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What Is Ketamine? Medical Uses, Effects, and Risks Explained

Ketamine is an anesthetic, not an FDA-approved psychiatric medicine in the United States. Learn how its approved uses differ from esketamine and understand the effects and risks of acute and repeated use.
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Ketamine is a prescription anesthetic used in clinical care, especially for anesthesia. In the United States, ketamine injection is FDA-approved for anesthetic uses, not for psychiatric disorders. Ketamine may be prescribed off-label in some settings, but it is not the same medicine as esketamine nasal spray (SPRAVATO), which has specific FDA-approved depression indications and must be administered under restricted clinical supervision.

What ketamine is and what it is approved to treat

Ketamine hydrochloride is a dissociative anesthetic: it can reduce awareness of surroundings and the perception of pain while producing anesthesia. The U.S. prescribing information for KETALAR, revised October 2025, lists three anesthetic uses for ketamine injection:

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  • As the sole anesthetic for selected diagnostic or surgical procedures that do not require skeletal muscle relaxation.
  • To induce anesthesia before other general anesthetic agents are used.
  • As a supplement to other anesthetic agents.

The prescription injection is given intravenously or intramuscularly in clinical care. The label says it must be administered by or under the direction of physicians experienced in general anesthesia, with vital signs continuously monitored and emergency airway equipment immediately available. It states: “Continuously monitor vital signs in patients receiving KETALAR.”

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Ketamine, off-label treatment, and esketamine are different

FDA approval depends on the specific drug and product, not just a shared name. The FDA said in a 2023 safety communication that ketamine is not approved for psychiatric disorders. Clinicians may sometimes use ketamine off-label for pain or depression that has not responded to other medicines, as MedlinePlus notes; off-label use is not an FDA-approved psychiatric indication. Compounded ketamine products are also not FDA-approved, and FDA has not evaluated their safety, effectiveness, or quality before marketing.

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Item Drug and product U.S. indication described in the cited sources Setting and oversight
Ketamine injection (KETALAR) Ketamine hydrochloride injection Selected anesthetic uses in the U.S. label revised October 2025; psychiatric disorders are not an FDA-approved indication. Administered by or under the direction of anesthesia-experienced physicians, with continuous vital-sign monitoring and emergency airway equipment available. Source: KETALAR prescribing information, October 2025.
SPRAVATO Esketamine nasal spray, a separate prescription product FDA-approved for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior; the latter indication is used in conjunction with an oral antidepressant. Restricted through the SPRAVATO REMS and administered in certified healthcare settings, with at least two hours of monitoring. Source: FDA warning letter, June 23, 2026.

The FDA-approved esketamine product is not interchangeable with injectable ketamine or compounded ketamine nasal sprays. The shared association with ketamine does not make their approved indications, routes, evidence, or supervision requirements equivalent.

What ketamine can feel like and its immediate risks

During and after clinical anesthesia, ketamine can cause dissociation and emergence reactions. The KETALAR label also lists elevated blood pressure and pulse among its most common adverse reactions. Confusion may occur during recovery. These effects are one reason clinical use requires monitoring and trained staff.

Acute non-medical exposure can also involve detachment from reality, hallucinations, agitation, poor coordination, abnormal muscle movements, or reduced consciousness, according to the UK Advisory Council on the Misuse of Drugs (ACMD) review updated January 28, 2026. Severe intoxication may involve psychosis, changes in pulse or blood pressure, prolonged sedation with respiratory depression, or convulsions.

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The KETALAR label warns that respiratory depression can occur in overdose or if the drug is administered too rapidly. It also warns that combining ketamine with benzodiazepines, opioid pain medicines, alcohol, or other central nervous system depressants can cause profound sedation, respiratory depression, coma, or death. These risks are not a guide to self-treatment: ketamine should be used only under appropriate clinical direction.

Risks associated with repeated or heavy use

Risks linked to chronic or frequent non-medical use are different from the risks of a one-time, medically supervised anesthetic. The ACMD review associates longer-term use with dependence and harm to the bladder and upper urinary tract, abdomen, liver, and bile ducts. Reported urinary symptoms include urgency, pain, frequent urination, and blood in the urine.

  • Urinary symptoms: About a quarter of regular users reported at least one urinary symptom, according to the ACMD review, which cites Winstock and colleagues (2012).
  • Abdominal pain: The ACMD review reports chronic abdominal pain in more than a quarter of regular users.
  • Liver and bile-duct effects: About 10% of regular users have been reported to have cholestatic liver injury or chronic bile-duct dilation, as summarized by the ACMD review.

These estimates apply to regular users, not to all patients receiving ketamine in medical care. They also have limitations: UK cases of ketamine-related urinary and hepatobiliary complications are not routinely collected, so precise incidence is difficult to establish.

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The evidence on lasting cognitive and other neuropsychiatric effects is less conclusive than evidence for some physical harms. Observational studies cannot establish causality confidently. The ACMD review says the overall evidence suggests chronic, frequent and/or high-dose illicit use can damage neural circuits and impair cognitive functioning, but that does not mean cognitive harm is inevitable for every person exposed to ketamine.

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How common is non-medical use?

In the United Kingdom, 264,000 people aged 16–59 (0.8%) reported ketamine use in the previous year in 2024/2025, according to the Crime Survey for England and Wales as reported in the ACMD’s January 2026 review. This is a UK population estimate; it is not a measure of use among U.S. patients or of exposure in medical care.

When to discuss ketamine with a clinician

If ketamine or esketamine is being considered as treatment, ask the prescribing clinician which specific drug and product is involved, whether the proposed use is FDA-approved or off-label in the United States, and what monitoring and follow-up apply. Anyone experiencing concerning symptoms after ketamine exposure should seek prompt medical advice; severe breathing problems, loss of consciousness, or convulsions warrant emergency help.

This overview is general information, not an individual diagnosis or treatment recommendation. A qualified clinician can assess a person’s health, medications, and treatment options.

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