We monitor the vital signs and mental/cognitive status of all clients before, during and after treatment. Blood pressure, pulse, and breathing always need to be monitored when using ketamine or esketamine.


Treatment with ketamine or esketamine always requires monitoring, and clients must be at baseline before discharge from care.  Once deemed to be back at baseline, clients will only be released to the supervision of another responsible adult.  Clients should not drive, use heavy machinery, or perform other potentially hazardous activities for 24 hours following ketamine or esketamine administration.


The most common side effects that may occur during ketamine or esketamine treatment are: dissociation, dizziness, nausea, vertigo, sedation, headache, loss of sense of taste, a feeling of body numbness, anxiety and lethargy.  Many clients experience a transient increase of blood pressure.  Our clinic is staffed and equipped to respond to those potential side-effects.


A COMPLETE list of possible side effects (reported per US FDA protocol) follows:


Allergic: anaphylaxis, breathing difficulties, facial, lip, throat and tongue swelling, hives


Cardiovascular: arrhythmias, blood pressure, is frequently elevated, bradycardia, hypotension, left ventricular dysfunction in patients with heart failure, respiratory and cardiac arrest


Gastrointestinal: anorexia, nausea, and vomiting


Muscular: muscle stiffness and spasms/tonic-clonic movements resembling seizures, enhanced skeletal muscle tone


Neurologic: confusion, seizures


Ophthalmologic: diplopia, increased intraocular pressure, nystagmus


Psychiatric: amnesia, anxiety, confusion, depression, disorientation, dysphoria, dissociative state (patients may not be able to speak or respond purposefully to verbal commands), emergence phenomena/delirium (6% to 12% in different studies and can last for up to 3 hours) including hallucinations, flashbacks, unusual thoughts, extreme fear, excitement, and irrational behavior, insomnia, physical and psychological dependence, addiction when used recreationally. (Drug dependence and tolerance may develop after prolonged use. Withdrawal symptoms may occur if stopping ketamine suddenly.)


Respiratory: apnea, increased laryngeal, and tracheal secretions, laryngospasm, airway obstruction in infants (may not be drug-related), respiratory depression


Skin: (infrequently) at the site of injection, local pain, and erythema, morbilliform rash