Ketamine in insulin resistance: Pharmacokinetics, cardiovascular implications and cellular effects on cardiomyocytes.
Diabetes, obesity & metabolism – May 01, 2025
Source: PubMed
Summary
Ketamine's impact on heart health takes an unexpected turn in people with insulin resistance. This anesthetic drug shows altered behavior in diabetic patients, affecting how their heart cells process energy. The drug's movement through the body changes significantly when blood sugar regulation is impaired, potentially increasing cardiovascular disease risk. However, understanding these mechanisms helps doctors better manage ketamine dosing in patients with diabetes complications, leading to safer treatment approaches.
Abstract
Ketamine, a dissociative anaesthetic, has expanded its clinical use beyond anaesthesia to pain management and treatment-resistant depression. As an N-methyl-d-aspartate receptor antagonist, ketamine disrupts the excitatory neurotransmission via interaction with the opioid, alpha-amino-3-hydroxy-5-methyl-4-isooxazole-propionic acid receptor and serotonin pathways, contributing to its broad therapeutic potential. However, its use is not without risks. In patients with insulin resistance, ketamine's effect on glucose metabolism, mitochondrial function and oxidative stress are exacerbated. This paper explores ketamine's pharmacokinetics, cardiovascular impact and its cellular effects on cardiomyocytes, particularly in insulin-resistant individuals. The findings discussed emphasize the importance of careful administration and monitoring in these vulnerable populations to balance ketamine's therapeutic benefits against its potential risks in patients with underlying metabolic or cardiovascular conditions.