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Ketamine Therapy: Infusion, IM injection, nasal spray or oral?

Updated: Nov 19, 2023

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When it comes to ketamine therapy, there are more options now than ever before.


The mental health benefits of ketamine therapy were first discovered around twenty years ago by researchers at Yale administering intravenous (IV) ketamine. Since that time, the vast majority of research and clinical practice has focused on the use of IV ketamine.


But in the last few years, there has been increased interest in other ways of administering the medication, such as a quick injection in the upper arm (intramuscular), nasal spray (intranasal), or by mouth (oral). Each method has its pros and cons.

ketamine routes of administration comparison


Experience


IV infusion: Leads to steady levels of ketamine in your system during treatment, producing the most predictable, consistent and smooth experience. Most patients can achieve psychedelic dissociation. The infusion was the first and most studied way of ketamine administration.


Intramuscular Injection: The level of medication in your system quickly increases, producing a more intense experience. This can be a positive or a negative.


Intranasal (ex: Esketamine or Spravato):

The experience can vary each session based on absorption (for example, a stuffy nose might prevent you from absorbing the medication well).

The experience varies significantly for each person based on the way their body absorbs and metabolizes the medication. Around 70% of the medication is lost to metabolism.


Oral (ex: lozenges, troches)

The experience is much more mild than the infusion or the intramuscular administration. Most patients will not have a psychedelic experience. Around 70% of the medication is lost to metabolism.


As you can see, IV ketamine has the most evidence behind it and creates the most predictable and customizable experience during treatment sessions. It is the “gold standard” of ketamine therapy. At Propel Therapeutics, we recommend IV ketamine for most patients. We also offer intramuscular ketamine for patients who prefer this option.


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