Ketamine Dosing Across Clinical Indications: A Narrative Review Organized by Proposed NMDA-Related Mechanisms.
Level 5 - mechanism / opinion, no new human data
Narrative review organizing clinical practices around mechanism-based reasoning with no original human data or systematic synthesis.
PubMed 42324786 · doi:10.1002/jcph.70225
What was done
This narrative review analyzed clinical indications and dosing strategies for ketamine by grouping them according to proposed N-methyl-D-aspartate (NMDA) glutamate receptor mechanisms.
What was found
The abstract provides no empirical numbers or quantitative effect estimates. It categorizes ketamine indications into three dosing frameworks based on glutamatergic tone: single-bolus dosing for indications with normal glutamatergic tone (anesthesia, procedural sedation, acute pain); prolonged continuous infusion for states of glutamatergic overactivity (status epilepticus, status asthmaticus); and intermittent bolus dosing for conditions where NMDA antagonism promotes neuroplasticity (treatment-resistant depression, anxiety).
Why it matters
Organizing disparate clinical applications of ketamine by their underlying NMDA mechanisms helps explain why dosing and duration differ dramatically across medical specialties, and offers a rational framework for exploring novel indications.
Limits
As a narrative review, it lacks a systematic literature search, standardized study selection methodology, and meta-analytic synthesis. Specific numeric doses, treatment durations, and clinical efficacy metrics are not reported in the abstract. Proposed applications to emerging indications (such as eclampsia, anorexia nervosa, and functional neurological disorders) remain theoretical.
Cited by
- contradicts Ketamine acts as a competitive antagonist at the NMDA receptor.