Ketamine is an anesthetic, blocker or antagonist of NMDA receptors, commonly used in veterinary medicine. Ketamine is also a 'club drug”, an hallucinogen and a dissociative drug used for recreation. The continued consumption leads to tolerance and dependence, in addition to cognitive and psychiatric disorders. The abuse and dependence on ketamine requires a multidisciplinary approach, combining medical, psychological aspects and social support. Its pharmacotherapy is not yet established.

Analyze the utility of paliperidone palmitate in the treatment of ketamine dependence through a clinical report.

We report the case of a 38-year-old man diagnosed with borderline personality disorder (BPD). Multi-drug consumer with serious ketamine addiction up to 5-6 g/day and a ketamine-induced cystopathy at risk of losing his bladder. History of various admissions to the psychiatric unit and hospital detoxification unit without success. Last year starts treatment with paliperidone palmitate in increasing doses from 75 to 150 mg combined with bupropion in high doses with clinical improvement and ketamine withdrawl.

From the start of treatment the patient is abstinent of ketamine. Impulsivity and dysphoria have improved and suicide ideation has gone. Subjective assessment of treatment is very good.

Treatment for ketamine addiction is a multidisciplinary issue. Pharmacotherapy is not well defined but Paliperidone palmitate may be useful in drug dose-reduction and maintaining abstinence.