Hepatobiliary Complications Associated With Ketamine Use: Clinical Insights and Future Directions

Abstract

Ketamine has been utilized in various medical contexts, particularly for its effects on the nervous system. Over time, its applications have expanded beyond its initial use, with emerging interest in its potential to influence mood and cognition. In certain clinical populations, it has been associated with a rapid reduction in depressive symptoms and suicidal thoughts, particularly when conventional treatments have proven insufficient. Despite these promising therapeutic effects, concerns remain regarding possible adverse consequences, including those related to liver and biliary function. This review explores the current understanding of how ketamine use may impact hepatic and biliary health, with a focus on observed complications, possible underlying mechanisms, clinical manifestations, and available management strategies. A structured examination of existing medical literature was conducted, drawing from multiple scientific sources to identify research on ketamine's effects on liver and biliary function. Studies involving human participants were included, particularly those documenting changes in liver enzyme levels, disruptions in bile flow, and structural alterations in the biliary system. The selection criteria emphasized original investigations, case reports, and clinical evaluations published in peer-reviewed sources. Findings indicate that ketamine exposure has been associated with a spectrum of liver and biliary changes, ranging from mild laboratory abnormalities to more serious conditions that require medical intervention. Several possible biological mechanisms have been proposed, including effects on bile flow regulation, oxidative stress, and toxicity affecting liver function. Notably, discontinuing ketamine use has been linked to improvements in many cases, and various treatment approaches, including supportive care and specific pharmacologic interventions, have been explored to alleviate symptoms. As ketamine continues to be incorporated into diverse therapeutic settings, understanding its full range of effects remains crucial. Further research is needed to clarify how these biological changes occur, identify individuals who may be more susceptible, and develop strategies to ensure safer use across different clinical and nonclinical populations.

Keywords: biliary duct abnormalities; chronic ketamine user; drug-induced hepatotoxicity; drug-induced liver failure; liver fibrosis; side effects of ketamine.

Figure 1. Flowchart depicting the study selection process for the scoping review