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Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.

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Drugs and Lactation Database (LactMed) [Internet].

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Ketamine

Last Revision: February 15, 2021.

Estimated reading time: 2 minutes

CASRN: 6740-88-1

image 134987353 in the ncbi pubchem database

Drug Levels and Effects

Summary of Use during Lactation

Breastmilk levels of ketamine have not been measured after administration to humans. Minimal data indicated that ketamine use in nursing mothers may not affect the breastfed infant or lactation. Until more data are available, ketamine should only be used in low doses with careful monitoring for sedation and poor feeding during breastfeeding. Alternate agents are preferred.[1,2]

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Four mothers who received epidural analgesia with lidocaine and bupivacaine for cesarean section also received general anesthesia with ketamine and midazolam (dosages not specified). Their infants were either breastfed or received their mother's breastmilk by bottle. No adverse effects were reported in the infants.[3]

A retrospective chart review of 298 mothers and infants born at 37 weeks or beyond was conducted to determine the effects of ketamine and diazepam on breastfed infants after maternal tubal ligation surgery. Surgery occurred on a median of day 2 (range 1 to 6) postpartum. Most infants were fully breastfed, with breastfeeding resumed 2 to 4 hours after the procedure. No differences were found in weight loss or phototherapy requirements of infants whose mothers received low dose (<1.16 mg/kg) and high dose (1.16 mg/kg or more) ketamine.[4]

Effects on Lactation and Breastmilk

A pregnant woman sustained 28% body surface area burns near term. She underwent an emergency cesarean section on her due date under ketamine anesthesia. Although the infant required vigorous resuscitation, the infant began breastfeeding immediately. The infant had transient jaundice that resolved in a few days.[5]

A study compared women undergoing cesarean section who received either placebo or S-ketamine (esketamine) 0.5 mg/kg intramuscularly, followed by a continuous infusion of 2 mcg/kg/minute for 12 hours. This low dose was used to enhance analgesia and reduce residual pain rather than to provide anesthesia. All women received intraspinal bupivacaine 8 to10 mg and sufentanil 5 mcg for analgesia, as well as midazolam 0.02 mg/kg intravenously before the S-ketamine or placebo injection. Postoperatively, patients received patient-controlled intravenous morphine for 24 hours, followed by acetaminophen, oral ketorolac and a single dose of ondansetron 8 mg intravenously as needed. Of the 56 patients enrolled in the study (28 in each group), 13 in each group were contacted at 3 years postpartum. Patients who received placebo reported breastfeeding for an average of 10.5 months and those who received S-ketamine reported breastfeeding for an average of 8 months; however, the difference was not statistically significant.[6]

A randomized, double-blind study compared the effects of intravenous propofol 0.25 mg/kg, ketamine 0.25 mg/kg, ketamine 25 mg plus propofol 25 mg, and saline placebo for pain control in mothers post-cesarean section. A single dose was given immediately after clamping of the umbilical cord. The time to the first breastfeeding was 58 minutes in those who received placebo, 31.9 minutes with ketamine and 25.8 minutes with propofol plus ketamine. The time was significantly shorter than the other groups with the combination.[7]

References

1.
Reece-Stremtan S, Campos M, Kokajko L, et al. ABM Clinical Protocol #15: Analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeed Med. 2017;12:500–6. [PubMed: 29624435]
2.
Mitchell J, Jones W, Winkley E, et al. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2020;75:1482–93. [PubMed: 32737881]
3.
Ortega D, Viviand X, Lorec AM, et al. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999;43:394–7. [PubMed: 10225071]
4.
Gilder ME, Tun NW, Carter A, et al. Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting. BMC Pregnancy Childbirth. 2021;21:121. [PMC free article: PMC7874624] [PubMed: 33563234]
5.
Mokube JA, Verla VS, Mbome VN, et al. Burns in pregnancy: A case report from Buea Regional Hospital, Cameroon. Pan Afr Med J. 2009;3:21. [PMC free article: PMC2984292] [PubMed: 21532730]
6.
Suppa E, Valente A, Catarci S, et al. A study of low-dose S-ketamine infusion as "preventive" pain treatment for cesarean section with spinal anesthesia: Benefits and side effects. Minerva Anestesiol. 2012;78:774–81. [PubMed: 22374377]
7.
Jaafarpour M, Vasigh A, Khajavikhan J, et al. Effect of ketofol on pain and complication after Caesarean delivery under spinal anaesthesia: A randomized double-blind clinical trial. J Clin Diagn Res. 2017;11:UC04–UC7. [PMC free article: PMC5427408] [PubMed: 28511482]

Substance Identification

Substance Name

Ketamine

CAS Registry Number

6740-88-1

Drug Class

Breast Feeding

Lactation

Anesthetics, Intravenous

Hypnotics and Sedatives

Anesthetics, Dissociative

Excitatory Amino Acid Antagonists;

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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