[Ketamine use in outpatients: What can we learn from current practices?]

Area of Science:

• Pharmacology
• Pain Management
• Public Health

Background:

• Ketamine is recommended for intractable palliative or postoperative pain but is also used off-label outside hospitals.
• Limited data exist on outpatient ketamine use, prompting a study by the French Addictovigilance Network.
• Hospital pharmacies play a key role in dispensing ketamine for both inpatient and outpatient settings.

Purpose of the Study:

• To assess ketamine dispensations for outpatient administration from January to April 2019.
• To analyze the indications, administration frequencies, and routes for ketamine use outside hospital settings.
• To identify deviations from recommended ketamine use in pain management.

Main Methods:

• A survey of 65 hospital pharmacies regarding ketamine dispensations for outpatients.
• Data collection covered a 4-month period (January 1-April 30, 2019).
• Analysis of 1352 dispensations for 553 patients, focusing on indications and administration details.

Main Results:

• Ketamine was predominantly used for non-palliative care (86%), primarily for fibromyalgia (44%) and neuropathic pain (29%).
• Administration frequencies varied significantly, especially in non-palliative care, unlike the daily use in palliative situations.
• Subcutaneous and oral routes were common in non-palliative care, contrasting with intravenous use in palliative settings; large quantities were dispensed.

Conclusions:

• Current ketamine use for pain management largely disregards recommendations, with significant heterogeneity in practice.
• There is an urgent need for clear guidelines and information on off-label ketamine use due to potential psychiatric, urologic, and hepatologic complications.
• The study underscores the risks associated with unproven off-label ketamine applications.