In March 2019, the U.S. Food and Drug Administration approved Spravato (esketamine) nasal spray, in conjunction with an oral antidepressant, for the treatment of depression in adults who have tried other antidepressant medicines but have not benefited from them (treatment-resistant depression). Because of the risk of serious adverse outcomes resulting from sedation and dissociation caused by Spravato administration, and the potential for abuse and misuse of the drug, it is only available through a restricted distribution system, under a Risk Evaluation and Mitigation Strategy (REMS). Early studies do not apparently show bladder damage but these was "fast tracked" through the FDA approval process. If you are using Spravato and experience urinary symptoms, please notify your doctor immediately.
Patients are assessed based upon their symptoms. Physicians may do a cystoscopy as well as other functional tests such as a voiding cystogram and/or urodynamics. A hydrodistention with cystoscopy may be used to examine the bladder wall. Patients with ketamine induced bladder damage have varying degrees of irritation, inflammation, petechial hemorrhages (bleeding blood vessels) or larger Hunner’s lesions. Bladder capacity is also reduced dramatically. Normal bladder capacity may be 500cc’s however some ketamine addicts can only hold 50cc’s of urine or less.
It is essential that physicians ask younger patients if they have, or are, using ketamine.
Ketamine is a veterinary anesthetic that has hallucinogenic properties and also impairs memory. Known as the poor mans cocaine and a cheaper alternative to heroin, ketamine has also been used as a “date rape” drug. Often cut into other drugs, ketamine has gained popularity at RAVES due to the “high” and “k-hole” it can give.. It can be taken orally, inhaled or injected into the muscle.
Ketamine is also legitimately used in pain management, particularly end of life care. It has gained popularity in pain management circles as an alternative to opioid medications. Bladder damage can happen with both legal and illegal use.
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