Ketamine is an
N-methyl-
D-aspartate (NMDA) receptor antagonist with psychotogenic and dissociative effects in healthy humans. These cognitive and perceptual
effects in humans are reportedly reduced by benzodiazepine premedication. This study assessed the interactive effects of a
ketamine (IV bolus of 0.26 mg/kg followed by an infusion of 0.65 mg/kg per hour) and lorazepam 2 mg., PO, in humans. Twenty-three
healthy subjects completed 4 test days involving the oral administration of lorazepam or matched placebo 2 h prior to the
IV infusion of ketamine or placebo. Ketamine: 1) produced behaviors similar to the positive and negative symptoms of schizophrenia
as assessed by the Brief Psychiatric Rating Scale (BPRS); 2) evoked perceptual alterations as measured by the Clinician-Administered
Dissociative States Scale (CADSS); 3) impaired performance on the Wisconsin Card Sorting Test (WCST) and other tests sensitive
to frontal cortical impairment; and 4) had amnestic effects. Lorazepam produced attention impairments, concrete proverb interpretations,
and recall impairments. Lorazepam reduced ketamine-associated emotional distress and there was a non-significant trend for
it to decrease perceptual alterations produced by ketamine. However, it failed to reduce many cognitive and behavioral effects
of ketamine, including psychosis. Further, lorazepam exacerbated the sedative, attention-impairing, and amnestic effects of
ketamine. There was no evidence of pharmacokinetic interaction between these medications. These data suggest that subhypnotic
lorazepam and ketamine show a spectrum of interactive effects, ranging from antagonism to potentiation.
Key words Ketamine - N-methyl-D-aspartate - Glutamate - Psychosis - Dissociation - GABA - Benzodiazepine - Memory - Attention - Frontal cortex - Wisconsin Card Sorting Test
Received: 1 April 1996/Final version: 20 May 1997