Nervana Medical
What are ketamine troches?
Ketamine troches are oral, dissolvable lozenges that contain a low dose of ketamine. They are designed to dissolve slowly in the mouth and be absorbed through the oral mucosa. Troches are used as part of a provider-directed ketamine treatment plan and are not the same as IV or IM ketamine.
What conditions are ketamine troches used for?
Ketamine troches may be considered for patients with conditions such as:
- Depression or treatment-resistant depression
- Anxiety disorders
- PTSD
- Chronic pain conditions
Your provider will determine whether ketamine troches are appropriate based on your medical history, symptoms, and response to prior treatments.
Are ketamine troches FDA-approved?
Ketamine is FDA-approved as an anesthetic medication. The use of ketamine troches for mental health or pain conditions is considered off-label, which is common in medical practice. Off-label use means the medication is being prescribed based on clinical judgment and available evidence, not that it is experimental.
How to take your troche:
1. Sit or lie down in a comfortable, quiet, safe place before taking your medication
2. Place the troche under your tongue (sublingual) or between your cheek and gum (buccal) as directed by your doctor
3. Let the troche dissolve slowly – do not chew or swallow it whole
4. Try to avoid swallowing your saliva for as long as comfortable to maximize absorption through your mouth
5. Keep the medication in your mouth for the full time recommended by your doctor (typically 10-15 minutes)
6. After the troche has dissolved, you may swallow normally
During and after treatment:
– Remain seated or lying down for at least 1-2 hours after taking the medication
– You may experience temporary side effects including:
– Feeling disconnected from your body or surroundings (dissociation
– Dizziness or lightheadedness
– Nausea
– Blurred vision
– Unusual thoughts or perceptions
– Increased blood pressure and heart rate (vital signs should be taken pre and post treatment)
– These effects are usually mild and temporary, typically resolving within 1-4 hours
– Have a trusted person nearby, especially during your first few doses
Can I drive or work after taking a ketamine troche?
No. Ketamine may cause impairment. Patients should not drive, operate machinery, or make important decisions on the day they take ketamine troches. Plan to rest and resume normal activities the following day unless otherwise directed.
Are ketamine troches the same as IV or IM ketamine?
No. Troches differ from IV or IM ketamine in:
- Absorption and bioavailability
- Onset and intensity and efficacy of effects
- Clinical supervision requirements
Your provider will discuss which route is most appropriate for your treatment goals.
What are the possible side effects?
Potential side effects may include:
- Nausea or vomiting
- Dizziness or lightheadedness
- Sedation or fatigue
- Anxiety or restlessness
- Headache
- Temporary increases in blood pressure
Most side effects are short-lived. Contact your provider if symptoms are severe or persistent.
Is ketamine addictive?
Ketamine has abuse potential when used improperly. At Nervana Medical, ketamine troches are prescribed at controlled doses, with careful screening and monitoring. Patients are expected to follow the treatment plan exactly as prescribed.
Will ketamine troches cure my depression or pain?
No treatment can guarantee results. Ketamine troches do not guarantee symptom relief, and responses vary. They are one component of a broader treatment plan and may work better for some patients than others.
Can I take ketamine troches with other medications?
Some medications may interact with ketamine. It is important to disclose all prescription medications, supplements, and substances you are using so your provider can assess safety.
Are ketamine troches covered by insurance?
Ketamine troches are often not covered by insurance and may require payment out-of-pocket. Our team will review costs and pharmacy coordination prior to starting treatment.
Where do ketamine troches come from?
Ketamine troches are typically prepared by a licensed compounding pharmacy. Nervana Medical coordinates prescribing, but pharmacies are responsible for compounding and dispensing.
Can I share my ketamine troches with someone else?
No. Ketamine is a prescription medication. Sharing, selling, or diverting it is illegal and unsafe and may result in discontinuation of treatment.
Before taking your troche:
– Do not eat for at least 2 hours before taking your medication
– Do not drink liquids for at least 30 minutes before taking your medication
– These restrictions help reduce nausea and improve medication absorption
– Use the bathroom before your dose, as you should remain seated or lying down during treatment
– Do not drive for at least 6-8 hours after treatment
How will my treatment be monitored?
Your provider will:
- Monitor response and side effects
- Adjust dosing if appropriate
- Review ongoing safety and effectiveness
- Determine whether continuation is appropriate
Regular follow-up is required. Dosing is typically titrated and a low dose is typically always our starting point.
Important safety information:
- Do not drive, operate machinery, or make important decisions for at least 6-8 hours after treatment
- Do not drink alcohol on the day of treatment
- Tell your doctor if you have high blood pressure, heart problems, or a history of substance use
- Contact your doctor immediately if you experience severe headache, chest pain, difficulty breathing, or thoughts of harming yourself
- Store medication securely away from children and others
- Do not share your medication with anyone else
Who can I contact with questions?
Our clinic team is available for general questions. For urgent symptoms or adverse reactions, contact your provider or seek emergency care as appropriate.
*Must live in Utah*
References
- FDA Orange Book. FDA Orange Book.
- Prevention and Management of Common Adverse Effects of Ketamine and Esketamine in Patients With Mood Disorders. Ceban F, Rosenblat JD, Kratiuk K, et al. CNS Drugs. 2021;35(9):925-934. doi:10.1007/s40263-021-00846-5.
- Safety, Effectiveness and Tolerability of Sublingual Ketamine in Depression and Anxiety: A Retrospective Study of Off-Label, at-Home Use. Hassan K, Struthers WM, Sankarabhotla A, Davis P. Frontiers in Psychiatry. 2022;13:992624. doi:10.3389/fpsyt.2022.992624.
- Oral Ketamine for Depression, 2: Practical Considerations. Andrade C. The Journal of Clinical Psychiatry. 2019;80(2):19f12838. doi:10.4088/JCP.19f12838.
- Oral Ketamine for Depression: A Systematic Review. Rosenblat JD, Carvalho AF, Li M, et al. The Journal of Clinical Psychiatry. 2019;80(3):18r12475. doi:10.4088/JCP.18r12475.