Rediscover Relief with At-Home Ketamine Troches from Nervana Medical

Are depression, anxiety, PTSD, or chronic pain holding you back from living fully? Nervana Medical now offers a convenient, affordable, and transformative solution, our Ketamine Troche (Lozenge) Program, designed for individuals seeking lasting relief from treatment-resistant mental health conditions and chronic pain, without frequent clinic visits.

What Is the Ketamine Troche Program?

Our ketamine troches are sublingual (under the tongue) or buccal (between the gum and cheek) tablets that deliver therapeutic ketamine doses safely and effectively in the comfort of your home. This monthly membership program includes:

• ✔️ Initial mental health evaluation
• ✔️ Monthly provider follow-ups and prescription management
• ✔️ Access to the Voyage Integration platform for guided support
• ✔️ Optional 1-on-1 integration coaching for deeper healing

Note: The program includes your medical care and access to integration support; the cost of medication is separate and fulfilled through a compounding pharmacy.

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Who Is It For?

You may be a good candidate if you are:

• Age 18 or older
• Diagnosed with depression, anxiety, PTSD, OCD, or chronic pain
• Have previously responded to ketamine therapy or are appropriate based on assessment
• Emotionally and psychologically stable with a supportive home environment

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Benefits of Troche Therapy

• 🏡 Convenience: Treat at home without the need for IVs or injections
• 💡 Autonomy: Manage your care with regular check-ins from our expert team
• 💊 Effective Relief: Especially for those who’ve found IV/IM ketamine helpful 🤝 Support: Ongoing integration and coaching options for personal growth

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How It Works

1. Initial Evaluation – Meet with our provider for mental health screening, consent, and setup
2. Receive Prescription – Troches are custom-compounded and delivered monthly
3. Use At Home – In a safe, quiet space, typically every 2–3 days
4. Follow Up Monthly – Track your progress, adjust dosage, and receive support
5. Integrate the Healing – Optional 1:1 guided coaching helps anchor insights into your daily life and lifetime access for 2x month of Integration coaching with Voyage (virtual with set dates).

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Safety First

Not everyone is a candidate. People with active substance use, uncontrolled psychosis, or certain medical issues may not qualify. Our thorough evaluation process ensures your safety and readiness for at-home ketamine therapy.

Start Your Journey

Get started for $300 initially and $50/month thereafter- includes your consults, ongoing care, and exclusive access to integration tools through Voyage. Medication is prescribed separately and designed for your needs. 💬 “I finally feel like myself again. I never thought a lozenge could be so life-changing.” – Actual Patient

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 Comparison: Ketamine Troches (Lozenges) vs. IV (Intravenous) vs IM (Intramuscular) Treatment Options

The efficacy of ketamine treatment varies significantly depending on the route of administration, primarily due to differences in bioavailability and onset of action.

## Bioavailability Comparison

• IV (Intravenous) ketamine has the highest bioavailability at approximately 99-100%, making it the most efficient delivery method[4][9]. This means nearly all of the administered dose reaches the bloodstream and brain directly. IM (Intramuscular) ketamine follows closely with about 90-95% bioavailability[10], while sublingual lozenges have significantly lower bioavailability at only 20-30%[10]. Oral ketamine has the lowest bioavailability at approximately 10-20%[10].

## Onset and Duration

• IV ketamine provides the fastest onset of effects, typically within 10 minutes[10], allowing for immediate relief from symptoms like depression[9]. IM injections also offer relatively quick effects. In contrast, ketamine lozenges (sublingual/oral) must pass through the digestive system and undergo liver metabolism before entering the bloodstream, resulting in a slower onset and potentially diminished efficacy[4].

## Treatment Effectiveness

• IV ketamine is often considered the “gold standard” due to its high bioavailability and rapid action[6]. Research shows it can swiftly alleviate symptoms, even reducing severe depression within hours[4]. The superior bioavailability of ketamine via infusions may result in more effective and faster-acting relief from depression and anxiety compared to other methods[4].

## Administration Control

• IV infusions offer precise dosage control, allowing for real-time adjustments based on patient response[5][6]. This level of control isn’t possible with lozenges or even IM injections. IV administration also allows providers to monitor onset reaction and adjust dosage in a timely fashion[6].

## Practical Considerations

• While IV ketamine may be more effective, ketamine lozenges offer convenience as they can be used at home and don’t require specialized equipment or staff[6]. However, this convenience comes with the trade-off of lower efficacy and less medical supervision[6]. IM injections represent a middle ground, offering high bioavailability without the need for IV access, though they may result in variable absorption rates depending on muscle mass, blood flow, and metabolism[6].

In summary, IV ketamine generally provides the highest efficacy due to its complete bioavailability and rapid onset, followed by IM injections, while ketamine lozenges offer significantly lower bioavailability but greater convenience.

• **IV ketamine** has the strongest and most consistent evidence for rapid and robust antidepressant effects in TRD, with higher absorption and faster onset[1][2][3][5].
• **Ketamine troches** are easier to use at home and may provide longer-lasting effects per dose, but their lower bioavailability means less of the drug reaches the brain, and current research suggests their antidepressant effect may be milder or less reliable than IV or IM routes[2][5].
• **IM ketamine** is fast-acting and has high absorption, but is less studied than IV for depression and also requires clinical administration[5][8].

IV ketamine is generally more effective and faster-acting for TRD than ketamine troches, which may offer convenience and longer duration but with less robust efficacy. Troches are sometimes used as maintenance or booster therapy between IV sessions[2][5]. More research is needed to clarify the long-term effectiveness of troches compared to IV and IM routes. 📞 Call Nervana Medical today or book online to schedule your Ketamine Troche Evaluation and take the first step toward reclaiming your mental wellness.     

From our Medical Director: I want to make my stance very clear on the ketamine troches- I do NOT believe they are an alternative to in clinic injections or infusions- The studies that have demonstrated efficacy in treatment for TRD are in the setting of injections or infusions and done with a series of 6 within 2-3 weeks. Troches have less bioavailability and when done at home without having gone thru the ketaverse within a clinical setting to have a better understanding of what to expect and how to prepare is something I would say is less than ideal. In my clinical opinion, troches should be utilized as a more cost effective approach for patients who have completed a series and need more maintenance intervention at a more cost effective solution. It should not be a substitute for maintenance injections/infusions but rather used in addition with hopes to increase the duration of time between maintenance treatments. Appropriate patient selection is key- Sources

• [1] Ketamine Infusion, Injection, Nasal Spray, or Oral Lozenge https://www.breakthrupsych.com/iv-ketamine-infusion-injection-nasal-spray-or-oral-lozenge/
• [2] Efficacy of IV Ketamine vs Lozenges https://nwketamineinfusion.com/efficacy-of-iv-ketamine-vs-lozenges/
• [3] IV Ketamine vs. Ketamine Lozenges: Which Is Best? https://www.ncinstneurohealth.com/iv-ketamine-vs-lozenges-which-is-best
• [4] IV vs. Oral Ketamine: Why Route Matters | Principium in NYC https://www.principiumpsychiatry.com/blog/iv-vs-oral-vs-intramuscular-vs-intranasal-ketamine-why-route-matters/
• [5] IV Ketamine Infusions vs. Intramuscular (IM) Ketamine Injections https://www.klarisana.com/blog/iv-ketamine-infusions-vs-intramuscular-im-ketamine-injections-whats-the-right-choice-for-you/
• [6] Understanding Different Types of Ketamine Therapy: Pros and Cons https://stellamentalhealth.com/resources/different-types-of-ketamine-therapy
• [7] IV VERSUS IM KETAMINE https://utahketamineinfusions.com/iv-versus-im-ketamine/
• [8] Ketamine Troches vs. IM/IV Injection in Durango, CO: What’s Right … https://elevatedmedicine.org/ketamine-therapy/research-and-innovations/latest-findings/ketamine-troches-vs-im-iv-injection-in-durango-co-whats-right-for-you/
• [9] Three Main Routes of Ketamine Administration https://theremedymn.com/ketamine/
• [10] The Many Ways to Receive Ketamine – EntheoTech https://entheotech.ca/blog/2022/02/02/the-many-ways-to-receive-ketamine-comparing-routes-of-administration/
•  Oral Ketamine in Treatment-Resistant Depression https://pmc.ncbi.nlm.nih.gov/articles/PMC5491240/
• IV vs. Oral Ketamine: A Comparative Analysis https://www.discreetketamine.com/resources/iv-vs-oral-ketamine-for-treatment-resistant-depression-a-comparative-analysis
• Ketamine Infusions and Oral Ketamine: A Comparison of 2 … https://voyagehealing.com/ketamine-infusions-vs-oral-ketamine/
• Comparative Effectiveness of Intravenous Ketamine and Intranasal … https://pubmed.ncbi.nlm.nih.gov/36724113/
• What is Ketamine and How Does it Work? https://avestaketaminewellness.com/what-is-ketamine-and-how-does-it-work/
• Switching From IV Ketamine to SPRAVATO or Vice Versa https://www.jnjmedicalconnect.com/products/spravato/medical-content/switching-from-iv-ketamine-to-spravato-or-vice-versa
• The Difference Between Ketamine and Esketamine (Spravato) for … https://www.midcitytms.com/the-difference-between-ketamine-and-esketamine-spravato-for-depression-treatment/
• Understanding the Different Types of Ketamine Treatments https://www.cambridgebiotherapies.com/understanding-the-different-types-of-ketamine-treatments/

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