Do not use in animals with pre-existing hepatic or renal pathology.
Do not use in animals with severe cardiac de-compensation or with apparent high blood pressure or glaucoma.
Do not reverse ketamine combinations in dogs with atipamezole.
Do not use ketamine as a sole agent in dogs or horses.
Do not use in animals with eclampsia or pre-eclampsia.
Do not use for surgical intervention on the pharynx, larynx, trachea or bronchial tree, if sufficient relaxation is not ensured by administration of a muscle relaxant (intubation obligatory).
Do not use in cases of hypersensitivity to the active substance or to and of the excipients.
For very painful and major surgical interventions, as well as for maintenance of anaesthesia, a combination with injectable or inhalation anaesthetics is necessary.
For surgical and diagnostic procedures requiring muscle relaxation, the concomitant use of muscle-relaxants is necessary.
For improvement of anaesthesia or prolongation of effect ketamine can be combined with α2-receptor-agonists, anaesthetics, neuroleptanalgesics, tranquilizers and inhalational anaesthetic agents.
It is generally accepted as good anaesthetic practice to fast animals for a period prior to anaesthesia where possible.
Induction and recovery should be allowed to occur in quiet and calm surroundings.
A small proportion of animals have been reported to be unresponsive to ketamine as an anaesthetic agent at normal dosages.
Use of premedicants should be followed by a suitable reduction in dosage.
Atropine premedication may reduce salivation in cats. Since use of atropine with alpha‑2-agonists, which are often administered with ketamine, may increase arterial blood pressure, heart rate and the incidence of arrhythmias, atropine premedication should only be used according to a benefit-risk assessment by the responsible veterinarian.
Muscular twitching and tonic convulsions have been reported in the cat at recommended dose rates. These subside spontaneously but may be prevented by use of xylazine premedication, or controlled by use of ultra-short acting barbiturates in low doses.
In the cat and dog, the eyes remain open and the pupils dilated. The eyes may be protected by covering with a damp gauze swab or using appropriate ointments.
Ketamine may exhibit pro-convulsant and anti-convulsant properties, and therefore should be used with care in patients with seizure disorders.
Ketamine may increase intracranial pressure and therefore, may not be suitable for patients with cerebrovascular insults.
Ketamine should be used with caution when pulmonary disease is present or suspected.
Muscle relaxation is not achieved with ketamine alone.
When used in combination with other products, consult the contra-indications and warnings that appear on the relevant data sheets.
Use of the product has not been assessed during pregnancy and lactation.
Due to transfer of ketamine across the placental barrier, foetal anaesthesia and respiratory depression in neonates may occur.
Use only according to the benefit/risk assessment by the responsible veterinarian.
Care should be taken when using ketamine-halothane combinations since the half-life of ketamine is prolonged. Neuroleptanalgesics, tranquilizers, morphine analogues and chloramphenicol potentiate ketamine anaesthesia. Barbiturates and opiates can prolong the recovery period.
Due to a chemical incompatibility, do not mix barbiturates or diazepam with ketamine in the same syringe. Do not mix with any other veterinary medicinal product.
In the absence of compatibility studies, this veterinary medicinal product must not be mixed with other veterinary medicinal products.
Dogs:
Very rare (<1 animal / 10,000 animals treated, including isolated reports) | mydriasis1 nystagmus1 muscle tremor (twitching) convulsion (tonic) injection site pain hypertension tachycardia ataxia2 excitation2 hypersensitivity to stimuli2 respiratory depression3 |
1 The eyes also remain open.
2 Emergence reactions; may occur during recovery.
3 Dose-dependent; when given too rapidly or in excessive doses, significant respiratory depression may occur.
Cats:
Very rare (<1 animal / 10,000 animals treated, including isolated reports) | mydriasis1 nystagmus1 hypersalivation2 muscle tremor (twitching) convulsion (tonic) injection site pain hypertension tachycardia ataxia3 excitation3 hypersensitivity to stimuli3 respiratory depression4 |
1 The eyes also remain open.
2 Atropine premedication may reduce this side effect.
3 Emergence reactions; may occur during recovery.
4 Dose-dependent; when given too rapidly or in excessive doses, significant respiratory depression may occur.
Horses:
Very rare (<1 animal / 10,000 animals treated, including isolated reports) | injection site pain hypertension tachycardia ataxia1 excitation1 hypersensitivity to stimuli1 respiratory depression2 |
1 Emergence reactions; may occur during recovery.
2 Dose-dependent; when given too rapidly or in excessive doses, significant respiratory depression may occur.
Reporting adverse events is important. It allows continuous safety monitoring of a veterinary medicinal product. Reports should be sent, preferably via a veterinarian, to either the marketing authorisation holder or its local representative or the national competent authority via the national reporting system. See also section 16 of the package leaflet for respective contact details.
Overdose of ketamine may result in CNS effects (e.g. seizures), apnoea, arrhythmia and dysphagia.
Respiratory depression may occur following administration of high doses of ketamine.
If necessary, suitable artificial aids to maintain ventilation and cardiac output should be used until sufficient detoxification has taken place to enable a return to adequate spontaneous ventilation and cardiac activity. Pharmacological cardiac stimulants are not recommended, unless no other supportive measures are available.
Withdrawal period
Horses:
Meat and offal:1 day
Milk:24 hours.
User warnings
This is a potent drug. Particular care should be taken to avoid accidental self-administration.
Preferably use a guarded needle until the moment of injection.
People with known hypersensitivity to ketamine or the excipients should avoid contact with the veterinary medicinal product.
Avoid contact with the skin and eyes. Wash any splashes from skin and eyes immediately with large amounts of water.
In case of accidental self-injection, or if symptoms occur after ocular/oral contact, seek medical advice immediately and show the package leaflet or the label to the physician, but DO NOT DRIVE.
Adverse effects on the foetus cannot be excluded. The veterinary medicinal product should not be administered by pregnant women.
Advice to doctors:
Do not leave patient unattended. Maintain airways and give symptomatic and supportive treatment.