia (slow heart rate)
- Irregular heartbeat/rate
- Cardiac arrest (heart suddenly stops beating)
- Seizures
- Stupor (nearly unconscious, minimal response)
- Coma
Ketamine toxicity and its dangers
Ketamine toxicity can occur at therapeutic or recreational doses, causing common symptoms such as hallucinations, nausea, and high blood pressure. It may also lead to long-term issues like bladder damage (ketamine bladder syndrome) or cognitive decline.
Overdose results from excessive consumption of the ketamine in a short time, leading to life-threatening symptoms. Toxicity is known to be less severe and may develop gradually; overdose is life-threatening and requires immediate attention. Both can involve hallucinations, cardiovascular changes, and cognitive impairment but differ in intensity and urgency.
Ketamine interactions that increase overdose risk
Ketamine is generally considered safe when used in controlled settings. However, it can interact with other substances that may increase the risk of overdose. Some key interactions that increase overdose risks include:[9][10][11][12][13][14]
- Central nervous system depressants: Alcohol, benzodiazepines (e.g., diazepam, lorazepam), opioids (e.g., morphine, fentanyl)
- Stimulants: Cocaine, methamphetamine, MDMA
- Anticholinergics and hallucinogens: Anticholinergic drugs (atropine, diphenhydramine) and other hallucinogens (e.g., LSD, psilocybin)
- Sedative Hypnotics: Non-benzodiazepine sleep aids or z-drugs. (e.g., zolpidem/Ambien)
- Other Anesthetics or Sedatives: Propofol, Nitrous Oxide (gas)
- Illicit drug combinations or polydrug use
To reduce harm, it’s essential to avoid mixing ketamine with other substances or drugs. Using ketamine exclusively in controlled settings—where factors such as environment, mental state, and dosage are carefully managed—can greatly mitigate risks.
Individuals with pre-existing respiratory or cardiovascular conditions should be particularly cautious, as these conditions can heighten vulnerability to adverse outcomes.
What to do in case of a ketamine overdose
In managing a ketamine overdose, it is crucial to stay with the person until medical help arrives, monitoring their breathing closely as respiratory depression is a common risk.
Handle the individual carefully, as ketamine can cause agitation or hallucinations, even during an overdose. While naloxone (Narcan) does not reverse ketamine's effects, it can be administered if opioid use is suspected alongside ketamine.
If someone shows signs and symptoms of ketamine overdose, the following are actionable advice to follow:[15][16][17]Â
The three H’s
- Hazards: Before approaching the person, ensure the area is safe for you and others. Remove any potential dangers (sharp objects, crowded spaces, etc.).
- Hello: Check for responsiveness by speaking to the person and gently tapping or rubbing their shoulder.
- Help: Call emergency services (911 or an ambulance) immediately, providing clear information about the situation.
If the person is unresponsive, follow ABC
Airway
- Make sure the airway is clear.
- Sweep the mouth gently with your finger to remove any obstructions, but only if you can see something blocking the airway.
- Position the person to keep the airway open, such as gently tilting the head back.
BreathingÂ
- Look, listen, and feel for signs of breathing.
- If the person isn’t breathing, provide two rescue breaths using a mouthpiece if available. Pinch their nose and breathe into their mouth, ensuring the chest rises.
- If you cannot give rescue breaths, continue chest compressions, which can help circulate oxygen in the blood.
CirculationÂ
- Check for a central pulse (on the neck or groin).
- If no pulse is detected, start chest compressions (CPR) immediately. Press hard and fast in the center of the chest at a rate of about 100-120 compressions per minute.
Is there a reversal agent for ketamine?
There are no medications approved by the U.S. Food and Drug Administration to treat a ketamine overdose, but certain medications can provide symptomatic management.[3]Â
Benzodiazepines such as lorazepam (Ativan) and diazepam (Valium) can alleviate agitation, psychomimetic effects (altered perceptions), high blood pressure, hyperthermia, and seizures.[3]Â
Ketamine overdose treatment
Ketamine overdose treatment primarily focuses on managing the symptoms rather than the direct reversal of ketamine's effects. Below are the vital elements of ketamine overdose treatment. [3]
- Immediate medical care: Severe cases may require airway management, oxygen supplementation, or intensive monitoring in a healthcare facility.
- Symptom management: Agitation or hallucinations are treated with benzodiazepines, while hypertension and tachycardia are managed using beta-blockers or calcium channel blockers if persistent and symptomatic. Seizures can be managed with benzodiazepines and anticonvulsants like phenytoin.
- Supportive measures: Vital signs are continuously monitored, IV fluids administered for hydration and blood pressure stabilization, and activated charcoal is considered for recent ingestion.
- Severe complications: Respiratory depression may necessitate intubation and mechanical ventilation.
- Psychiatric follow-up: After stabilization, patients may require evaluation for underlying substance use disorders or psychiatric conditions.
Preventing ketamine overdose
- Learn about ketamine's risks: Understand ketamine’s narrow safety margin and avoid mixing it with other substances.
- Use ketamine only under medical supervision: Stick to approved medical purposes and follow professional guidance.
- Incorporate harm reduction practices: Use drug testing kits, access safe consumption spaces, and follow safer use practices.
- Monitor each other: Stay alert for overdose signs in others and respond immediately if needed.
- Seek treatment support: Access resources for managing ketamine use disorder through addiction treatment programs.
- Avoid mixing substances: Never combine ketamine with alcohol, opioids, or sedatives to lower overdose risks.
Seeking help for ketamine abuse
Ketamine abuse involves the use of frequent, high doses beyond prescribed or safe limits. Ketamine can cause dissociation, hallucinations, and euphoria, making it appealing to users. However, prolonged misuse may lead to:[3]
- Urinary tract damage, bladder dysfunction, and liver toxicity.
- Memory loss, depression, and cognitive impairment.
- Strained relationships, financial problems, and isolation.
If you or a loved one is struggling with ketamine abuse, getting professional help can be difficult at first but necessary for a fulfilling life.
Rehabilitation programs tailored to substance abuse provide comprehensive support, including:
Finding the right rehab is the first step toward recovery.
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