Intranasal ketamine is approved for use in pediatric sedation (physician-administered) and will primarily be used in the pediatric ED. The injectable product is used and administered via an atomizer.

Ketamine was approved for use by ED physicians for analgesia at doses of 0.2-0.5 mg/kg IV push (max 50 mg). Medication to be administered IV push by a physician.

ICU Ketamine for Sedation (ketamine for continuous ICU sedation) PowerPlan is restricted to Critical Care/Pulmonology/Intensivists/Trauma.

Palliative Care may order low dose IVPB ketamine for analgesia in all areas. IM use (low dose for palliative care) on the floor is strongly discouraged due to operational concerns.

IM Ketamine:

*IM use [low dose (generally < 30 mg) ordered by palliative care] on the floor is allowed, but STRONGLY discouraged due to operational concerns.  If unavoidable, IM doses for non-emergent indications are dispensed from pharmacy. For IM doses to be drawn up in PSP, the pharmacist enters an order for ketamine 100 mg/mL Inj Soln 5 mL (PSP) or ketamine 10 mg/1 mL Inj Soln 5 mL (PSP) product depending on dose.

*IM doses for emergent or procedural indications (such as extreme agitation refractory to other interventions or procedural sedation) in ED, critical care areas, or procedural areas may be drawn up from the 500 mg/5 mL vial (pulled from Pyxis or delivered) by the nurse or provider.

Oral Ketamine: Some patients are now using oral ketamine (compounded product) at home for pain. If the home medication is continued in the hospital, the patient may use their own supply (requires secure storage via POCS process) or the injectable product may be dispensed for oral use (same dose). For the oral liquid, enter the order as ketamine 10 mg/mL ORAL Soln STOCK and the ordered dose will be pulled up in pharmacy and dispensed for the patient

Reviewed: February 28, 2012 (Intranasal Ketamine) and 23 June 2015 (ED use of ketamine IVP for analgesia), and Jan 2021 (Ketamine ICU sedation)

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