From the FDA Drug Label
Ketamine administration is associated with hepatobiliary dysfunction (most often a cholestatic pattern), with recurrent use (e.g., misuse/abuse or medically supervised unapproved indications). Biliary duct dilatation with or without evidence of biliary obstruction has also been reported with recurrent use. Obtain baseline LFTs, including alkaline phosphatase and gamma glutamyl transferase, in patients receiving ketamine as part of a treatment plan that utilizes recurrent dosing. Monitor those receiving recurrent ketamine at periodic intervals during treatment.
Ketamine can cause deranged Liver Function Tests (LFTs), particularly with recurrent use. This is associated with hepatobiliary dysfunction, which may manifest as a cholestatic pattern. It is recommended to obtain baseline LFTs and monitor patients receiving recurrent ketamine at periodic intervals during treatment 1.
From the Research
Yes, ketamine can cause deranged liver function tests (LFTs). The most recent and highest quality study, 2, published in 2020, reports two cases of substantial liver enzyme elevations less than 2 days after initiation of repeat ketamine infusion. This study highlights the importance of close monitoring of liver enzymes every 1 to 2 days during ketamine infusions.
Key Points
- Ketamine-induced liver injury is relatively uncommon but has been documented in both recreational users and patients receiving therapeutic doses.
- The pattern of liver injury typically shows elevated transaminases (ALT and AST), which may be accompanied by increases in alkaline phosphatase, gamma-glutamyl transferase (GGT), and occasionally bilirubin.
- Risk factors include high doses, prolonged use, and pre-existing liver conditions.
- For patients on ketamine therapy, regular monitoring of LFTs is recommended, especially during the initial treatment period.
- Liver abnormalities are often reversible with dose reduction or discontinuation of ketamine, as seen in the study by 3, where liver enzymes returned to reference values within 2 months after termination of ketamine infusion.
Recommendations
- Healthcare providers should obtain baseline LFTs before starting ketamine treatment and monitor periodically, particularly in patients with risk factors for liver disease or those on long-term therapy.
- Close monitoring of liver enzymes every 1 to 2 days during ketamine infusions is recommended, as suggested by 2.
- In cases of deranged LFTs, consideration should be given to dose reduction or discontinuation of ketamine, as well as further investigation for other biliary pathology, as seen in the study by 4.