In this post, Dr. Pullara delves into the intricacies of hemorrhagic and interstitial cystitis, shedding light on concerns regarding ketamine-induced bladder damage. By differentiating between illicit high-dose misuse and controlled low-dose IV ketamine treatments, we aim to address prevalent misconceptions regarding ketamine and your bladder. Grounded in current medical research, we emphasize our unwavering commitment to patient safety, well-being, and the application of best practices in treatment.


Note: Sources for this post come from the textbook “Ketamine for Treatment-Resistant Depression: The First Decade of Progress” by Sanjay J. Mathew and Carlos A. Zarate Jr.

Table of Contents

  1. Hemorrhagic Cystitis 
  2. Interstitial Cystitis

1. Hemorrhagic Cystitis 

The primary worry about ketamine-induced bladder damage from hemorrhagic cystitis arises from individuals misusing large amounts of illicitly-obtained ketamine regularly. Engaging in such illicit drug use greatly increases the chances of developing hemorrhagic cystitis, where the bladder becomes inflamed and bleeds.

In a nutshell:

  • “Hemorrhagic” means bleeding.
  • “Cystitis” refers to inflammation of the bladder.

Critics of low-dose IV ketamine

Some critics of therapeutic low-dose IV ketamine treatments have expressed concerns about this potential risk. However, it’s crucial to distinguish between illicit, frequent, high-dose ketamine misuse and the controlled, professional administration of low-dose IV ketamine for medical purposes.

Any evidence to support these concerns?

To date, there is no clinical evidence suggesting a link between low-dose IV ketamine treatments and the development of hemorrhagic cystitis. Above all, we prioritize the safety and well-being of our patients, and we only offer treatments rooted in rigorous medical research and best practices.

2. Interstitial Cystitis

Having discussed hemorrhagic cystitis, touching on possible ketamine-induced bladder damage from interstitial cystitis is equally important, though it is an even more rare concern. Medical research has yet to pinpoint the exact cause and mechanisms of interstitial cystitis fully. Patients with this condition often report feelings of pressure, discomfort, or spasms in the bladder. Interestingly, many experience relief after emptying their bladder.

How Common is Interstitial Cystitis?

While the incidence of interstitial cystitis related to low-dose IV ketamine treatment remains a gray area, it’s worth noting that such cases more commonly arise with other ketamine administration methods, such as oral or sublingual routes. However, many clinicians still regard the risk as exceptionally low.

What Happens if Interstitial Cystitis Develops?

In the event a client does exhibit these symptoms, they typically appear early in the treatment phase. Fortunately, this early manifestation facilitates prompt detection and intervention. As with all our services, we put patient safety and well-being above all else to ensure that treatments remain both effective and comfortable.

Frequently Asked Questions

While we cannot say the risk is absolutely 0%, what we can say that the likelihood of developing hemorrhagic cystitis secondary to a low-dose IV ketamine infusion is incredibly low and would be considered a very rare side effect if it did occur. 

The true incidence is unknown but widely believed by providers across the country to be incredibly low, especially with low-dose IV ketamine. While still very rare, this condition is more commonly seen with alternative formulations of ketamine such as oral or sublingual ketamine. 

If you are experiencing symptoms consistent with either hemorrhagic cystitis or interstitial cystitis, it is important to bring these concerns to your doctor before continuing with treatment. Steps can be taken to mitigate these symptoms, such as adding N-acetylcysteine (NAC) to your treatment regimen. 

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