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The latest research, learnings, and insight on mental health.
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The latest research, learnings, and insight on mental health.
Ketamine, originally known as a powerful dissociative anesthetic, has gained recognition for its ability to treat a variety of conditions, including depression, anxiety, and chronic pain.1 As its applications continue to expand, it's essential for patients and caregivers to understand the different ways ketamine can be administered. In this blog post, we'll break down the differences between intravenous (IV), intramuscular (IM), sublingual (SL), intranasal (IN) formulations, and more. We'll also explore their effectiveness to help you make informed decisions about treatment.
IV ketamine is the most common and well-studied method of administration. It involves injecting the drug directly into the bloodstream through a vein. This allows for precise dosing and rapid onset of effects, usually within minutes. IV ketamine is typically administered in a clinical setting under close supervision, ensuring patient safety and comfort. Studies have shown that IV ketamine is highly effective in treating conditions like depression and chronic pain.1
IM ketamine is injected directly into a large muscle, such as the thigh, arm, or buttock. The drug is absorbed into the bloodstream slightly more slowly than with IV administration, leading to a longer onset time and a longer duration of effects.2 IM ketamine is often used in emergency situations but can also be an option for patients who cannot tolerate IV treatment. Its effectiveness is considered comparable to IV ketamine.3
SL ketamine is administered by placing a tablet or lozenge under the tongue, where it dissolves and is absorbed into the bloodstream. This method avoids the need for needles and can be more convenient for some patients. However, the onset of effects is minutes slower than with IV or IM ketamine, and the dosing can be less precise. Research on SL ketamine is still limited, but preliminary studies suggest it may be equally effective as IV or IM ketamine for some conditions.4
IN ketamine is delivered through a nasal spray, making it a needle-free and non-invasive option. It has a rapid onset of effects, similar to IV administration, but with the convenience of at-home use.4 IN ketamine has been FDA-approved for treatment-resistant depression under the brand name Spravato.5 Spravato contains only the S-ketamine enantiomer (form) of ketamine, whereas compounded IN ketamine contains racemic (S- and R-ketamine forms) ketamine. Studies have shown it to be effective, but it may not work for all patients, and its long-term safety has not been fully established.5
While IV, IM, SL, and IN are the most common ketamine formulations, other less frequently used formulations include oral and rectal administration. However, these methods are less well-studied and may have limitations in terms of bioavailability and effectiveness.
Oral ketamine is taken in the form of a pill or liquid solution. Although this method is non-invasive and convenient, it has several drawbacks. Oral ketamine has lower bioavailability, meaning that a smaller proportion of the drug is absorbed into the bloodstream compared to other administration routes [6]. Furthermore, the onset of effects is slower, and the drug may undergo first-pass metabolism in the liver, potentially reducing its effectiveness [7]. Research on oral ketamine is limited, and its use in clinical settings is less common.
Rectal ketamine is another alternative administration route, typically involving the use of a suppository. Although this method may offer some benefits, such as avoiding first-pass metabolism and allowing for relatively rapid drug absorption, it is less commonly used in clinical settings [7]. Studies on rectal ketamine are scarce, and its efficacy and safety profile remain less well-established compared to other formulations.
The effectiveness of ketamine is influenced by factors such as administration route, individual patient characteristics, and the specific condition being addressed. Among the most extensively researched and commonly used formulations are IV, IM, SL, and IN ketamine. Alternative methods like oral and rectal ketamine are less studied and may exhibit limitations in bioavailability and efficacy. It is crucial to conduct ketamine therapy under the supervision of a qualified healthcare professional who can evaluate individual needs and oversee treatment progress. As research advances, our comprehension of ketamine formulations and their effectiveness is anticipated to broaden, resulting in more customized treatment options for those who require them.
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