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In a press release sent on August 30, the ANSM insisted on recalling the proper use of ketamine, a drug narcotic indicated in anesthesia, which has been used for several years to manage stubborn pain in palliative care and chronic pain. Indeed, the psychotropic properties of ketamine mean that this substance is also used for non-medical use.

“We closely monitor the use of ketamine through the pharmacovigilance centers (CRPV) and the addictovigilance centers (CEIP). Serious complications following the administration of ketamine are still reported to us regularly, in a medical or non-medical setting (party or sexual use). These are serious damage to the liver, biliary and urological tracts. They most often result from prolonged and/or repeated use, which can also cause ketamine addiction.declares the National Agency for the Safety of Medicines and Health Products.

In a context of significant increase in the use of ketamine for several years, the ANSM wishes to recall the risks of ketamine and the precautions to be taken, in particular when it is used for a prolonged period for treat stubborn pain or chronicles.

Drugs containing ketamine are narcotic drugs. Their prescription is therefore limited to 28 days, written in full and on a secure prescription. These drugs are reserved for hospital use. They can also be administered by any doctor specializing in anaesthesia-resuscitation or emergency medicine when he intervenes in an emergency situation or within the framework of a mobile medical assistance structure or medical repatriation.

What are the effects of ketamine?

The CRPV and CEIP networks have observed an overall increase in the use of ketamine-based drugs, in prolonged use for the treatment of chronic pain (use outside of marketing authorisation, validated by recommendations), including fibromyalgia. An increase in the illegal consumption of ketamine, used as a party product or as part of chemsex, was also observed by CEIPs.

However, for both medical and non-medical purposes, prolonged and/or repeated use of ketamine causes risks of damage, often serious, to the liver and bile ducts (hepatitis, cholestasis or cholangitis) or urinary tract (non-infectious interstitial cystitis) with possible repercussions on the kidney (acute renal failure, hydronephrosis, etc.). Reports of medication errors due to confusion between the different dosages of ketamine-based drugs are regularly reported.

How to take ketamine?

When prescribing ketamine, in order to reduce the risk of hepatobiliary and uro-nephrological damage, we recommend that you:

• Respect the recommended dosages and do not prescribe or administer ketamine for a prolonged period
• Regularly monitor liver (transaminases, GGT, alkaline phosphatase and bilirubin) and kidney functions, as well as urine cytology
• Ask the patient to monitor the appearance of blood in the urine or pelvic pain, which are warning signs of urinary tract involvement and to consult their doctor if necessary
• Consider stopping treatment in the event of disturbance of the liver or uro-nephrological assessment, with the help of an addictologist if necessary.

To avoid medication errors due to confusion between the different dosages available when preparing the infusion solutions, we invite you to carefully read the information relating to the concentrations on the ampoules.

We remind you that the occurrence of hepatobiliary and/or uro-nephrological damage in the patient may be linked to repeated use of ketamine for festive or sexual purposes (chemsex practice). In this case, it is necessary to refer him to an addictologist.

In the case of home treatment, we invite you to remind the patient that he must return the unused ampoules to the hospital pharmacy or to the pharmacy, given the potential risk of abuse and misuse of the ketamine.