Ketamine Use and Tinnitus
Introduction to Ketamine and Tinnitus
- Ketamine can potentially worsen tinnitus as a side effect, particularly when administered intravenously for pain management, according to the National Comprehensive Cancer Network guidelines 1
- The American College of Physicians and other medical societies should be aware that ketamine is a noncompetitive N-methyl D-aspartate (NMDA) receptor antagonist that blocks glutamate, which may influence auditory perception 1
Clinical Use of Ketamine
- The National Comprehensive Cancer Network guidelines note that ketamine is primarily used at sub-anesthetic doses for management of cancer pain that is refractory to other treatments and potential improvement in mood for individuals with depressive disorders 1
- Ketamine is typically administered at 0.5 mg/kg, but doses range from 0.1-0.75 mg/kg depending on individual response, although the optimal dose is not well established 1
Considerations for Patients with Tinnitus
- When considering ketamine use in patients with tinnitus or at risk for developing tinnitus, the route of administration matters, as intravenous administration may pose higher risks for side effects including potential auditory disturbances 1
- Patients with pre-existing tinnitus or at risk for developing it should be monitored for changes in tinnitus symptoms if ketamine is administered, and alternative analgesics or antidepressants should be considered if a patient reports worsening tinnitus with ketamine 2, 3
Potential Side Effects of Ketamine
- Ketamine can cause various sensory disturbances, including auditory effects, as part of its dissociative properties, and emergence reactions (floating sensations, vivid dreams, hallucinations, delirium) in 10-30% of adults 2, 3, 4
- Cardiovascular effects of ketamine include dose-dependent increases in heart rate, blood pressure, and cardiac output 3, 4
- Recovery agitation, particularly in patients with higher ASA status, is a potential side effect of ketamine 5