SHOP

Sale!

Ketalar (Ketamine HCL)

$190.00$2,500.00

Clear

Description

 Buy Ketalar online without prescription 

Ketalar is an anesthetic medication. Ketalar is used to put you to sleep for surgery and to prevent pain and discomfort during certain medical tests or procedures. Ketalar may also be used for purposes not listed in this medication guide. Important Information You should not be treated with Ketalar if…
Buy Ketalar online without prescription
Note: This document contains side effect information about ketamine. Some of the dosage forms listed on this page may not apply to the brand name Ketalar.
For the Consumer
Applies to ketamine: injection solution
Along with its needed effects, ketamine (the active ingredient contained in Ketalar) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking ketamine:
Incidence Not Known
Bloody or cloudy urine
bluish lips or skin
blurred vision
chest pain or discomfort
confusion
confusion as to time, place, or person
convulsions
cough
difficult or troubled breathing
difficult, burning, or painful urination
difficulty with swallowing
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast, slow, or irregular heartbeat
frequent urge to urinate
hives
holding false beliefs that cannot be changed by fact
irregular, fast or slow, or shallow breathing
itching
not breathing
pale or blue lips, fingernails, or skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
seeing, hearing, or feeling things that are not there
shortness of breath
skin rash
sweating
tightness in the chest
unusual excitement, nervousness, or restlessness
unusual tiredness or weakness
Some side effects of ketamine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence Not Known
Double vision
dream-like state
flushing or redness of the skin
loss of appetite
nausea
pain at the injection site
seeing double
uncontrolled eye movements
unusually warm skin
vomiting
weight loss
For Healthcare Professionals
Applies to ketamine: compounding powder, injectable solution, intravenous solution
Cardiovascular
Common (1% to 10%): Blood pressure increased, heart rate increased, increased pulse rate
Uncommon (0.1% to 1%): Bradycardia, arrhythmia, hypotension
Frequency not reported: Arrhythmia[Ref]
Respiratory
Common (1% to 10%): Respiratory rate increased
Uncommon (0.1% to 1%): Respiratory depression, laryngospasm
Rare (less than 0.1%): Obstructive airway disorder, apnea[Ref]
Ocular
Common (1% to 10%): Nystagmus, diplopia
Frequency not reported: Intraocular pressure increased[Ref]
Gastrointestinal
Common (1% to 10%): Nausea, vomiting, anorexia
Rare (less than 0.1%): Salivary hypersecretion[Ref]
Musculoskeletal
Common (1% to 10%): Hypertonia, tonic clonic movements[Ref]
Local
Uncommon (0.1% to 1%): Injection site pain, injection site rash[Ref]
Dermatologic
Common (1% to 10%): Erythema, morbilliform rash[Ref]
Psychiatric
Common (1% to 10%): Hallucination, abnormal dreams, nightmare, confusion, agitation, abnormal behavior
Uncommon (0.1% to 1%): Anxiety
Rare (less than 0.1%): Delirium, flashback, dysphoria, insomnia, disorientation
Frequency not reported: Psychotic episodes[Ref]
Genitourinary
Rare (less than 0.1%): Cystitis, hemorrhagic cystitis[Ref]
Hepatic
Frequency not reported: Liver function test abnormal[Ref]
Hypersensitivity
Common (1% to 10%): Anaphylactic reaction[Ref]
References
  1. Cerner Multum, Inc. “Australian Product Information.” O 0
  2. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0
  3. “Product Information. Ketalar (ketamine).” JHP Pharmaceuticals, Saddle River, NJ.
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Some side effects may not be reported. You may report them to the FDA
Buy Ketalar online without prescription
Ketalar Dosage
Note: Barbiturates and KETALAR, being chemically incompatible because of precipitate formation, should not be injected from the same syringe.
If the KETALAR dose is augmented with diazepam, the two drugs must be given separately. Do not mix KETALAR and diazepam in syringe or infusion flask. For additional information on the use of diazepam, refer to the WARNINGS and DOSAGE AND ADMINISTRATION Sections of the diazepam insert.
Preoperative Preparations:
  1. While vomiting has been reported following KETALAR administration, some airway protection may be afforded because of active laryngeal-pharyngeal reflexes. However, since aspiration may occur with KETALAR and since protective reflexes may also be diminished by supplementary anesthetics and muscle relaxants, the possibility of aspiration must be considered. KETALAR is recommended for use in the patient whose stomach is not empty when, in the judgment of the practitioner, the benefits of the drug outweigh the possible risks.
  2. Atropine, scopolamine, or another drying agent should be given at an appropriate interval prior to induction.
Onset and Duration:
Because of rapid induction following the initial intravenous injection, the patient should be in a supported position during administration.
The onset of action of KETALAR is rapid; an intravenous dose of 2 mg/kg of body weight usually produces surgical anesthesia within 30 seconds after injection, with the anesthetic effect usually lasting five to ten minutes. If a longer effect is desired, additional increments can be administered intravenously or intramuscularly to maintain anesthesia without producing significant cumulative effects.
Intramuscular doses, in a range of 9 to 13 mg/kg usually produce surgical anesthesia within 3 to 4 minutes following injection, with the anesthetic effect usually lasting 12 to 25 minutes.
Dosage:
As with other general anesthetic agents, the individual response to KETALAR is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. The drug should be titrated against the patient’s requirements.
In individuals with a history of chronic ketamine use for off-label indications, there have been case reports of genitourinary pain that may be related to the ketamine treatment, not the underlying condition (see Adverse Reactions Section). Consider cessation of ketamine if genitourinary pain continues in the setting of other genitourinary symptoms.
Induction:
Intravenous Route: The initial dose of KETALAR administered intravenously may range from 1 mg/kg to 4.5 mg/kg. The average amount required to produce five to ten minutes of surgical anesthesia has been 2 mg/kg.
Alternatively, in adult patients an induction dose of 1 mg to 2 mg/kg intravenous ketamine at a rate of 0.5 mg/kg/min may be used for induction of anesthesia. In addition, diazepam in 2 mg to 5 mg doses, administered in a separate syringe over 60 seconds, may be used. In most cases, 15 mg of intravenous diazepam or less will suffice. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this induction dosage program.
Note: The 100 mg/mL concentration of KETALAR should not be injected intravenously without proper dilution. It is recommended the drug be diluted with an equal volume of either Sterile Water for injection, USP, Normal Saline, or 5% Dextrose in Water.
Rate of Administration: It is recommended that KETALAR be administered slowly (over a period of 60 seconds). More rapid administration may result in respiratory depression and enhanced pressor response.
Intramuscular Route: The initial dose of KETALAR administered intramuscularly may range from 6.5 to 13 mg/kg. A dose of 10 mg/kg will usually produce 12 to 25 minutes of surgical anesthesia.
Maintenance of Anesthesia:
The maintenance dose should be adjusted according to the patient’s anesthetic needs and whether an additional anesthetic agent is employed.
Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia. However, it should be noted that purposeless and tonic-clonic movements of extremities may occur during the course of anesthesia. These movements do not imply a light plane and are not indicative of the need for additional doses of the anesthetic.
It should be recognized that the larger the total dose of KETALAR administered, the longer will be the time to complete recovery.
Adult patients induced with KETALAR augmented with intravenous diazepam may be maintained on KETALAR given by slow microdrip infusion technique at a dose of 0.1 to 0.5 mg/minute, augmented with diazepam 2 to 5 mg administered intravenously as needed. In many cases 20 mg or less of intravenous diazepam total for combined induction and maintenance will suffice. However, slightly more diazepam may be required depending on the nature and duration of the operation, physical status of the patient, and other factors. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this maintenance dosage program.
Dilution: To prepare a dilute solution containing 1 mg of ketamine per mL, aseptically transfer 10 mL from a 50 mg per mL vial or 5 mL from a 100 mg per mL vial to 500 mL of 5% Dextrose Injection, USP or Sodium Chloride (0.9%) Injection, USP (Normal Saline) and mix well. The resultant solution will contain 1 mg of ketamine per mL.
The fluid requirements of the patient and duration of anesthesia must be considered when selecting the appropriate dilution of KETALAR. If fluid restriction is required, KETALAR can be added to a 250 mL infusion as described above to provide a KETALAR concentration of 2 mg/mL.
KETALAR 10 mg/mL vials are not recommended for dilution.
Supplementary Agents:
KETALAR is clinically compatible with the commonly used general and local anesthetic agents when an adequate respiratory exchange is maintained.
The regimen of a reduced dose of KETALAR supplemented with diazepam can be used to produce balanced anesthesia by combination with other agents such as nitrous oxide and oxygen.
SPECIAL NOTE
EMERGENCE REACTIONS HAVE OCCURRED IN APPROXIMATELY 12 PERCENT OF PATIENTS.
THE PSYCHOLOGICAL MANIFESTATIONS VARY IN SEVERITY BETWEEN PLEASANT DREAM-LIKE STATES, VIVID IMAGERY, HALLUCINATIONS, AND EMERGENCE DELIRIUM. IN SOME CASES THESE STATES HAVE BEEN ACCOMPANIED BY CONFUSION, EXCITEMENT, AND IRRATIONAL BEHAVIOR WHICH A FEW PATIENTS RECALL AS AN UNPLEASANT EXPERIENCE. THE DURATION ORDINARILY IS NO MORE THAN A FEW HOURS; IN A FEW CASES, HOWEVER, RECURRENCES HAVE TAKEN PLACE UP TO 24 HOURS POSTOPERATIVELY. NO RESIDUAL PSYCHOLOGICAL EFFECTS ARE KNOWN TO HAVE RESULTED FROM USE OF Ketalar.
THE INCIDENCE OF THESE EMERGENCE PHENOMENA IS LEAST IN THE ELDERLY (OVER 65 YEARS OF AGE) PATIENT. ALSO, THEY ARE LESS FREQUENT WHEN THE DRUG IS GIVEN INTRAMUSCULARLY AND THE INCIDENCE IS REDUCED AS EXPERIENCE WITH THE DRUG IS GAINED.
THE INCIDENCE OF PSYCHOLOGICAL MANIFESTATIONS DURING EMERGENCE, PARTICULARLY DREAM-LIKE OBSERVATIONS AND EMERGENCE DELIRIUM, MAY BE REDUCED BY USING LOWER RECOMMENDED DOSAGES OF Ketalar IN CONJUNCTION WITH INTRAVENOUS DIAZEPAM DURING INDUCTION AND MAINTENANCE OF ANESTHESIA. (See DOSAGE AND ADMINISTRATION Section). ALSO, THESE REACTIONS MAY BE REDUCED IF VERBAL, TACTILE, AND VISUAL STIMULATION OF THE PATIENT IS MINIMIZED DURING THE RECOVERY PERIOD. THIS DOES NOT PRECLUDE THE MONITORING OF VITAL SIGNS.
IN ORDER TO TERMINATE A SEVERE EMERGENCE REACTION, THE USE OF A SMALL HYPNOTIC DOSE OF A SHORT-ACTING OR ULTRA SHORT-ACTING BARBITURATE MAY BE REQUIRED.
WHEN Ketalar IS USED ON AN OUTPATIENT BASIS, THE PATIENT SHOULD NOT BE RELEASED UNTIL RECOVERY FROM ANESTHESIA IS COMPLETE AND THEN SHOULD BE ACCOMPANIED BY A RESPONSIBLE ADULT.
Ketalar Description
Ketalar is a nonbarbiturate general anesthetic chemically designated dl 2-(0-chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride. It is formulated as a slightly acid (pH 3.5-5.5) sterile solution for intravenous or intramuscular injection in concentrations containing the equivalent of either 10, 50 or 100 mg ketamine base per milliliter and contains not more than 0.1 mg/mL Phemerol® (benzethonium chloride) added as a preservative. The 10 mg/mL solution has been made isotonic with sodium chloride.
Ketalar – Clinical Pharmacology
Ketalar is a rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. The mechanism of action is primarily due to antagonism of N-methyl-D-aspartate (NMDA receptors) in the central nervous system.
A patent airway is maintained partly by virtue of unimpaired pharyngeal and laryngeal reflexes. (See WARNINGS and PRECAUTIONS Sections).
The biotransformation of Ketalar includes N-dealkylation (metabolite I), hydroxylation of the cyclohexone ring (metabolites III and IV), conjugation with glucuronic acid and dehydration of the hydroxylated metabolites to form the cyclohexene derivative (metabolite II).
Following intravenous administration, the ketamine concentration has an initial slope (alpha phase) lasting about 45 minutes with a half-life of 10 to 15 minutes. This first phase corresponds clinically to the anesthetic effect of the drug. The anesthetic action is terminated by a combination of redistribution from the CNS to slower equilibrating peripheral tissues and by hepatic biotransformation to metabolite I. This metabolite is about 1/3 as active as ketamine in reducing halothane requirements (MAC) of the rat. The later half-life of ketamine (beta phase) is 2.5 hours.
The anesthetic state produced by Ketalar has been termed “dissociative anesthesia” in that it appears to selectively interrupt association pathways of the brain before producing somatesthetic sensory blockade. It may selectively depress the thalamoneocortical system before significantly obtunding the more ancient cerebral centers and pathways (reticular-activating and limbic systems).
Elevation of blood pressure begins shortly after injection, reaches a maximum within a few minutes and usually returns to preanesthetic values within 15 minutes after injection. In the majority of cases, the systolic and diastolic blood pressure peaks from 10% to 50% above preanesthetic levels shortly after induction of anesthesia, but the elevation can be higher or longer in individual cases (see CONTRAINDICATIONS Section).
Ketamine has a wide margin of safety; several instances of unintentional administration of overdoses of Ketalar (up to ten times that usually required) have been followed by prolonged but complete recovery.
Ketalar has been studied in over 12,000 operative and diagnostic procedures, involving over 10,000 patients from 105 separate studies. During the course of these studies Ketalar was administered as the sole agent, as induction for other general agents, or to supplement low-potency agents.
Specific areas of application have included the following:
  1. debridement, painful dressings, and skin grafting in burn patients, as well as other superficial surgical procedures.
  2. neurodiagnostic procedures such as pneumonencephalograms, ventriculograms, myelograms, and lumbar punctures. See also Precaution concerning increased intracranial pressure.
  3. diagnostic and operative procedures of the eye, ear, nose, and mouth, including dental extractions.
  4. diagnostic and operative procedures of the pharynx, larynx, or bronchial tree. NOTE: Muscle relaxants, with proper attention to respiration, may be required (see PRECAUTIONS Section).
  5. sigmoidoscopy and minor surgery of the anus and rectum, and circumcision.
  6. extraperitoneal procedures used in gynecology such as dilatation and curettage.
  7. orthopedic procedures such as closed reductions, manipulations, femoral pinning, amputations, and biopsies.
  8. as an anesthetic in poor-risk patients with depression of vital functions.
  9. in procedures where the intramuscular route of administration is preferred.
  1. in cardiac catheterization procedures.
In these studies, the anesthesia was rated either “excellent” or “good” by the anesthesiologist and the surgeon at 90% and 93%, respectively; rated “fair” at 6% and 4%, respectively; and rated “poor” at 4% and 3%, respectively. In a second method of evaluation, the anesthesia was rated “adequate” in at least 90%, and “inadequate” in 10% or less of the procedures.
Indications and Usage for Ketalar
Ketalar is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation.
Ketalar is best suited for short procedures but it can be used, with additional doses, for longer procedures.
Ketalar is indicated for the induction of anesthesia prior to the administration of other general anesthetic agents.
Ketalar is indicated to supplement low-potency agents, such as nitrous oxide.
Specific areas of application are described in the CLINICAL PHARMACOLOGY Section.
Contraindications
Ketamine hydrochloride is contraindicated in those in whom a significant elevation of blood pressure would constitute a serious hazard and in those who have shown hypersensitivity to the drug.
Warnings
Cardiac function should be continually monitored during the procedure in patients found to have hypertension or cardiac decompensation.
Postoperative confusional states may occur during the recovery period. (See Special Note).
Respiratory depression may occur with overdosage or too rapid a rate of administration of Ketalar, in which case supportive ventilation should be employed. Mechanical support of respiration is preferred to administration of analeptics.
Pediatric Neurotoxicity
Published animal studies demonstrate that the administration of anesthetic and sedation drugs that block NMDA receptors and/or potentiate GABA activity increase neuronal apoptosis in the developing brain and result in long-term cognitive deficits when used for longer than 3 hours. The clinical significance of these findings is not clear. However, based on the available data, the window of vulnerability to these changes is believed to correlate with exposures in the third trimester of gestation through the first several months of life, but may extend out to approximately three years of age in humans. (See PRECAUTIONS/Pregnancy).
Some published studies in children suggest that similar deficits may occur after repeated or prolonged exposures to anesthetic agents early in life and may result in adverse cognitive or behavioral effects. These studies have substantial limitations, and it is not clear if the observed effects are due to the anesthetic/sedation drug administration or other factors such as the surgery or underlying illness.
Anesthetic and sedation drugs are a necessary part of the care of children needing surgery, other procedures, or tests that cannot be delayed, and no specific medications have been shown to be safer than any other. Decisions regarding the timing of any elective procedures requiring anesthesia should take into consideration the benefits of the procedure weighed against the potential risks.
Precautions
General
Ketalar should be used by or under the direction of physicians experienced in administering general anesthetics and in maintenance of an airway and in the control of respiration.
Because pharyngeal and laryngeal reflexes are usually active, Ketalar should not be used alone in surgery or diagnostic procedures of the pharynx, larynx, or bronchial tree. Mechanical stimulation of the pharynx should be avoided, whenever possible, if Ketalar is used alone. Muscle relaxants, with proper attention to respiration, may be required in both of these instances. Buy Ketalar online without prescription

Additional information

Ketalar

10 vials, 20 vials, 30 vials, 60 vials, 90 vials, 120 vials, 360 vials