Ketamine Detox

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KEY TAKEAWAYS

Ketamine detox is done by either:

  • A medical detox using up to 250mg chlordiazepoxide for 7-10 days
  • A symptom-managed detox treating ketamine withdrawal symptoms with medication as needed (e.g. 5g Haloperidol daily for psychosis)

Ketamine detox at Abbeycare is decided on a case-by-case basis by our medical professionals. 

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IMPORTANT: Below, we discuss possible approaches that meet the specific detox needs around ketamine. Not all treatment centres will provide these specific interventions.

For an overview of the Abbeycare programme contents for ketamine detox, click here.

How Is Ketamine Detox Done?

Patients are treated on a case-by-case basis during a detox from ketamine to establish whether withdrawal symptoms require: 

  • A medical detox using up to 250mg chlordiazepoxide daily for 7 - 10 days and symptomatic treatment for up to 28 days 
  • Symptomatic treatment only using medications such as paracetamol or propranolol to manage abdominal pain and anxiety 

Withdrawal Symptom

Treatment

Reason For Use 

Abdominal Pain

Antispasmodics (e.g. 200mg Mebeverine hydrochloride 2x daily)


1000mg paracetamol every 4 – 6 hours


100mg Pentosan polysulfate 3 times daily 

To relieve abdominal pain by relaxing gut muscles and easing inflammation/irritation of the bladder lining 

An Overactive Bladder

Anticholinergics (e.g. up to 20mg Oxybutynin daily)


Beta-3 Agonists (e.g. 50mg Mirabegron daily) 

To control bladder instability and minimise involuntary contractions by relaxing the detrusor muscle 

Anxiety

Antihistamines (e.g up to 100mg Hydroxyzine daily)


Beta blockers (e.g. up to 40mg Propranolol daily)


SSRIs (e.g. up to 200mg sertraline daily) if anxiety persists >2 weeks

To regulate mood + ease physical symptoms (e.g. heart palpitations) by enhancing serotonin and lowering heart rate (<100 BPM)

Ketamine-Induced Psychosis

Antipsychotics (e.g. 5 - 10mg Haloperidol or 16mg Risperidone daily)


NMDA-receptor antagonists (e.g. up to 20mg Memantine daily) 

To control hallucinations and delusions by regulating dopamine, serotonin, and glutamate activity in the brain

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Physical Symptoms During Ketamine Detox

Patients with suspected neurological or physical damage (e.g. eGFR decline >30%) are thoroughly assessed on a case-by-case basis before admission to Abbeycare to establish whether the ketamine rehab programme is suitable to meet the patient's specific needs.

Abdominal Pain

Abdominal pain is a physical symptom of ketamine detoxification because epithelial inflammation of the bladder in 71% of long-term users (≥ 6 months) is exacerbated during the detox process due to [1]:

  • Vomiting and diarrhoea in 18% of heavy users (>300 times) within 72 hours of cessation, aggravating pelvic floor muscles due to repeated straining and causing stomach pain due to irritation in the gut and surrounding organs (e.g. the bladder) [2]
  • Persistent ‘K cramps’ resulting in severe abdominal pain in the right upper quadrant, epigastric, and suprapubic regions, worsening symptoms of ketamine-induced cystitis (e.g. dysuria) after 3 years of drug-taking [3]
  • A loss of electrolytes (e.g. sodium) after vomiting up to 8 times in 2 hours impairs the bladder’s ability to contract, empty, and control urine flow, causing further discomfort due to a buildup of urine and pressure [3]

In a study by Avra, et al, (2024), a 31-year-old man who consumed 1–3g of ketamine daily experienced a 33% reduction in abdominal pain within 2 hours of receiving intravenous fluid therapy and full resolution of abdominal tenderness and dyspepsia within 30 hours of detox [4].

Feeling Cold

Feeling cold is a physical sign of ketamine detoxification because the body struggles to maintain a stable temperature (37°C) due to rebound sympathetic activity, disrupted hypothalamic signalling, and neurotransmitter imbalances, leading to [5]:

  • Excessive shivering and chills within 24 – 72 hours of cessation, peaking during days 3 – 7 and subsiding within 2 weeks as thermoregulatory responses normalise (e.g. shivering to generate heat) after being blunted during active use
  • Excessive sweating in the absence of a temperature change or physical exertion in up to 8% of long-term users (36+ months) during week 1 of withdrawal, exacerbated by shaking and heart palpitations in up to 30% [2]

Clinicians regularly check vital signs (e.g. body temperature) and administer the CINA to gauge the severity of temperature fluctuations (e.g. cold/clammy hands, uncontrolled shivering) and monitor patient progress during the ketamine withdrawal process.

Urinary Retention Or An Overactive Bladder

Urinary retention/overactive bladder are physical signs of ketamine detoxification because regular use increases the risk of cystitis by 3-4-fold, and the incidence of lower urinary tract symptoms (e.g. urge incontinence) is 6.2 times higher than in non-users, leading to [7]:

  • A micturition frequency every 15 – 90 minutes (normal frequency = every 2 – 3 hours) due to detrusor overactivity and a reduced bladder capacity (≤100 ml) in 51%, resulting from severe inflammation of the bladder lining after 3.5 years of ketamine use (check to quantify type of inflammation) [1]
  • Incomplete bladder emptying, an intermittent urinary stream, nocturia, and urinary urgency in 35 - 67% caused by bladder dysfunction after snorting ketamine daily for 6 years, lasting up to 1 year in some cases [8]
  • Some users claiming that “I was going a lot more, but when I was going, I wasn’t passing much” and “I kept going to the toilet every 30 minutes” within 7 months of discontinuing ketamine [9]

Urinary retention and an overactive bladder typically develop within 2 years of heavy ketamine use (up to 10g daily), although 48% of users do not seek medical attention and are likely to have advanced ketamine bladder syndrome by the time treatment is initiated [8].

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Psychological Symptoms During Ketamine Detox

Cognitive Dysfunction

A 14% reduction in executive functioning is a psychological effect of ketamine detoxification because neural circuits involved in decision-making, planning, and attention in the prefrontal cortex are temporarily disrupted due to NMDA-glutamate imbalances, resulting in [2]:

  • Around 40% of heavy users (used >200 times) feeling disinhibited, demotivated, “not wanting to do anything”, lacking attention, and being unable to concentrate within 1 week of detoxing from ketamine [2][10]
  • A 4 – 9% reduction in cognitive flexibility and semantic retrieval skills during the first month of detox, although verbal fluency scores increase by 3% after 12 months of continued abstinence [11]

A 15 - 30% reduction in verbal memory skills (e.g. 30 min delayed recall) occurs during ketamine detoxification due to disrupted glutamate transmission and a 6-12% reduction in cerebral grey matter volume after 3+ years of ketamine misuse, resulting in [2][12]:

  • Self-reported claims of having a “really bad memory” 3 months after the onset of withdrawal symptoms following 6 – 7 years of heavy ketamine use (consuming up to 1g per session) [13]
  • Forgetfulness and confusion (e.g. difficulty understanding what people are saying or getting directions mixed up) in 28% of patients within the first 7 days of a detox programme [2]
  • Long-term verbal recognition memory impairments after 7 years of ketamine use, as prose recall (delayed and immediate) abilities decline by 25% from baseline (1 month ketamine-free) to 12 months after withdrawal symptoms begin [11]

Existential Anxiety

Existential anxiety is a psychological symptom of withdrawal that occurs during ketamine cessation because: 

  • ‘Normal’ consciousness returns after the drug wears off, and up to 31% feel depersonalised, anxious, and confused/disoriented after experiencing mind-body dissociation whilst intoxicated [2][10] 
  • NMDA receptor and glutamate imbalances exacerbate feelings of emptiness and detachment as users attempt to establish a sense of self after experiencing “out-of-body experiences with a whole new world and different reality in your head” [13]
  • Self-referential thinking (identity, time, memory) is distorted, and users feel “gloomy about the future” after 25% claim to feel ‘all-powerful’ and ‘understand the world better’ whilst having an exaggerated self-image/superiority complex whilst high [2][10]

Symptoms of existential anxiety (e.g. worry/confusion about one’s personal identity or the nature of reality) typically begin within 24 hours of ketamine detoxification and may be exacerbated by: 

  • Drug-induced psychosis or co-occurring adjustment, anxiety, or depressive disorders in up to 13% of long-term (3+ years) users [2]
  • Permanent depersonalisation/derealisation, as dissociative experiences (e.g. standing outside the body or not remembering a car journey) increase by 11% from baseline to 12 months after detoxing from ketamine [11]

Clinicians regularly administer the Mental Status Examination (MSE) and CINA to establish: 

  • The severity of psychological (restlessness) and physical (sweating) symptoms of anxiety with a scoring technique (0-3), e.g. 0 = normal activity vs 2 = moderately fidgety and restless/shifting position frequently
  • Whether symptoms (e.g. perceptual abnormalities, i.e. delusions) are anxiety-related or caused by an underlying condition such as schizophrenia or drug-induced psychosis
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Hallucinations

Post-use hallucinations during a detox from ketamine are psychological withdrawal symptoms caused by excessive glutamate release and a 24% upregulation of dopamine receptors in the dorsolateral prefrontal cortex, as NMDA receptors are no longer blocked [14]. 

2 – 4% experience hallucinations and delusions during days 1 – 3 of ketamine detoxification, and up to 32% of cases develop into a psychotic disorder after 6+ months of drug abuse [2][15].

In a study by Liang, et al (2015),  a man experienced paranoid ideation and auditory hallucinations of a hostile God condemning him to hell during withdrawal from ketamine after previously snorting up to 4g hourly and spending over £3000 a month to fund his addiction [16].

In a study by Liang, et al (2015), a man experienced visual, olfactory, auditory, and tactile hallucinations within 1 – 2 days of abstaining from ketamine, including a demon’s voice commanding and controlling him by “making his ear move” that lasted for 6 days [16].

Positive Indicators Of Ketamine Detox

Bladder Function Recovery

An 11-fold increase (38 to 400ml) in bladder capacity is a positive indicator of ketamine detoxification because [17]: 

  • Satisfactory bladder emptying is achieved within 3 months of abstaining due to the management of inflammation, fibrosis, and detrusor overactivity after 3 – 15 years of ketamine abuse [17]
  • 53.1% of chronic ketamine users (up to 10g daily for 6 years) are relieved of lower urinary tract symptoms (e.g. urinary frequency = 15 – 30 min vs 2 – 3 hours) after receiving oral medication (e.g. 20mg Oxybutynin daily) during detox [18]

Hospital care may be arranged during or after detox for patients with severe ketamine-induced bladder dysfunction to receive cystoscopy with hydrodistension or intravesical injections with botulinum toxin due to the 71 – 100% response rates, although this is managed on a case-by-case basis and depends on the specific needs of the patient [18].

Reduction In Ketamine-Induced Hallucinations

Complete resolution of ketamine-induced hallucinations within 2 – 6 days is a positive indicator of ketamine detoxification as psychotic behaviour (e.g. paranoia, hearing voices) subsides after receiving 4.5mg Haloperidol and 40mg Propranolol daily [16]. 

Visual/auditory hallucinations continue to decrease by 21% from baseline (1 month of abstinence) to 12 months after detoxing from ketamine due to the restoration of regular glutamatergic and dopaminergic function after 7 years of drug-taking [11].

Ketamine rehabs liaise with specialist mental health services during treatment to establish appropriate care strategies and medication schedules to manage persistent hallucinations in the 32% of patients who develop drug-induced psychosis after 9 years of use [15].

Temperature Regulation Improvements

The regulation of body temperature (37°C) is a positive indicator of ketamine detoxification because thermoregulatory responses stabilise within 2 weeks of cessation after patients excessively shiver and sweat within the first 24 - 72 hours of treatment. 

After the first week of ketamine detoxification, temperature fluctuations are no longer exacerbated by tachycardia (>100 bpm), shaking, and palpitations in up to 39% of patients, as for every 10 bpm increase in heart rate, body temperature increases by 1°C [2][19][20].

Ketamine detox assists temperature regulation with daily vital signs checks and administration of the CINA to assess/score symptoms (e.g. uncontrolled shivering) from 0 – 2 to monitor changes and establish any interventions needed (e.g. warm fluids to alleviate chills). 

Inpatient Ketamine Detox Vs....


Inpatient Rehab

Hospital

Supervision Level

Daily assessments + hourly monitoring from nurses/physicians

24-hour monitoring + nursing care

Medical Intervention

Symptomatic treatment for up to 28 days (e.g. 20mg Oxybutynin daily for an overactive bladder)

Symptomatic treatment + specialised procedures if required (e.g. Intravesical botox injections)

Joined-Up Care Approach?

Yes

Yes

Bladder Recovery Support

Physical exams + medication to reduce inflammation/control bladder instability


Aftercare planning (e.g. arranging pelvic floor therapy)

Specialist advice + interventions (e.g. cystoscopy with hydrodistention)


Referred back to GP for ongoing treatment

Cost

Around £3,500 - £5,000 p/wk (private) vs free on NHS (up to 1 year wait time + strict eligibility)

Free at NHS hospitals (assessed on patient need) or up to £40,000 for 4 weeks in a private mid-range hospital


Outpatient

At Home

Supervision Level

Monitored at predetermined intervals (e.g. 2 - 3 days a week)

Daily review with GP during days 1 - 7 + regular check-ins with addiction nurse

Medical Intervention

Symptom-managed (e.g. 1g paracetamol for abdominal pain)

Medication prescribed by doctor as needed (e.g. propranolol) + self-care tips (e.g. 3L of water to replace fluids lost from sweating)

Joined-Up Care Approach?

No

No

Bladder Recovery Support

Referrals to urologists to provide a formal diagnosis + suggest appropriate treatment

General advice about ‘bladder-friendly’ diets (e.g. avoiding spice)


Symptom tracking with a bladder diary

Cost

Around £1,500 per week or free on the NHS (3+ week wait time)

Around £2,000 for 2 weeks of at-home monitoring and medication support

Ketamine Detox Combined With Other Drugs 

Ketamine And PCP Detox

Ketamine detoxification is altered when combined with PCP because: 

  • Violent behaviour is increased by 1-2-fold, as 36% of ketamine users feel angry, hostile, or act aggressively (e.g. assaulting staff members) during the first week of withdrawal, compared to 80% of PCP users, typically arising within 2 – 3 days of last use [2][21][22]
  • Chronic PCP users (≥ 3 times per week) typically stay in treatment longer than non-PCP users (e.g. 108 days vs 68 days) due to a 24% increase in cases of drug-induced psychosis with hallucinations and delusions lasting 3 – 6 weeks rather than 7 days [2][21]
  • 10mg Haloperidol is required to manage psychosis, rather than 4-5mg for ketamine alone, and 1 – 1.5mg/kg dantrolene sodium may be administered alongside rapid cooling measures (e.g. ice baths) to reduce high body temperatures (e.g. 40 - 42°C) [21]

Ketamine + PCP patients may be required to complete the detox process in a general/psychiatric hospital because: 

  • Some patients fall into a comatose state for 2 – 24 hours or up to 1 month for heavy users (3+ months of daily use), requiring 24-hour monitoring with airway management and ventilatory support whilst regaining full consciousness [21]
  • Restraints may be required for the protection of the patient and the staff in extreme cases of psychosis and violence, as up to 80% attempt to assault or make sexual advances towards staff members during treatment [21][22]

Aggressive behaviour is managed during ketamine detoxification by: 

  • Having clear admission protocols to screen potentially aggressive/violent patients and developing a plan to enlist the support of law enforcement or security staff if necessary
  • Ensuring staff are trained in strategies to de-escalate aggression, including removing the patient away from loud noises or distractions, and speaking in a soft voice to provide reassurance whilst avoiding confrontation, judgment, or an angry tone
  • Treating aggressiveness symptomatically with close supervision or transporting patients to a psychiatric hospital if necessary to prevent self-harm or danger to others [23]

Ketamine And Alcohol Detox

Ketamine detoxification is altered when combined with alcohol because:

  • 26% are hospitalised within 48 hours due to severe withdrawal symptoms (e.g. seizures) caused by a 51% decrease in GABAergic neurotransmission within 10 days of last drinking alongside the reversal of ketamine-induced NMDA receptor blockade [24][25]
  • The risk of withdrawal hallucinations increases by 6-fold as both substances are CNS depressants (sedative-hypnotic vs dissociative anaesthetic) and disrupt glutamate signalling in the brain when removed from the body [26]
  • Withdrawal symptoms develop within 6 – 24 hours of cessation rather than 24 – 72 hours for ketamine alone, and the CIWA-Ar is administered to monitor patient progress and adjust medication as needed (e.g. 50-100mg chlordiazepoxide if score is >8–10) [27] 
  • Delirium tremens may occur during days 2 – 5 of withdrawal, presenting with extreme agitation or restlessness, confusion, and disorientation, requiring 2– 5 L of intravenous rehydration and up to 80mg of diazepam daily for 1 week to achieve sedation [28]
  • Thiamine (e.g. 100mg 3x daily) is administered for 1-2 weeks to prevent Wernicke’s encephalopathy, and other symptomatic medications (e.g. 10mg metoclopramide every 4 - 6 hours) may be required to manage heightened nausea/vomiting [28]

Ketamine Detox At Abbeycare

Ketamine detoxification at Abbeycare is incorporated into a full 28-day rehab programme to safely begin management of physical and psychological symptoms (e.g. existential anxiety, feeling cold) arising within 24 – 48 hours of cessation by: 

  • Providing a single-occupancy room in the detox wing during days 1 – 7 to receive regular observations, and assigning each client with a key worker to develop an individualised treatment plan.
  • Administering anti-psychotics (e.g. up to 10mg Haloperidol) and anti-anxiety medication (e.g. 40mg propranolol) to manage ketamine-induced hallucinations, delusions, heart palpitations, and feelings of dread/worry during the first week of withdrawal. These are examples only - all prescribed medications are determined by our medical team upon individual assessment.
  • Utilising the Clinical Institute Narcotic Assessment to evaluate changes in withdrawal symptoms (e.g. no sweat visible vs beads of sweat obvious on forehead) and adjusting medications/interventions as needed to aid recovery

Abbeycare typically treats ketamine addiction with up to 250mg chlordiazepoxide daily for 7 - 10 days, although this is always reviewed on an individual basis due to variations in personal care plans and medical requirements. 

Abbeycare cannot provide medical treatment for ketamine bladder syndrome, although if suspected, GPs are contacted to provide appropriate medical advice and discuss treatment options and onward referral (e.g. oral medications or intravesical injections) during or after withdrawal.

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About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: February 3, 2026