Safe Administration of Targin and Ketamine

Introduction to Combination Therapy

The combination of Targin (oxycodone/naloxone) and ketamine can be safely administered, but careful monitoring is required due to potential respiratory effects when combining these medications, as recommended by the American College of Emergency Physicians and the American Society of Anesthesiologists 1, 2, 3

Ketamine should be avoided in patients with ischemic heart disease, cerebrovascular disease, or hypertension, as it produces dose-dependent increases in heart rate, blood pressure, and cardiac output, and requires dose reduction in elderly patients due to altered pharmacokinetics, as recommended by the American Geriatrics Society and supported by the American Society of Anesthesiologists 1, 4, 5, 6
Ketamine produces a dose-dependent increase in heart rate, blood pressure, and cardiac output through stimulation of the sympathetic nervous system, causing elevation in systolic and diastolic blood pressure, and increasing cardiac output, but does not depress airway or cardiovascular reflexes, maintains respiratory drive at standard doses, and preserves protective airway reflexes better than benzodiazepine/opioid combinations 7, 1

Emergence reactions (floating sensations, vivid dreams, hallucinations) occur in 10-30% of adults when using ketamine, and can be mitigated by combining ketamine with midazolam, as recommended by the Gastroenterology society and the American Society of Anesthesiologists 1, 7, 8

Ketamine can be administered via IV (0.1-0.5 mg/kg titrated to effect) or IM (1-2 mg/kg if IV access unavailable), and the minimum effective dose should be used and titrated carefully, especially in elderly patients or those with underlying medical conditions, as recommended by the American Geriatrics Society and supported by the American Society of Anesthesiologists 3, 6, 1, 5
Naloxone should be readily available for reversal of opioid-induced respiratory depression when administering this combination, as recommended by the American College of Emergency Physicians and the American Society of Anesthesiologists 2

This combination may be particularly useful for procedural sedation and analgesia, as recognized by the American College of Emergency Physicians and the American Society of Anesthesiologists 2, 3, 5, 6
Continuous monitoring of vital signs is essential during ketamine administration, particularly in patients with underlying cardiovascular conditions or those at risk of respiratory depression, as emphasized by the medical community and the American Geriatrics Society 1, 5, 6
Ketamine is effective as an adjunct to opioids in acute and chronic pain management, helping to prevent or reduce opioid tolerance when administered at sub-anesthetic doses, as recognized by the American Society of Anesthesiologists 4, 9
Ketamine can be used for procedural sedation, particularly in emergency settings, and can be used cautiously for sedation during spinal anesthesia, especially in elderly patients, as recommended by the American Society of Anesthesiologists and the American Geriatrics Society 5, 6

Ketamine works primarily as an N-methyl-D-aspartate/glutamate receptor (NMDA) antagonist that interferes with the normal excitatory effects of glutamate and aspartate, and it also interacts with opioid receptors, which contributes to its analgesic properties, as noted by the American Society of Anesthesiologists 4
Ketamine has a rapid onset of 1 minute for IV administration with a short duration of 15-30 minutes, according to the Gastroenterology society and supported by the American Society of Anesthesiologists 1, 7