What to Do If You Have a Bad Reaction to Ketamine at Home

Why You Need a Plan Before You Need One

At-home ketamine therapy is generally safe when prescribed and monitored by a qualified provider. However, adverse reactions can occur, and being prepared to handle them is a non-negotiable part of responsible treatment. Whether you experience physical side effects, psychological distress, or a medical emergency, having a clear plan in place before your session can make the difference between a manageable situation and a dangerous one.

This guide is not meant to replace your provider's emergency instructions. It is a complement to them — a reference you should read, understand, and keep accessible during every session.

Recognizing a Bad Reaction

Physical Symptoms That Require Attention

Moderate — Contact your provider:

• Persistent nausea or vomiting that does not resolve within 30 minutes
• Elevated heart rate that feels uncomfortable or alarming
• Dizziness or vertigo that is significantly worse than previous sessions
• Headache that is severe or unlike your typical headaches
• Numbness or tingling in extremities that persists after effects should have worn off
• Difficulty urinating or bladder pain (especially with repeated use)

Severe — Call 911 or go to the emergency room:

• Difficulty breathing or shortness of breath
• Chest pain or pressure
• Loss of consciousness
• Seizures
• Severe allergic reaction (swelling of face, throat, or tongue; hives; difficulty swallowing)
• Blood pressure above 180/120 if you are monitoring (hypertensive crisis)
• Uncontrollable vomiting with risk of aspiration

Psychological Symptoms That Require Attention

Moderate — Contact your provider:

• Intense anxiety or panic that feels unmanageable
• Distressing hallucinations or frightening imagery
• Feeling "stuck" in a dissociative state longer than expected
• Crying, emotional overwhelm, or surfacing of traumatic memories
• Confusion that is significantly worse than in previous sessions
• Depersonalization or derealization that persists well after the session

Severe — Call 911 or your crisis line:

• Suicidal ideation or urges to self-harm
• Paranoia or belief that you or others are in danger
• Psychotic symptoms (hearing voices, delusional thinking) that are new
• Complete inability to communicate or respond to your support person
• Agitation or aggression that puts you or others at risk

Step-by-Step Response Guide

Step 1: Stop and Assess

If you are mid-session and something feels wrong:

• Stop taking any additional medication — If you are using sublingual troches, spit out any remaining medication. If using nasal spray, do not take additional doses.
• Tell your support person — If someone is with you, communicate what you are experiencing. If you cannot speak, use a pre-arranged signal (such as raising your hand).
• Tell your provider — If you are being monitored via video, speak up or use the chat function. If you are not on a live call, have your support person contact the provider.

Step 2: Ground Yourself

For psychological distress that is uncomfortable but not dangerous:

• Open your eyes if they are closed. Remove your eye mask.
• Focus on physical sensations — Feel the chair beneath you, touch a textured object, hold an ice cube.
• Breathe slowly — Inhale for 4 counts, hold for 4, exhale for 6. Repeat.
• Orient to your environment — Name 5 things you can see, 4 you can hear, 3 you can touch.
• Remind yourself this is temporary — Ketamine's effects typically peak within 30 to 45 minutes and subside within 1 to 2 hours. You will return to baseline.
• Change the stimulus — If music is playing, turn it off or switch to something calming. Adjust lighting. Change your physical position.

Step 3: Contact Your Provider

Your telehealth ketamine provider should have given you a direct contact method for emergencies. This may be:

• An on-call phone number
• A secure messaging system
• A 24/7 nurse or clinician line
• A direct line to your prescribing provider

If your provider did not give you emergency contact information, this is a significant red flag. See our guide on red flags in telehealth ketamine clinics.

When you contact your provider, report:

• What you took (medication, dose)
• When you took it
• What symptoms you are experiencing
• How long symptoms have been present
• Whether symptoms are getting better, worse, or staying the same
• Any other medications you took today

Step 4: Decide Whether to Call 911

Call 911 immediately if:

• You or your support person believe there is a medical emergency
• You are having difficulty breathing
• You have lost consciousness or are unresponsive
• You are experiencing chest pain
• You are having a seizure
• You are having thoughts of harming yourself or others and cannot ensure safety

When you call 911, tell the dispatcher:

• "I am having a reaction to prescribed ketamine medication"
• Your address
• Your symptoms
• The name and dose of the medication
• Your provider's name and phone number (if available)
• Any other medications you are taking

Important: Do not be afraid to call 911 because ketamine is a controlled substance. You are taking a prescribed medication under medical supervision. Emergency responders are trained to help you, not judge you.

Step 5: Post-Reaction Care

After a bad reaction has resolved:

• Do not drive or make important decisions for at least 4 to 6 hours
• Stay hydrated — Drink water, avoid alcohol and caffeine
• Rest — Your body and mind need recovery time
• Document what happened — Write down the timeline of events, symptoms, what helped, and what did not. This information is invaluable for your provider.
• Schedule a follow-up with your provider within 24 to 48 hours to discuss what happened and whether to continue treatment

The Role of Your Support Person

If you are the designated support person (sitter) for someone undergoing at-home ketamine therapy, your responsibilities include:

• Stay sober and alert throughout the session and recovery period
• Monitor the patient for changes in breathing, consciousness, or behavior
• Know the emergency plan — Have the provider's emergency number, the patient's medication list, and the nearest hospital address readily available
• Do not leave the patient alone until they have fully returned to baseline
• Stay calm — Your demeanor affects the patient. Even if the situation is concerning, remaining composed helps them feel safer.
• Know when to act — If the patient cannot communicate, is breathing irregularly, or appears to be in distress, contact the provider immediately and call 911 if directed.

For more on arranging support, see our support systems guide.

Preventing Bad Reactions

While not all adverse reactions are preventable, you can significantly reduce your risk:

• Follow your provider's dosing instructions exactly — Do not take more than prescribed
• Disclose all medications and substances — Drug interactions are a leading cause of adverse reactions; see our medication management guide
• Do not use alcohol or recreational drugs on treatment days
• Eat lightly 2 to 3 hours before your session (unless your provider advises fasting)
• Be well-rested — Sleep deprivation intensifies ketamine's effects
• Skip your session if you feel unwell — Illness, fever, or severe stress can increase the likelihood of a bad reaction
• Set your environment — A calm, comfortable, familiar space reduces the chance of psychological distress; see our set and setting guide
• Take your blood pressure before the session if your provider requires it

When a Bad Reaction Signals a Bigger Problem

A single bad experience does not necessarily mean ketamine therapy is wrong for you. Sometimes a dose adjustment, timing change, or environmental modification resolves the issue. However, recurring adverse reactions may indicate that:

• Your dose is too high and needs to be lowered
• A medication interaction is occurring that was not identified
• Ketamine may not be the right treatment for your condition
• An underlying medical condition (such as undiagnosed cardiovascular disease) needs evaluation
• Your psychological state requires stabilization before continuing ketamine

Your provider should take every adverse reaction seriously and adjust your treatment plan accordingly. If they dismiss your concerns, consider seeking a second opinion. Our guide on how to verify a telehealth provider can help you evaluate your options.

Emergency Resources

Keep these numbers accessible during every session:

• 911 — For life-threatening emergencies
• 988 Suicide and Crisis Lifeline — Call or text 988 for suicidal thoughts or emotional distress
• Poison Control Center — 1-800-222-1222 for medication-related emergencies
• Your provider's emergency line — Should be provided at the start of treatment
• Crisis Text Line — Text HOME to 741741

The Bottom Line

Bad reactions to at-home ketamine therapy are uncommon but real. The best response is one you planned before the session started. Know the signs, have your contacts ready, keep your support person informed, and never hesitate to call for help. Your safety is always more important than finishing a session.

For a comprehensive overview of safety in at-home ketamine therapy, read our safety protocols guide and emergency protocols guide.

References

• Ketamine Safety Profile — NIH National Library of Medicine — Systematic review of ketamine adverse effects and safety considerations
• Managing Psychiatric Emergencies in Telehealth — American Psychiatric Association — APA guidance on emergency management during telehealth sessions
• Adverse Effects of Ketamine for Depression — Journal of Clinical Psychiatry — Research on side effect profiles in therapeutic ketamine use
• 988 Suicide and Crisis Lifeline — SAMHSA — National crisis support resource
• Poison Control — American Association of Poison Control Centers — 24/7 guidance for medication-related emergencies
• Ketamine Dissociative Effects and Management — Mayo Clinic — Clinical overview of ketamine side effects