Oral ketamine is prescribed off-label, with physician follow-up. Its side effects belong to the same family as those of ketamine in other forms, and the safety data come from small trials with short follow-up. This article covers the risks we watch for, how we monitor them, and when we will say no.
Common effects during treatment
The effects reported most often are dissociation (feeling disconnected from yourself, your thoughts, your surroundings or time), sleepiness, and dizziness (Spravato leaflet; UIC review). In the Domany trial, euphoria and dizziness were more common with oral ketamine than with placebo (Domany 2019).
Blood pressure
Ketamine can raise blood pressure for some hours after a dose (Spravato leaflet). Because ketamine can raise blood pressure, we check it before treatment starts and do not start people whose blood pressure is not controlled.
Driving and daily activity
The UK patient leaflet for Spravato advises not to take part in driving or machinery until the next day after a restful sleep (Spravato leaflet). We give the same advice for oral ketamine, which is not licensed, and we ask you to arrange a safe ride home on treatment days.
Misuse, bladder and dependence
Ketamine has misuse potential, and it is a controlled substance (schedule III in the US, according to the UIC review). We ask about past and current substance use before prescribing. Bladder symptoms are the best-known harm of heavy use: in a 2022 review, lower urinary tract symptoms were common among recreational users, were linked to dose and frequency, and usually improved when use stopped (Anderson 2022). We ask about urinary symptoms at follow-up.
How we monitor treatment
- A physician review before the first prescription, covering your history, current medicines and safety.
- Clear written instructions on dosing, timing and what to do if you feel unwell.
- Scheduled follow-up to check mood, blood pressure, side effects and whether the treatment is still helping.
- A plan to stop or change treatment if it is not helping or is causing harm.
Who should not use it
- People with a history of psychosis, because the trials excluded people with psychotic symptoms (UIC review).
- People with uncontrolled high blood pressure or certain heart or brain conditions, which the Spravato leaflet flags for serious complications.
- People with a current substance use disorder, because the trials excluded substance use (UIC review).
- People who are pregnant or breastfeeding. Our physicians review each case before any prescription.
If you are in crisis
Ketamine does not replace crisis care. If you have thoughts of harming yourself, call or text 988 in the US to reach the 988 Suicide and Crisis Lifeline, available day and night. If you are in immediate danger, call 911.
What we do and do not do
We prescribe oral ketamine only after a physician review, with follow-up, and we say no when the risks outweigh the evidence for you.
We do not sell it as a shortcut, and it does not replace therapy, a diagnosis or crisis care.
Explore weight loss treatmentsSources
- 1.What evidence is available for oral ketamine in treatment-resistant major depressive disorder? UIC College of Pharmacy, 2022
- 2.Domany Y et al. Repeated oral ketamine for out-patient treatment of resistant depression: randomised, double-blind, placebo-controlled, proof-of-concept study. Br J Psychiatry, 2019
- 3.Spravato (esketamine) patient information leaflet Electronic Medicines Compendium (UK)
- 4.Ketamine-induced cystitis: a comprehensive review of the urologic effects of this psychoactive drug. Anderson DJ et al. Health Psychology Research, 2022
- 5.988 Suicide and Crisis Lifeline 988lifeline.org