Ketamine: interactions

Ketamine enhances the effects of other drugs, including MDMA, amphetamine, methamphetamine, cocaine, nitrous oxide, and alcohol [1].

Co-use with depressants — alcohol, opioids, or benzodiazepines — significantly increases the risk of adverse effects [1].

Ketamine is commonly found together with MDMA, amphetamine, methamphetamine, cocaine, or carisoprodol, and turns up occasionally in polydrug MDMA tablets [2].

Ketamine is reported to be vulnerable to pharmacokinetic drug interactions because of extensive first-pass metabolism and poor oral bioavailability [3].

Deaths linked exclusively to ketamine are uncommon; where ketamine is involved in a death, other drugs or existing health conditions are usually also involved [1].

As with dissociatives generally, the severity of an overdose is reported to depend on the dose taken, the route used, and whether other substances are involved [4].

References

1. Ketamine: an updated review of use and harms (accessible) — UK Government (Advisory Council on the Misuse of Drugs)
2. Ketamine (drug fact sheet) — DEA Diversion Control Division
3. Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthesia and Pain Therapy — Clinical Pharmacokinetics (Springer)
4. Dissociatives: Dosage, Effects, Duration & Safety Guide — SubstanceWiki