Focus (American Psychiatric Publishing)Aug 1, 2026

Current Evidence and Medical Use of Ketamine and Esketamine in Children

Psychedelic Science Weekly Brief ↗PubMed ↗DOI ↗

Updated Aug 3, 2026

Abstract

Ketamine has varying bioavailability based on administration route, with intravenous use presenting 100% bioavailability.

Bioavailability of ketamine varies significantly: intravenous (100%), intramuscular (64%-93% in adults, 41% in children), and intranasal (43%-48% in adults, 50% in children).
Different routes of administration lead to distinct clinical effects due to varying dosing requirements.
The complexity of ketamine’s clinical use is heightened in children and adolescents, influenced by developmental stage and pharmacokinetics.
Ongoing clinical trials are investigating ketamine and esketamine for psychiatric conditions in pediatric populations.

Simplified

Ketamine is a well-established anesthetic agent that is gaining increasing recognition for its diverse therapeutic applications, including the management of chronic pain, refractory status epilepticus, major depressive disorder, and suicidality. Although it has been used clinically since the 1960s, multiple clinical trials with ketamine and esketamine in adults and pediatric populations are ongoing. There has been recent growing interest in ketamine and esketamine for psychiatric conditions in children and adolescents. The clinical use of ketamine is complex, in part because of the numerous available formulations and administration routes. Ketamine has different bioavailability depending on the route of administration: intravenous (100%), intramuscular (64%-93% in adults, 41% in pediatric populations), intranasal (43%-48% in adults, 50% in pediatric populations), sublingual (29%-32%), rectal (25%-30%), epidural (77%), and oral (17%-18%), which is due to extensive first-pass hepatic metabolism. Differences in dosing also produce distinct clinical effects. The challenges associated with ketamine use are further magnified in pediatric populations, for which developmental stage, pharmacokinetics, and neurodevelopmental factors play critical roles in guiding safe and effective treatment. In this review, the authors summarize the pharmacodynamics, pharmacokinetics, adverse effects and contraindications, and clinical applications of ketamine and esketamine among adult and pediatric populations.

Funding

Competing interests

The authors report no financial relationships with commercial interests.

PubMed

Current Evidence and Medical Use of Ketamine and Esketamine in Children

Abstract

Funding

Competing interests

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the psychedelic science brief

Abstract

Funding

Competing interests

Related papers

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the psychedelic science brief