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Why does Victory Clinic use nasal esketamine or ketamine for treatments?

Nasal esketamine and nasal ketamine are usually very well tolerated by people with treatment resistant depression and result in a high rate of remission from depression. An advantage to the nasal route is that it is less invasive and less painful for the patient than a treatment by either IV (intravenous) or IM (intramuscular injection) routes. This is particularly true since patients receive multiple treatments (8 total in the first 4 weeks).

Wouldn’t an IV or shot be more effective?

Nasal esketamine and nasal ketamine are very well absorbed through the nasal mucosa and are dosed to give an equivalent bioavailability to what would be in the IV or shot dose. Patients who have experienced ketamine by IV or shot often report a very similar effect with nasal esketamine or nasal ketamine.

What about oral ketamine?

Ketamine can be formulated into a lozenge, which are typically very low dose. Also, the oral forms have an extremely low bioavailability. This means that the body doesn’t absorb much of the ketamine medication in the oral form. Ketamine lozenges probably are not much more than placebo. Even so, we do not recommend using any form of ketamine, including oral lozenges, outside of the medical setting due to potential for sedation and other side effects.

Is there a difference between esketamine and ketamine?

Chemically, esketamine is the left-handed isomer of the ketamine molecule.  Sometimes for medical and/or financial reasons, the medical provider will recommend ketamine rather than esketamine. When nasal custom compounded ketamine is prescribed, the dosing gives the patient an approximate equivalent of the esketamine in the branded SPRAVATO® treatment.

Is there a difference between the ketamine and SPRAVATO® treatment protocols?

Patients at Victory Clinic who receive either nasal esketamine (SPRAVATO®) or generic nasal custom compounded ketamine are observed under a similar protocol for at least 120 minutes, which includes frequent blood pressure checks. It is recommended that patients do not eat for 2 hours prior to treatment and do not drive or operate heavy equipment for the rest of the day after a treatment.

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