Ketamine Bladder Syndrome

Ketamine is often used for its anesthetic and analgesic effects on cats, dogs, rabbits, rats, and other small animals. It is frequently used in induction and anesthetic maintenance in horses.

Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a treatment for depression and in pain management. Ketamine is an NMDA receptor antagonist which accounts for most of its psychoactive effects.

At anesthetic doses, ketamine induces a state of dissociative anesthesia, a trance-like state providing pain relief, sedation, and amnesia.

As a result of its dissociative and paralytic effects, ketamine is increasingly popular for 'recreational use'. But regular use can have some unexpected detrimental effects on your health. Serious and frequently irreversible damage to the urinary tract is a recently recognised an important side effect of that recreational ketamine use.

Ketamine is toxic for your bladder and urinary tracks. Urinary toxicity occurs primarily in people who use ketamine routinely, with around 25% of frequent users having bladder complaints. These complaints include a range of disorders from cystitis to hydronephrosis to kidney failure.

The typical symptoms of ketamine-induced cystitis are frequent urination, dysuria, and urinary urgency sometimes accompanied by pain during urination and blood in urine[1]. The damage to the bladder wall has similarities to both interstitial and eosinophilic cystitis. The wall is thickened and the functional bladder capacity is as low as 10–150 millilitres.

Management of ketamine-induced cystitis involves ketamine cessation as the first step[2]. This is followed by NSAIDs and anticholinergics and, if the response is insufficient, by tramadol. The second line treatments are epithelium-protective agents such as oral pentosan polysulfate or intravesical (intra-bladder) instillation of hyaluronic acid.

Guess who is a regular user of ketamine 'for his depression'? Elon Musk.

[1] Castellani et al: What urologists need to know about ketamine-induced uropathy: A systematic review in Neurourology and Urodynamics – 2020
[2] Srirangam, Mercer: Ketamine bladder syndrome: an important differential diagnosis when assessing a patient with persistent lower urinary tract symptoms in Britisch Medical Journal - 2012