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. Author manuscript; available in PMC: 2024 Jun 1.
Published in final edited form as: Pharmacol Ther. 2023 May 3;246:108431. doi: 10.1016/j.pharmthera.2023.108431

Figure 1. Chemical structure of (S)- and (R)-ketamine and their metabolic pathways.

Figure 1.

(S)-ketamine and (R)-ketamine are metabolized in a stereoselective manner by P450 liver enzymes. The enantiomers are first metabolized to their norketamine counterparts through nitrogen-mediated demethylation. Subsequent metabolism leads to dehydroxynorketamine (DHNK) or hydroxylation to hydroxynorketamine (HNK). Each enantiomer can also be metabolized to hydroxyketamine, another intermediary step for HNK.