Perinatal EvidenceCompass
Prepopulated workbenchMED-045

Antidepressants — rapid-acting/glutamatergic

Ketamine (intramuscular psychiatric use)

Off-label emergency agitation or rapid-acting psychiatric use

Not a categorical safety rating

This record organizes questions; it does not close them.

The clinical fields and position statements are prepopulated from the public-source corpus. They have not completed individual dual extraction, formal appraisal, exact-label reconciliation, or multidisciplinary sign-off. Do not use this page to justify abrupt discontinuation or reflexive switching.

Inventory identity

What this record represents

Canonical generic name
Ketamine (intramuscular psychiatric use)
Entity type
single-ingredient drug
Active component(s)
Ketamine
Formulation / route / interval
Intramuscular injection; psychiatric use is off-label
Attachment entry
Ketamine — IM
Separate monograph status
Yes — route-specific parenteral use
Identity and cross-reference
Not populated in v0.95
Inventory verification confidence
Moderate — molecule-level source; exact product/jurisdiction pending

Decision taxonomy

Five positions kept separate

These are workbench statements for reviewer execution. They are not independently commissioned, patient-specific recommendations.

  1. 01

    Stable continuation

    Workbench statement

    Do not withhold or discontinue solely because of pregnancy or lactation. For this record, assess indication, prior response, relapse severity, dose/formulation, alternatives, exposure timing, and mapped evidence; individual commissioned adjudication remains pending.

  2. 02

    New initiation in pregnancy

    Workbench statement

    For a new start, prefer an effective option with the strongest diagnosis-specific efficacy and reproductive evidence when clinically suitable. This record has not received an individual, independently verified initiation ranking.

  3. 03

    Switch before conception

    Workbench statement

    Before conception, consider a switch only when expected benefit exceeds relapse, withdrawal, failed-switch, and dual-exposure risks. Build and monitor the plan before pregnancy when feasible; no universal switch direction is assigned here.

  4. 04

    Unplanned exposure

    Workbench statement

    After unplanned exposure, confirm product, route, dose, timing, indication, co-exposures, and symptoms; do not advise abrupt cessation. Use the mapped evidence and current label to decide whether any targeted fetal assessment is indicated.

  5. 05

    Delivery, postpartum & lactation

    Workbench statement

    Create separate delivery, postpartum-dose, neonatal-observation, and lactation plans. Do not infer breastfeeding suitability from pregnancy evidence or routinely taper before delivery without drug-specific support.

Linked evidence

4 mapped claim summaries

Mapping can include class-wide, framework, formulation, regulatory, or evidence-gap claims. A linked claim is not necessarily a drug-specific causal estimate.

A-020Provisional public source

A small lactation pharmacokinetic study found low ketamine and norketamine relative infant doses after single doses.

Public-source certainty descriptor
low for infant safety; moderate for measured transfer under studied conditions; not GRADE
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
postpartum single-dose dosing
Comparator
dose groups; no unexposed infant comparator
Effect or numbers carried forward

Mean RID 0.650% after 0.5 mg/kg and 0.766% after 1 mg/kg.

Limitations

Small sample; limited/no infant ingestion and outcomes; cannot support repeated maintenance treatment or long-term neurodevelopment.

Sources, citation controls, and verification state

Linked sources

PMID
35880962
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
A-021Evidence gap

No adequate human cohort evaluates repeated psychiatric-dose ketamine exposure in pregnancy; anesthesia exposure is not a valid proxy for IV, IM, or compounded psychiatric regimens.

Public-source certainty descriptor
insufficient evidence; not GRADE
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
pregnancy
Comparator
no adequate comparator cohort
Effect or numbers carried forward

No reliable quantitative estimate.

Limitations

Route, dose, frequency, indication, and compounded-product quality vary; animal findings do not quantify human risk.

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
A-067Provisional public source

FDA prescription labeling uses narrative Pregnancy and Lactation Labeling Rule sections rather than the former A/B/C/D/X letter categories.

Public-source certainty descriptor
high for US regulatory framework
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
pregnancy and lactation
Comparator
not applicable
Effect or numbers carried forward

No reliable quantitative estimate.

Limitations

Exact labeling and revision date remain product-specific; non-US systems differ.

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
A-078Provisional public source

A four-participant lactation pharmacokinetic study found low ketamine and norketamine relative infant doses during a short treatment series.

Public-source certainty descriptor
low for infant safety; moderate for measured transfer under studied conditions; not GRADE
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
postpartum short-course dosing
Comparator
no unexposed infant comparator
Effect or numbers carried forward

Ketamine RID 0.34%–0.57%; norketamine RID 0.29%–0.95%.

Limitations

Four participants; limited infant ingestion/outcomes; cannot support repeated maintenance treatment or long-term neurodevelopment.

Sources, citation controls, and verification state

Linked sources

PMID
37683228
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending