The Pharmacokinetics of Ketamine in the Breast Milk of Lactating Women:
Quantification of ketamine and metabolites
Abstract
Abstract: There is no available data on the secretion and concentration
of ketamine and its metabolites in breastmilk. There are statements in
the literature made as to the safety of the use of ketamine in lactating
women, though these are unsupported. This information is pertinent for
the treatment of breastfeeding women who may have depression, PTSD,
postpartum depression, and other emotional difficulties and would
benefit from ketamine treatment. The objective of this study was to
measure the presence and concentration of ketamine in breastmilk and
three of its metabolites. We have provided a longitudinal
pharmacokinetic analysis of the presence of ketamine and several of its
major metabolites (norketamne, dehydronorketamine and hydronorketamine)
in 4 women receiving 2 different intramuscular doses of
ketamine—0.5mg/kg and 1.0mg/kg. Our results demonstrate the
insignificance of ketamine’s presence In breast milk after a 12-hour
period of suspension. Given ketamine’s proven record of effectiveness
for the treatment of depression, and its intermittent use for this
purpose, our data support the safety of its administration for the
treatment of postpartum depression (PPD)and other emotional disorders
during a woman’s chosen period to provide breast milk to her child
without significant interruption or exposure. This provides the
necessary data for the study of ketamine assisted psychotherapy as a
potential treatment of postpartum emotional disorders without the loss
of the relationship between mother and child which breast feeding so
vitally provides. We review conventional pharmacologic treatments
involved in the treatment of PPD.