Ketamine: safety and risks
Common effects during treatment include dissociation, dizziness, nausea and a temporary rise in blood pressure, which usually settle within hours under supervision. Clinicians weigh heart and blood pressure problems, psychosis, and any history of substance use. Ketamine can be misused, and frequent use, mostly recreational, is linked to serious bladder damage.
Ketamine's common side effects, who needs extra caution, misuse risk and bladder harm, explained calmly and with sources. Education, not medical advice.
Usually manageable under supervision; more serious outside it.
Key takeaways
- Most side effects are short-lived and are why monitoring is required.
- Blood pressure can rise temporarily, which matters for people with heart or blood vessel conditions.
- Ketamine has misuse potential; clinicians check for it before and during treatment.
- Frequent recreational use is linked to bladder inflammation and, over time, kidney damage.
Common effects during treatment
Dissociation (feeling detached or unreal), dizziness, nausea, sleepiness and perceptual changes are common and usually pass within a couple of hours. Blood pressure can rise for a few hours after esketamine, which is why it is checked before each dose and during monitoring.
Who needs extra caution
This is an individual medical decision, not a checklist on a web page. Factors clinicians consider include heart and blood vessel conditions, uncontrolled blood pressure, a history of psychosis, a history of substance use, and other medicines. Tell your clinician everything, including alcohol and recreational drug use.
Misuse and dependence
Ketamine is a controlled substance because it can be misused. Esketamine's restricted program requires clinicians to watch for signs of misuse and dependence. Unsupervised use removes that safeguard.
Bladder and kidney harm
A 2022 review found that urinary symptoms are common among frequent recreational ketamine users and rise with dose and frequency. Symptoms include urgency, pain and blood in the urine, and prolonged use can damage the kidneys. Stopping usually helps in early cases, but advanced damage can be permanent. Tell a doctor promptly about any urinary symptoms.
Reporting a side effect
Tell your prescriber, and report it to the FDA through MedWatch. Reports from patients help regulators spot problems.
Frequently asked questions
Is ketamine addictive?
It can be misused and can cause dependence, especially with frequent unsupervised use. Supervised treatment includes checks for this.
Is a dreamlike feeling dangerous?
Dissociation is an expected, usually short-lived effect, and supervision is there to keep you safe while it passes.
Related on Beiing
- The four kinds of ketamine - Why supervision differs so much between them.
- Crisis resources - Verified urgent support if you need help now.
- Ketamine for mental health - The hub for every page in this guide.
Sources
- SPRAVATO (esketamine) nasal spray, prescribing information - Janssen Pharmaceuticals, via DailyMed (U.S. National Library of Medicine)
- SPRAVATO approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression (21 January 2025) - Johnson & Johnson (manufacturer press release)
- FDA warns patients and health care providers about potential risks associated with compounded ketamine products, including oral formulations, for the treatment of psychiatric disorders (October 2023) - U.S. Food and Drug Administration
- Anderson DJ, et al. Ketamine-induced cystitis: a comprehensive review of the urologic effects of this psychoactive drug. Health Psychology Research, 2022 - Health Psychology Research, via PubMed Central
- MedWatch: report a side effect - U.S. Food and Drug Administration
Written by Beiing Editorial Team · Editorially reviewed by Beiing Editorial & Research Review · Published · Last reviewed . Editorial and research review by Beiing writers and researchers. This is not medical or clinical review, and no clinician signs off on our content.
Educational content only - not medical advice. In a crisis, call or text 988 (US) or your local emergency number. See crisis resources.