PO ketamine in neuropathic pain

chrisiginla · Mar 17, 2008

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,
Chris

lobelsteve · Mar 17, 2008

chrisiginla said:
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,
Chris

Most of the aggressive young folks here will chime in and ask how her SCS trial went.

I think topical lidocaine/gabapentin/ketoprofen will be a wonderful option. I have little experience with PO ketamine (grew up passed the point when Special K was the drug du jour). I think you will titrate to side effects and declare it didn;t work.

I'd rather her try Dapsone before Ketamine.

NOSfan · Mar 17, 2008

CTX-induced neuropathy

Alpha-lipoic Acid (ALA), Topiramate, Methadone, Mexilitine.

You may also try other Sodium channel blockade medications (Cabamazepine or Phenytoin).

Tenesma · Mar 18, 2008

have had wonderful responses to intra-thecal bupivacaine/clonidine for chemo induced neuropathy... if the PO agents fail.

joshmir · Mar 18, 2008

I'm helping conduct a trial on intranasal ketamine

if anybody has pts w/ CA pain (or CA-related pain, ie strictures, chemo-induced neuropathy,etc) on high dose narcotics in the New England/NY state area, we can enroll them for free intranasal ketamine inhalers at BID in Boston...they take the inhalers home and use them as outpts to treat breakthough pain...no rewtrictions on other pain meds

in a nutshell, pts have loved it, with minimal, benign side effects

caveat: I cannot enroll them if they are having planned chemo, xrt, surgery, or BMT in the near future

PM me if you have a pt that may benefit from this

stim111 · Mar 27, 2008

There was a recent study in Pain Physician, I believe, that used oral ketamine for CRPS and but it was not found it to be helpful. I have a patient that underwent IV ketamine administered in an ICU for 2 days ( I do not know the doses) who had failed every intervention for CRPS and has been pain free for 11 months.

mille125 · Apr 22, 2008

stim111 said:
There was a recent study in Pain Physician, I believe, that used oral ketamine for CRPS and but it was not found it to be helpful. I have a patient that underwent IV ketamine administered in an ICU for 2 days ( I do not know the doses) who had failed every intervention for CRPS and has been pain free for 11 months.

IV ketamine and/or lidocaine infusion are commonly used for CRPS

PO ketamine in neuropathic pain

chrisiginla

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lobelsteve

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NOSfan

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Tenesma

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joshmir

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stim111

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mille125

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