Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Expert Opin Drug Saf. 2022 Jan;21(1):83-94. doi: 10.1080/14740338.2021.1949454. Epub 2021 Jul 1.
Ketamine is a dissociative anesthetic that is currently considered for several new indications.
To deduce the safety of long-term ketamine treatment using the harm of heavy recreational (non-medical) ketamine use as a proxy for maximal possible harm of ketamine treatment.
Systematic literature review according to PRISMA guidelines to identify controlled studies on ketamine-related harm in heavy recreational ketamine users. Results were compared with serious adverse events (SAEs) in patients treated with ketamine according to three systematic reviews considering dosing regimen and cumulative dose.
The systematic search yielded 25 studies. Heavy recreational ketamine use can escalate to ketamine dependency and was often dose-dependently associated with other SAEs, including cognitive and mental disorders, and gastrointestinal and urinary tract symptoms, which disappeared upon marked reduction of ketamine use. Heavy ketamine users have a much higher cumulative exposure to ketamine than ketamine treated patients (>90 times), which may explain why SAEs in the clinical context are mostly mild and reversible and why ketamine dependence was not reported in these patients.
Treatment of patients with ketamine is not associated with ketamine dependency or SAEs. However, caution is needed since data on long-term clinical ketamine use with a long-term follow-up is lacking.
氯胺酮是一种分离性麻醉剂，目前被认为有几种新的适应证。
以重度娱乐性（非医疗）氯胺酮使用的危害为代表，推断长期氯胺酮治疗的安全性，即氯胺酮治疗可能造成的最大危害。
根据 PRISMA 指南进行系统文献回顾，以确定重度娱乐性氯胺酮使用者与氯胺酮相关危害的对照研究。将结果与根据三个考虑剂量方案和累积剂量的系统综述中接受氯胺酮治疗的患者的严重不良事件（SAE）进行比较。
系统搜索产生了 25 项研究。重度娱乐性氯胺酮使用可进展为氯胺酮依赖，且常与其他 SAE 呈剂量依赖性相关，包括认知和精神障碍以及胃肠道和尿路症状，这些症状在显著减少氯胺酮使用后消失。重度氯胺酮使用者的氯胺酮累积暴露量比接受氯胺酮治疗的患者高得多（>90 倍），这可能解释了为什么临床环境中的 SAE 大多为轻度和可逆的，以及为什么在这些患者中没有报告氯胺酮依赖。
氯胺酮治疗患者与氯胺酮依赖或 SAE 无关。然而，需要谨慎，因为缺乏长期临床使用氯胺酮并长期随访的数据。
