How to Prescribe Ketamine Topicals

Effective January 2, 2020, Rhode Island prescribers must sign and transmit electronic prescriptions in schedules II, III, IV, and V to comply with RI Law §21-28-3.18 section 3.

How to Electronically Prescribe Ketamine Topicals

1. Select Ketamine (bulk) powder as the drug.  The drug selected needs to be a controlled substance
2. In the instructions, directions, or notes field, please indicate:
   a. The concentration of the preparation
   b. The directions (ex. Apply 1ml three times daily)
   c. An ICD-10 diagnosis code
   d. A quantity of dose units dispensed. Federal law prohibits more than 100 dosage units
   e. Refills (maximum of 5)
3. Do not use the name brand (Ketalar®) when prescribing Ketamine containing compounds

The prescription needs to be sent by the prescriber with the controlled substance selected as the active drug for the Electronic Prescriptions for Controlled Substances (EPCS) signature to be validated.

Most Common Formulations

Here are the most requested formulations of this controlled compound:

• Ketamine HCl 5%/Gabapentin 10%/Clonidine HCl 0.2%/Baclofen 2% Topical Lipoderm®
• Diclofenac Sodium 10%/ketamine HCl 10%/Gabapentin 6%/Verapamil HCl 6% Topical Lipoderm Activemax®
• Ketamine HCl 10% Topical Lipoderm®
• Ketamine HCl 10%/Amitriptyline HCl 5% Topical Lipoderm ActiveMax®
• Ketamine HCl 10%/Baclofen 2%/Cyclobenzaprine HCl 2%/Gabapentin 6%/Lidocaine 5% Topical Gel (PermE8 Anhydrous)
• Ketamine HCl 10%/Diclofenac Sodium 8%/Gabapentin 6%/Baclofen 2%/Cyclobenzaprine HCl 2%/Bupivacaine HCl 1% Topical Lipoderm ActiveMax®
• Ketamine HCl 10%/Gabapentin 6%/Amitriptyline HCl 5%/Baclofen 2% Topical Lipoderm ActiveMax®
• Ketamine HCl 10%/Gabapentin 6%/Clonidine HCl 0.2%/Lidocaine 2% Topical Gel (PermE8® Anhydrous)
• Ketamine HCl 10%/Gabapentin 6%/Diclofenac Sodium 3%/Baclofen 2%/Cyclobenzaprine HCl 2%/Bupivacaine HCl 0.5% Topical Lipoderm®
• Ketamine HCl 10%/Gabapentin 6%/Lidocaine 3%/Nifedipine 2%/Piroxicam 2% Topical Lipoderm®
• Ketamine HCl 10%/Gabapentin 6%/Lidocaine 5%/Baclofen 2%/Cyclobenzaprine HCl 2% Topical Lipoderm ActiveMax®
• Ketamine HCl 10%/Gabapentin 6%/Lidocaine HCl 2%/Clonidine HCl 0.2% Topical Lipoderm®
• Ketamine HCl 10%/Gabapentin 6%/Nifedipine 2%/Clonidine HCl 0.2% Topical Lipoderm®
• Ketamine HCl 10%/Gabapentin 6%/Nifedipine 2%/Tizanidine HCl 0.2% Topical Lipoderm ActiveMax®
• Ketamine HCl 10%/Gabapentin 6%/Orphenadrine Citrate 5%/Diclofenac Sodium 3%/Cyclobenzaprine HCl 2%/Tetracaine 2% Topical Lipoderm ActiveMax®
• Ketamine HCl 10%/Nifedipine 10%/Gabapentin 6%/Pentoxifylline 5%/Lidocaine 3%/Prilocaine 3% Topical Lipoderm ActiveMax®
• Ketamine HCl 30% Topical Lipoderm ActiveMax®
• Ketamine HCl 4%/Ketoprofen 10%/Lidocaine 2% Topical Gel (PermE8® Anhydrous)
• Ketamine HCl 5%/Gabapentin 10%/Clonidine HCl 0.2%/Baclofen 2 % Topical Lipoderm ActiveMax®
• Ketamine HCl 5%/Gabapentin 10%/Clonidine HCl 0.2%/Baclofen 2% Topical Gel (PermE8® Anhydrous)
• Ketamine HCl 5%/Gabapentin 10%/Tizanidine HCl 0.2%/Baclofen 2% Topical Lipoderm®
• Ketamine HCl 7.5%/Gabapentin 10%/Baclofen 2% Topical Lipoderm®
• Ketoprofen 10%/Ketamine HCl 4%/Lidocaine HCl 2% Topical Lipoderm®
• Ketoprofen 10%/Ketamine HCl 5%/Amitriptyline HCl 2%/Baclofen 2% Topical Lipoderm®
• Ketoprofen 20%/Amitriptyline HCl 2%/Guaifenesin 2%/Ibuprofen 2%/Ketamine HCl 2%/Clonidine HCl 0.2% Topical Lipoderm®