In selected cases, following a ketamine treatment series, we (client and physician) decide to initiate oral ketamine. Oral ketamine is not designed to replace IV infusions but is used to extend the duration of the benefits of IV infusions. Typically, oral ketamine is administered in lozenge form. For unclear reasons, they are referred to as “troches” (pronounced trochees). Intranasal preparations are also possible but less commonly used due to variable absorption. For those who cannot tolerate the oral troches because of their taste or side effects such as nausea, rectal suppositories are also available at certain compounding pharmacies.
The decision to initiate oral ketamine is based on several factors, including the patient’s response to initial IV infusions, the severity of presenting symptoms, and the extent and duration of symptomatic improvement. The initial dosage is typically 2-2.5 times the optimal IV infusion dose. For most clients, we recommend starting at 2-3 times a week, often taken before bedtime. In certain cases, oral ketamine can be activating, not sedating. In these instances, it is recommended to take the ketamine troches earlier.
We understand that the oral lozenges taste terrible. One client recently suggested, “Tell future clients that they taste horrible, but once you get used to them, they taste like relief.” The oral troches are not to be used (except in some instances) on an as-needed basis. In other words, if you are feeling stressed out or depressed, don’t reach for an oral troche. To promote continued neuroplasticity and changes in brain chemistry, the lozenges should be taken regularly at a schedule and dosage to be discussed with Dr. Rosen. The ideal dosage lets you relax into a different head space while remaining calm and meditative. Ideally, it would be best if you tried to recreate a “clinic-like experience” with good music or a guided meditation. The experience with oral troches is different from what you have experienced with IV infusions. It is not as intense. For those who have had alcohol in the past, it should feel like you have had a glass of wine. Breathwork is essential to help ensure a positive experience. DO NOT text or play with your cell phone. DO NOT mix with other drugs (such as marijuana or alcohol). It is often helpful to block out extraneous noise or light with noise-canceling headphones and eye shades. For those of you who are experimenting with Virtual Reality, some programs may enhance the experience. Be aware; however, distractions may sometimes diminish “the work” that often accompanies the ketamine experience. As always, feel free to reach out to our clinic staff for additional questions or guidance.
PLEASE BE ADVISED: AS KETAMINE IS A CONTROLLED SUBSTANCE, WE CANNOT REFILL/MODIFY PRESCRIPTION SCHEDULES AHEAD OF REFILL DATES WITHOUT AN APPOINTMENT/CONSULTATION.