Drug Safety Directory

At standard doses (25-200 mg/day), sertraline is one of the most common medications our patients are already taking when they start ketamine. There's no pharmacologic conflict, no required washout, and no special precaution beyond standard intake review. Most patients continue Zoloft throughout the ketamine course.

Bupropion at standard therapeutic doses (Wellbutrin XL up to 450 mg/day) combines safely with at-home ketamine. The two medications work through different neurotransmitter systems and the FDA has separately approved a bupropion plus NMDA-antagonist combination for depression. The one clinical consideration is dose form and total daily dose: IR formulations and doses above 450 mg/day get a brief intake conversation about seizure threshold; standard XL dosing does not.

Alcohol and ketamine require active management, not passive monitoring. On dose days, alcohol is prohibited (the standard rule is 24 hours before a session and 24 hours after). During the loading phase (first 4-6 weeks) we strongly encourage complete abstinence; after loading, light drinking on non-treatment days is generally fine. Patients with active or recent alcohol use disorder need to disclose at intake; depending on severity, the AUD may need to be addressed alongside or before ketamine in coordination with addiction medicine.

Lithium combined with ketamine is pharmacologically safe with no documented interaction concerns. The case-by-case nature comes from context: most patients on lithium are being treated for bipolar disorder, and bipolar depression on at-home ketamine carries a low but real manic-switch consideration that is meaningfully lower when the mood stabilizer is continued. Patients on lithium for unipolar treatment-resistant depression augmentation are usually straightforward candidates with an intake review of recent lithium level and renal function. Patients on lithium for bipolar I or II disorder need a more detailed conversation about whether at-home is the right setting and we coordinate with the prescribing psychiatrist as part of intake.

Patients on active MAOI therapy are not candidates for at-home ketamine at Tovani Health. This is an operational position, not an evidentiary claim that the combination is universally dangerous: recent published literature (Veraart et al. 2022, N=39, no adverse events; Veraart et al. 2021 systematic review, no documented hypertensive crisis or serotonin syndrome) suggests the combination is safer in carefully monitored research and clinical settings than was historically presumed. At-home unmonitored is not that setting. After a 14-day washout from an irreversible MAOI under your prescribing psychiatrist's care, you become eligible.