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Chris Iginla
 Mar 17, 08 - 11:16 PM |
PO ketamine in neuropathic pain
PO ketamine in neuropathic pain -------------------------------------------------------------------------------- Hi all, I'm a clinical pharmacist working in an ambulatory cancer Pain & Symptom Control Clinic. We've been dealing with a pt for quite some time (chemo-induced neuropathy: main problem area is her feet) and went through the usual list of useful medications for neuropathic pain without success. We have started PO ketamine in the couple of weeks. Since she is elderly, we have started really low & tirating upwards very gradually. She is currently at 20 mg TID (increasing by 5mg q3d) - she has not had any adverse effects thus far and unfortunately little to no pain relief. Since we have exhausted most treatment options already, we are going to proceed to a 100 mg total daily dose and if no effect, then discontinue and look at what options we may have left. Anyone have experience with using PO ketamine for neuropathic pain? If so, what were the results (ie effectiveness, adverse effects, common doses used, etc.)? Other suggestions welcomed as well...about the only options we have yet to try are compounded neuropathic agents such as gabapentin, amitriptyline, etc (our Dr's seem to be reluctant to try these with lack of solid evidence, but I'll be pushing for a trial with these). All suggestions/comments welcomed! Thanks in advance |
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Dee
Mar 18th, 2008 - 5:59 PM |
Re: PO ketamine in neuropathic pain
Just a comment then as no one else has so far  I have no experience with oral ketamine but routinely use amitriptyline/gabapentin/pregabalin for neuropathic pain with good results. Why are your docs so opposed to these? Where are you based? |
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Simon Higgs
Mar 18th, 2008 - 10:01 PM |
Re: PO ketamine in neuropathic pain
I agree with Dee, I would use pregabalin or amitriptyline before ketamine. Ketamine has been discussed in other threads, may I suggest typing Ketamine into the search box. |
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Chris Iginla
Mar 19th, 2008 - 5:53 PM |
Re: PO ketamine in neuropathic pain
Thanks for the replies Dee & Simon, but the reason stated for this trial of oral ketamine is that the typical adjuvant options have been tried to no avail. The pt is currently on methadone and as stated we are titrating ketamine. |
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Simon Higgs
Apr 2nd, 2008 - 4:59 PM |
Re: PO ketamine in neuropathic pain
At a conference recently there was a speaker talking about the use of ketamine. What they advocated was trial of an intravenous dose first to see if it switched off the receptors and then they started oral if the IV worked, unfortunately I can't remember the dose they used. Sorry I can't be of anymore help. |
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