By Trish Scherrer, MD

Sounds like the current shortage of ketamine will continue at least until later this year and may not be significantly improved until mid 2019.

Pfizer Hospira, the primary manufacturer, is experiencing a manufacturing delay due to upgrade work at their manufacturing site. In a "dear valued customer" letter sent out in January and re-verified on August 8th, Hospira anticipates that full production recovery for ketamine will occur in the second quarter of 2019. The other 3 US manufacturers of ketamine, Mylan, Par, and West-Ward, all cite increased demand for the drug as the primary cause of their respective shortages. Each of these companies expects backorders and intermittent supply until late 2018. 

Although major distributors such as McKesson cite the current opioid shortage as a significant reason for the current increased utilization and decreased supply of ketamine, it seems clear that at least part of the demand is related to increasing interest in the role of ketamine in the management of depression. Ketamine's popularity as an attractive alternative to electroconvulsive therapy or even to multiple medication management of depressive disorders continues to grow in both the medical and lay press. There are companies springing up all over the country specifically offering ketamine infusions for treatment of depression, although at this time it is still an off label (not FDA approved) use. However, there are numerous success stories out there on CBS News, NPR, Twitter, and etc., and so ketamine will likely remain a hot commodity in the near future. Perhaps that will mean that there is increased manufacturing interest, but this depends on companies not preferentially manufacturing formulations, concentrations, isomers, or other variations on the primary drug that would allow them to obtain patent protection solely for psychiatric use.

In the meantime, stay tuned to the FDA website ( and the American Society of Health-System Pharmacists ( for the latest medication shortage updates and guidelines.