Ketamine Uses
Ketamine is a Schedule III non-narcotic drug, which means it has a moderate to low potential for physical or psychological dependence. Its main use is as a dissociative anesthetic. Users will feel sedated, calm, and relaxed. It can give a slightly euphoric state as well as provide pain relief, which is why it is becoming more widely used for depression and chronic pain.
Depression
Ketamine has become a viable alternative to SSRIs. It takes a different approach and influences the brain in a different manner. While SSRIs help the brain produce more serotonin in order to create “good feelings,” ketamine instead interacts with glutamate. This neurotransmitter plays a role in our learning, memory, and development of neural connections.
Ketamine also works more quickly than SSRIs. Ketamine patients can experience an improvement in depressive symptoms within 24 hours, while SSRIs may take months for patients to feel relief.
Many patients who fail multiple SSRI cycles have tried ketamine and found success.
Chronic Pain
Ketamine influences our brains in a variety of ways. Though much of it has not been established, recent studies show its effects on chronic pain. Ketamine has anti-inflammatory effects, which help provide relief from pain. It primarily works by inhibiting the N-methyl-D-aspartate (NMDA) receptor. Ketamine can provide short-term (immediate) as well as long-term (3 months+) pain relief.
2 Types of Ketamine Nasal Spray
Ketamine nasal sprays have become widely used due to their positive results in providing depression relief. There are two options available for nasal spray: traditionally prescribed or compounded nasal sprays.
Traditionally Prescribed Esketamine Nasal Spray
Due to its recent success, the FDA approved the first product (Spravato) using the S-enantiomer of ketamine in a nasal spray. This enantiomer was chosen because it has a stronger interaction with NMDA glutamate receptors. Spravato is designed to deliver small amounts of esketamine intranasally. Each spray contains 14 mg, and each device contains two sprays.
Patients are required to take ketamine under a doctor’s supervision. This means taking it in a doctor’s office or a similar setting. This allows the doctor to observe any side effects, including shortness of breath and hallucinations. Depending on the doctor’s recommendations, patients will take 56 mg or 84 mg per application.
For the first 4 weeks, ketamine is administered twice per week. For the next four weeks, it is administered once a week. After that, it may be administered every other week. This, of course, is dependent on guidance from the doctor.
Compounded Ketamine Nasal Spray
Compounding pharmacies can compound ketamine nasal spray for people suffering from depression. Compounding the nasal spray allows us to produce the medication without preservatives like benzalkonium chloride. Without preservatives, proper storage will be more important, and it may be necessary to take smaller doses.
The nasal sprays can also be made into any dosage size, not just limited to two 28 mg per bottle. The concentration and size can all be customized at the direction of the prescriber. Probably the most important distinction between compounded and traditionally prescribed ketamine is the ability to take the medication at home. While patients would need to be directly under doctor supervision when traditionally prescribed, compounded ketamine patients can take the medication in the comfort of their own homes.
How Much Does Ketamine Nasal Spray Cost?
Prices will vary depending on insurance and the location of purchase. Spravato nasal sprays can go for $729.40 (56 mg dose) or $1,089.35 (84 mg dose). Compounding pharmacies will have different prices often under $100 for 30 ml.
Do I Need a Prescription for Ketamine Nasal Spray?
Yes. Ketamine is a Schedule III non-narcotic drug and is not available over the counter. A prescription from a medical provider is required. Doctors can write a traditional prescription for Spravato or a compounding pharmacy.
Do I Need a Prescription for Ketamine Nasal Spray?
Full doses of ketamine can cause hallucinations and powerful euphoric feelings. Nasal sprays, however, contain doses low enough to not cause hallucinations. In fact, side effects are usually very mild because of how small the dose is. Side effects include dizziness, forgetfulness, vomiting, slowed breathing, and others. Ketamine nasal sprays can be compounded with other active ingredients that reduce side effects.
Should I Take Ketamine?
Ketamine continues to show positive results providing relief for depression. Studies have shown its propensity to alleviate treatment-resistant depression. Only you and your doctor can decide whether ketamine is a good fit.
Rachel Burns, PharmD
Lead Pharmacist, ClearSpring Pharmacy
