Oral ketamine may offer a solution to the ketamine conundrum

Megan Dutton; Adem T. Can; Jim Lagopoulos; Daniel F. Hermens

doi:10.1007/s00213-023-06480-x

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Oral ketamine may offer a solution to the ketamine conundrum

Journal article

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Peer reviewed

Oral ketamine may offer a solution to the ketamine conundrum

Megan Dutton, Adem T. Can, Jim Lagopoulos and Daniel F. Hermens

Psychopharmacology, Vol.240, pp.2483-2497

2023

DOI: https://doi.org/10.1007/s00213-023-06480-x

PMCID: PMC10640543

PMID: 37882811

Appears in Thompson Institute Research Collection

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Abstract

oral ketamine

norketamine

pharmocokinetics

bioavailability

efficacy

clinical use

Ketamine

Thompson Institute Special Collection

Ketamine has received considerable attention for its rapid and robust antidepressant response over the past decade. Current evidence, in clinical populations, predominantly relates to parenterally administered ketamine, which is reported to produce significant undesirable side effects, with additional concerns regarding long-term safety and abuse potential. Attempts to produce a similar drug to ketamine, without the psychotomimetic side effects, have proved elusive. Orally administered ketamine has a different pharmacological profile to parentally administered ketamine, suggesting it may be a viable alternative. Emerging evidence regarding the efficacy and tolerability of oral ketamine suggests that it may be a favourable route of administration, as it appears to obtain similarly beneficial treatment effects, but without the cost and medical resources required in parenteral dosing. The pharmacological effects may be due to the active metabolite norketamine, which has been found to be at substantially higher levels via oral dosing, most likely due to first-pass clearance. Despite bioavailability and peak plasma concentrations both being lower than when administered parenterally, evidence suggests that low-dose oral ketamine is clinically effective in treating pain. This may also be due to the actions of norketamine and therefore, its relevance to the mental health context is explored in this narrative review.

Details

Title: Oral ketamine may offer a solution to the ketamine conundrum
Authors: Megan Dutton (Corresponding Author) - University of the Sunshine Coast, Queensland, Thompson Institute
Adem T. Can (Author) - University of the Sunshine Coast, Queensland, Thompson Institute
Jim Lagopoulos (Author) - University of the Sunshine Coast, Queensland, Thompson Institute
Daniel F. Hermens (Author) - University of the Sunshine Coast, Queensland, Thompson Institute
Publication details: Psychopharmacology, Vol.240, pp.2483-2497
Publisher: Springer
Date published: 2023
DOI: 10.1007/s00213-023-06480-x
ISSN: 1432-2072
PMID: 37882811; PMC10640543
Copyright note: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Organisation Unit: Thompson Institute
Language: English
Record Identifier: 99975398502621
Output Type: Journal article

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