Ketamine and other NMDA receptor antagonists

Marie Fallon, Cameron Fergus and Barry J.A. Laird

in Neuropathic Pain

Second edition

Published on behalf of Oxford University Press

ISBN: 9780199563678
Published online May 2011 | e-ISBN: 9780199607426 | DOI:

Series: Oxford Pain Management Library

Ketamine and other NMDA receptor antagonists

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• Ketamine is a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist and is most effective in pain states where hyper-excitability is established • Ketamine undergoes first-pass metabolism to norketamine, which is a more potent analgesic than ketamine. This can explain why oral ketamine is more potent than parenteral ketamine • There is much clinical experience supporting use of ketamine in neuropathic pain states but the evidence base is not well established • Dextromethorphan is an alternative NMDA receptor antagonist and has been combined with morphine in some successful clinical trials • It is likely that more selective NMDA receptor subtype antagonists will be identified and developed in the future.

Chapter.  3091 words. 

Subjects: Anaesthetics ; Pain Medicine

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