Compounded ketamine nasal spray is a well-known dosage form and contains a different isomer than the commercial ketamine nasal spray, therefore has different advantages. Compounded ketamine does not require office administration like the commercial product.

Rapid onset: 5-10 mins

These dissolve faster than larger troches. One tablet may be cut into four pieces for flexible dosing, allowing easy titration. Directions: Dissolve tablet(s) in the mouth (on the tongue).

Troches are small lozenges that can be placed and dissolved between the cheek and gum (buccally) or under the tongue to deliver medication. Troches should not be chewed or swallowed. Medication delivered this way is absorbed quicker than taking medication orally. Ketamine is naturally very bitter. Therefore, we add sweeteners and flavors to mask the bitterness. The higher the dose, the harder it is to mask the bitterness.

A good option for those sensitive to the taste of ketamine in all other dosage forms. The absorption and onset are slower than troches.

Variable onset: 30 mins-hours

It can be used orally or sublingually, depending on the concentration and dose desired.

The advantage of using a solution is that it has a quick onset, and it is also easy for the doctor to make dosage adjustments without the patient needing a new prescription compounded. The disadvantages are that a liquid is less convenient and has a shorter expiration date than other dosage forms.

These troches can be divided in 4’s so the patient can adjust the dose as directed. Directions: Dissolve (¼, ½, ¾, or one) troche under the tongue or between the cheek and gum, as directed.