Last update July 10, 2023

Ketamine Hydrochloride

Low Risk

Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

Ketamine is a fast-acting general anesthetic used for the induction of anesthesia, usually in combination with a muscle relaxant. Intravenous administration. It is also used as a recreational drug of abuse because of its dissociative effects orally, inhaled, intravenously, intramuscularly or rectally. (NIH 2023, Royo 2004)

Since the last update we have not found published data on its excretion in breastmilk.

It is excreted in breast milk in clinically insignificant amounts (Wolfson 2022).

Its low oral bioavailability minimizes the passage into infant plasma from ingested breast milk.

No problems have been seen in infants whose mothers were treated with ketamine. (Gilder 2021, Ortega 1999)

The use of S-ketamine or Ketamine as post-caesarean analgesia did not affect the duration of breastfeeding (Suppa 2012) and shortened the time to first breastfeeding. (Jaafarpour 2017)

t may be a cause of hallucinatory/psychotic reactions in the mother within the next 24 hours after usage: close follow-up is mandatory. (Pfizer 2020, Vallersnes 2016, Sandoz 2015, OMS 2003)

Several medical societies and expert authors consider the use of this medication possible during breastfeeding. (Howie 2006, WHO 2002)

Until more published data is known about this drug in relation to breastfeeding, known safer alternatives are preferable (Reece 2017), especially during the neonatal period and in the event of prematurity.

It should not be used as a drug of abuse during lactation. It is recommended to wait to breastfeed 15 hours (5 ½ T) after the last recreational use. There is no scientific evidence on the benefits and risks of microdosing of psychedelic/disociative drugs. (NIH 2023, Kaypak 2022, de Wit 2022, Szigeti 2021, Lea 2020, Kuypers 2019)


See below the information of this related product:

  • Esketamine Hydrochloride (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)

Alternatives

  • Dexmedetomidine Hydrochloride ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Etomidate ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Fentanyl ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Methohexital ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Propofol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Groups

Ketamine Hydrochloride belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Ketamine Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 17 %
Molecular weight 274 daltons
Protein Binding 54 %
VD 0.06 l/Kg
pKa 7.5 -
Tmax 0.03 hours
2.5 - 3.1 hours
Relative Dose 0.65 - 0.76 %

References

  1. NIH. National Institute on Drug Abuse Psychedelic and Dissociative Drugs. - 2023 Consulted on July 10, 2023 Full text (link to original source)
  2. Wolfson P, Cole R, Lynch K, Yun C, Wallach J, Andries J, Whippo M. The Pharmacokinetics of Ketamine in the Breast Milk of Lactating Women: Quantification of Ketamine and Metabolites. J Psychoactive Drugs. 2022 Jul 26:1-5. Abstract
  3. Kaypak AC, Raz A. Macrodosing to microdosing with psychedelics: Clinical, social, and cultural perspectives. Transcult Psychiatry. 2022 Oct;59(5):665-674. Abstract Full text (link to original source)
  4. de Wit H, Molla HM, Bershad A, Bremmer M, Lee R. Repeated low doses of LSD in healthy adults: A placebo-controlled, dose-response study. Addict Biol. 2022 Mar;27(2):e13143. Abstract Full text (link to original source)
  5. Szigeti B, Kartner L, Blemings A, Rosas F, Feilding A, Nutt DJ, Carhart-Harris RL, Erritzoe D. Self-blinding citizen science to explore psychedelic microdosing. Elife. 2021 Mar 2;10. pii: e62878. Abstract Full text (link to original source)
  6. Gilder ME, Tun NW, Carter A, Tan FFSL, Min AM, Eh H, Aye P, Carrara VI, Angkurawaranon C, McGready R. Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting. BMC Pregnancy Childbirth. 2021 Feb 9;21(1):121. Abstract Full text (link to original source)
  7. Lea T, Amada N, Jungaberle H, Schecke H, Klein M. Microdosing psychedelics: Motivations, subjective effects and harm reduction. Int J Drug Policy. 2020 Jan;75:102600. Abstract
  8. Pfizer. Ketamina. Ficha técnica. 2020 Full text (in our servers)
  9. Kuypers KP, Ng L, Erritzoe D, Knudsen GM, Nichols CD, Nichols DE, Pani L, Soula A, Nutt D. Microdosing psychedelics: More questions than answers? An overview and suggestions for future research. J Psychopharmacol. 2019 Sep;33(9):1039-1057. Abstract Full text (link to original source)
  10. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  11. Jaafarpour M, Vasigh A, Khajavikhan J, Khani A. Effect of Ketofol on Pain and Complication after Caesarean Delivery under Spinal Anaesthesia: A Randomized Double-blind Clinical Trial. J Clin Diagn Res. 2017 Mar;11(3):UC04-UC07. Abstract Full text (link to original source)
  12. Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I; Euro-DEN Research Group., Dargan PI. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry. 2016 Aug 18;16:293. Abstract Full text (link to original source)
  13. Sandoz. Ketamine. Drug Summary. 2015 Full text (in our servers)
  14. Suppa E, Valente A, Catarci S, Zanfini BA, Draisci G. A study of low-dose S-ketamine infusion as \preventive\ pain treatment for cesarean section with spinal anesthesia: benefits and side effects. Minerva Anestesiol. 2012 Jul;78(7):774-81. Abstract Full text (link to original source) Full text (in our servers)
  15. Howie WO, McMullen PC. Breastfeeding problems following anesthetic administration. J Perinat Educ. 2006 Abstract Full text (link to original source) Full text (in our servers)
  16. Royo-Isach J, Magrané M, Domingo M, Cortés B. La «keta» (ketamina): del fármaco a la droga de abuso. Clínica biopsicosocial del consumidor y algunas propuestas terapéuticas. ["Keta" (ketamine): from medication to drug abuse. Bio-psycho-social clinical profile of users and some therapy proposals]. Aten Primaria. 2004 Jul-Aug;34(3):147-51. Spanish. No abstract available. Abstract Full text (link to original source)
  17. OMS. Comité de Expertos de la OMS en Farmacodependencia. Examen crítico de psicofármacos. OMS. Serie de informes técnicos, 33 informe. 2003 Full text (in our servers)
  18. WHO Expert Committee on Drug Dependence. Critical review of psychoactive substances. WHO Technical Report Series. Thirty-third Report 2003 Full text (link to original source) Full text (in our servers)
  19. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Abstract Full text (link to original source) Full text (in our servers)
  20. Ortega D, Viviand X, Lorec AM, Gamerre M, Martin C, Bruguerolle B. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999 Abstract

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