Background
- Phencyclidine (PCP) derivative
- Inhibits NMDA (N-methyl-d-aspartate) receptors
- Dose-dependent effects: low doses are primarily analgesic, while high doses cause dissociative anesthesia
- When used for management of acute pain, can be opioid-sparing
Dosing
- Analgesia1
- Intermittent: start at 0.1 mg/kg IV q4h, and titrate (max 0.35 mg/kg)
- Continuous infusion: start at 0.1 mg/kg/h IV infusion, and titrate (max 0.25 mg/kg/h)
- Dissociative anesthesia: ≥1 mg/kg
Hepatic Dosing
- Avoid in liver dysfunction
Safety
- Avoid in patients with psychosis, severe cardiovascular disease, or liver dysfunction
Adverse Effects
- Primarily dose-dependent, with nausea, vomiting, vivid dreams, hallucinations, and dissociation seen at high doses
Pregnancy
- Unclear safety in pregnancy
