Oral ketamine in hepatocellular carcinoma

Ketamine, an NMDA antagonist, has been used in pain treatment for a number of years. Recent reports have suggested its utility in a variety of pain states including post-herpetic neuralgia [1], cancer [2], and postoperative pain [5]. While a variety of neuropsychologic side effects are observed with parenteral ketamine, in oral use these side effects have been less pronounced [2,3]. We report a patient with severe hepatic disease who developed hallucinations following a 75-mg oral dose of ketamine for treatment of severe cancer pain unresponsive to morphine.