and side effects experienced by folks that have tried this? A compound pharmacy gave me 100mg to try, but I am always apprehensive about trying something new for fear of how my weirdo body reacts to things. I don't have official diagnosis but it seems like I have RSD. Could it help depression too? I've read there has been some success, but I don't know if nasal form would be the same.
How does Ketamine nasal spray work for pain, and is there problems?
Question posted by Anonymous on 11 July 2012
Last updated on 21 May 2024
6 Answers
drtracyharrison
22 May 2022
I am an anesthesiologist, pain physician, and Hospice and Palliative Medicine board-certified physician.
As of May 2022, commercially available intranasal ketamine is restricted for use in a health care setting and 2 hours of observation is required to evaluate your safety. This applies to every administration episode of the medication as there are problematic side effects that can be unsafe and worsen your symptoms. Some pharmacies will compound ketamine but even less is known about the safety of that formulation. While the commercially available ketamine is FDA approved, this is not true for the compounded medication.
Indication for intranasal ketamine is treatment-resistant major depressive disorder (MDD).
Many health care providers are not aware of these safety restrictions but nonetheless, patients are 'being prescribed' these products possibly unaware of the potential harms with permission to take this at home. This recommendation is outside the recommendations made by the pharmaceutical company and could be very risky.
Be careful when your doctor is prescribing medications and ask these questions:
1-what are the expected benefits and how long will they last?
2-is the medication safe to use?
3-what are the side effects and what should I look out for?
4-is it safe for me to drive after taking intranasal ketamine (FYI, it is not).
5-how long will I need to be on this medication?
6-what other strategies/therapy should I use for treatment of my depressive disorder?
I hope this is helpful.
Ciabella
31 March 2023
Thank you so much your comment answered a lot of my questions . I have went to a clinic in NJ twice to do the spravato nasal spray .. They observed me well took my blood pressures every 20 min ,I noticed that each time the nurse came in & took my blood pressure it would spike higher each time that scared me ,especially since my BP is almost always 120/80 to 125/85 .. I read that other people were getting it through a pharmacy then I tease what u said .. - they can’t anymore ,and maybe that is best ,because for me I definitely needed the monitoring Thx
marlainesews
2 April 2023
Thank you very much for your comments. I am looking into ketamine nasal spray for Trigeminal Neuralgia pain that has been non-responsive to a long list of meds and 2 surgeries. I would appreciate your general comments about cognitive side effects or a link to a site that describes side effects as it relates to use for pain. One medical expert in the field suggests up to 24 puffs of compounded Ketamine 100mg/ml. Most info I find is about treatment for depression. It would be so nice to get enough pain relief to function and still function; if you know what I mean. Again many thanks for taking the time to make your previous comments. It is very difficult to find a doc who has expertise in pain management for facial pain.
Annamarialucania
5 days ago
First, thank you very much for the true information which you provided. Since this is your speciality, you would have a vast amount of knowledge more than any other specialist MD on this subject. I live in Florida. My neurologist prescribed this for me about 2 years ago from a compound pharmacy without any instructions for observations. At first, I just felt strange taking this med and didn't feel any relief from pain. My MD encouraged me to take it in the evening before bed for pain and insomnia. Now, last year I did have 4 titanium discs put in my cervical spine and a fairly large metal plate which did reduce the pain. It was done to prevent spine compression. I would never drive on this med. I'm now taking Lyrica which has been a miracle medication for all of the unbearable pain. I don't know if you contact anyone back, but do you think I should discontinue the Ketamine?
DLM2004
28 April 2020
I had the ketamine infusion in my psychiatric Aprn's office, which is the only way you can be given ketamine by infusion aside from the nasal spray. However, because I don't have the time or even access to my doctor in person now in order to have infusions due to the pandemic, I thought the spray might be available by prescription but all I can find in PA are clinics that give it in their office. So, I'm surprised to read that some of your have been able to find doctors that allow you to take it at home. Does anyone know of a doctor in PA that allows for home use? I had it for TRD and then the pandemic hit so I was only given one treatment and then just left to wait...
snoop176
5 June 2020
Delware Valley Pain & Spine Institute - Dr Bromberg is my CRPS specialist. He prescribes the ketamine nasal spray from a Compounding pharmacy. It helps me a lot, however is very short lived at only a very hours at a time when I take it.
LanceCarb
30 Oct 2019
kaismama: Great answer, thank you. One note to make though (and it just may have changed since you wrote that); ketamine nasal spray CAN be refilled without needing a new ‘script (at least in PA.) I get a paper script every few months and it’s good for 2 refills.
Crazy Cajun Angel
1 Sep 2018
I was prescribed compound ketamine nasal spray 100mg/ml on 7/21/18 one spray every 4 hours. This was prescribed to me by a headache specialist on my first visit. I have had a migraine for 18 months. Tried everything available. I am also in pain management for my neck and back (opiates), tried all migraine rx’s, IV’s, Botox, occipital nerve blocks, etc etc... I started getting some relief pretty quick using this. One month later 8/21/18 went back to same dr. And was prescribed same except now I can have one spray per nostril (2) every 4 hours. I’m not cured of pain, but it definitely helps! side note... for my migraine... anew drug came out a couple of months ago and my first RX of it will be given to me the day after Labor Day. The specialist I saw was trained by the best at Diamond Clinic and told me none of my meds preventive and abortive would interfere with this medication. My experience- I would recommend it. Try it if it does not work for you stop. Best wishes for a pain free life for all of us!
Ciabella
31 March 2023
Hi I just saw ur post . I started w the spravato nose spray at a clinic in NJ I have similar problems like urself . I did ok w the nose spray , what I was not comfortable with was the Two hours after the clinic I had to sit there . ( I understand for safety reasons ) my blood pressure went up a bit ,,, My appointment was at 1:00 in New Jersey ,& I did not get back to NY which is only a half hour 40 min from my house till almost 5:00-5:30 my whole day was shot . To me I felt stressed out . I am going to try to find a place where u can take it home or call the clinic I went to & see if they give you the spray to bring home after a certain amount of time .. thx I wish u the best
matthewmucci37
13 May 2018
Hi my doctor recently prescribed me Ketamine Nasal Spray 60mg every other day to start to see how I respond. First dose was done in the office. It's compounded and the doctor was able to just call it in. I am also afraid to start/try new things as sometimes I will have the opposite reaction. Anyways, it's 10mg per spray which is 6 sprays per dose. I seemed to tolerate the initial dose ok while in the office. I felt really good for two hours, but then I started feeling miserable again, but it got better as the day went on. I kept taking it but honestly the week before I started using it was better. Every time I take it, the first two hours I feel good but then I feel worse. I was told what I would feel in the first two hours were side effects and the antidepressant effect could start later that day or in a few days. I am due for another dose tonight but I am not taking it for a few days to see how I do without it.
I am on other meds which my doctor is aware of except a new one Fioricet, which I take in the morning so I am not sure if this is interfering, or maybe the starting dose of 60mg is just too high for me. I may try it again at only 10mg to see and not take the Fioricet in the morning.
kaismama
11 July 2012
Ketamine is an anesthetic that works by interrupting pathways in the brain to inhibit pain sensation. It can effect your cognition, causing confusion and hallucinations. It can interact with barbituates and narcotics. It reacts badly with amiodarone. I'm assuming your pharmacist considered any medications you are on before giving it to you. I found this on the spray specifically:
ketamine Nasal Spray
What Is It?: Ketamine, or ketamine hydrochloride, is a non-barbiturate, rapid-acting disassociative anesthetic used on both animals and humans. It may be compounded into topical/transdermal creams for the local treatment of pain. It may also be compounded into nasal sprays or drops for more generalized pain relief. Ketamine is only available by prescription.
How To Use: The compounded sprays and drops are usually ordered for the management of pain. Use as directed and only as frequently as prescribed. Additional use increases the risk of side effects and addiction. Do not increase your dose or stop abruptly without direct approval from your doctor.
Possible Side Effects and Warnings: While low doses of Ketamine can increase heart-rate, at higher doses it depresses consciousness and breathing and is extremely dangerous to combine with other depressant items like alcohol, Valium or GHB. Frequent, un-prescribed use can cause disruptions in consciousness and lead to neuroses or other mental disorders. Ketamine can cause psychological dependence (addiction.)
Storage: Keep in the original container. Keep out of the reach of children and pets. May be stored at room temperature. Some liquids should be stored in the refrigerator (see your prescription label.) Store all medicines away from excess heat and moisture. Do NOT store in the bathroom.
Note: Prescriptions for ketamine are not refillable. The pharmacy needs a new prescription for each order.
Inactive
12 July 2012
Your answer was EXTREMELY helpful, and you took so much time to answer me! After using it, I don't feel so good. I felt extremely depressed and still do. I don't think I will use it again. I had such high hopes, but this is too risky and as bad as I feel right now... I was depressed enough before I did the nasal spray. Thank you so much.
kaismama
13 July 2012
You're welcome. Its important for all the info when trying a med. Prevents disasters and law suits, lol
Lilpnutvt1972
9 July 2014
I have been I it for rsd/crps and it helps me feel a little better makes me relax and sleepy. I'd recommend it to people
lynne3865
22 Jan 2015
Ketamine cream is safe. I wouldn't worry about the side effects... I'd try it slowly... and ease into it. Everyone is different and everyone experiences pain relief and side effects differently. It CAN in certain DOSES cause problems but they are short lived as far as I've heard. I'm not a doctor... I'm a patient. I would LOVE to try it. My doc is conservative so I doubt I'll be able to get it.
lynne3865
22 Jan 2015
I'd love to know the pharmacy you said gave you some to TRY. I live in Ohio. Any chance of me getting to try this... would be so appreciated. I'm not talking about illegal misused drugs. I'm talking about intractable pain relief. Again the cream helps a little bit... but not for long. A few minutes but sometimes pain is so bad... I'll take the few minutes. :(
bmblue
18 Oct 2016
Agreed, however, use of ketamine NASAL spray which is titered down to the level the individual needs carries with it very few if no side effects. The dosages via the nasal spray are so small as to invoke no side effects when used as directed. This route of administration is easy and safe for the patient, however, it must be prepared for the patient by a COMPOUNDING pharmacy per RX. The cost of $56/mo. for me (a bargain) is low, one may have to pay around $75 in some pharmacies, insurance does not yet pay. I'm
just starting, but seem to be getting consistently good results.
OklahomaRed
5 July 2017
I have been taking Ketamine nasal spray 6 weeks for maintenance of the antidepressant effects of a 3 week IV Ketamine infusion treatment and to stop muscle spasm from MS that have plagued me for 35 years. By stopping the spasms it stops the pain. It also controls the pain of other crap I have accumulated over nearly 75 years.
I take 100 mg in 4 1/4 ml doses twice per nostril up to 3 times a day. I convinced my psychiatrist to prescribe it after 4 or 5 years when I found a clinic and took 6 IV Ketamine infusions for depression.
that were successful. My drug store make it up for $45 bucks a month.
I feel a lot like you describe when I take it only I feel less depressed after I take it. The time I feel out of it gets shorter with time. It almost completely does away with the muscle spasms and pain from them that were driving me slowly to suicide if I use it 3 times a day. I am OK most days with using Ketamine twice a day and 1 OK some days I can skip a day.
The only side effects I have are the bitter taste and the hour or so I don't drive after I take a dose. If I over exercise muscle spasms bite me back hard but it gets better with exercise. I try to not swallow and any Ketamine but spit it out as drains down my throat. It doesn't seem to bother my stomach if I swallow it.
Ketamine is not psychically addictive. It doesn't stay in your system long enough and it just does't work that way. The dosage for pain and depression it to low to induce hallucinations other that a possible night mare of you fall asleep after you take it. The night mares aren't that bad for me.
All of us are different and my pain and problem are different from yours, so our experices may or may not relate to each other.
Phyllisneridn
31 July 2017
Ketamine is not working for me at all. My pain doctor is pushing for me to get the infusions, but why do that if the nasal spray isn't working? Why bother?
bmblue
31 July 2017
My answer is to Philliser... (whatever... ): I've found it takes a long learning curve to know just how to use Ketamine Nasal spray best for YOU. When I started I really wasted it using too much, or too soon after the last dose. For ME, it's best to take one does (two sprays per nostril) each 30 minutes up to three half hour periods for pain. If that much doesn't work, then it just isn't going to work even with a lot more. Three doses in 1 1/2 hours is a lot of Ketamine, and actually one or two work for my pain normally. Make sure you are holding a constant position with the head slightly tilted forward, as if reading something (reading is a good activity after spraying): the reason is it will just run down the back of your throat and be uselessly digested when in the stomach. If some does run down anyway, then try to capture it with some saliva which you then retain in your mouth, swishing it around until the Ketamine is absorbed.
Really BITTER stuff, but WTF! Any pain medication is best used prophylactically in anticipation of a pain episode. One can sometimes develop a sensitivity to oncoming, increasing, pain and take doses of Ketamine to minimize it. If the pain is already revere, then the Ketamine will not be as effective as it is too late. I am having episodic pain, so far, and this works for me. If you have constant severe pain, then you will have to develop your own style of dealing with it.
daisybear8049
17 Sep 2017
Someone stated that since nasal spay did not work, afraid to try IV. The IV works best for extreme flairs. B/c of side effects with other conditions I have outside of my RSD, I very rarely take my spray, and only do infusions when having surgery or something that can flair the neuropathy with the severe burning pain. But, the IV is still worth trying. Be aware if already have tachycardia and high blood pressure, can elevate even more. My nasal spray does is only 5 mg. Lowered from 10 because of side effects. I am allowed to do 2sprays to equal 10mg, but if do that, I space it out.
daisybear8049
17 Sep 2017
Also, forgot to add that since the nasal spray tastes horrible, I always suck in a hard candy to mask the taste. Will not take it without!
Related topics
pain, ketamine, side effect, pharmacy, fear
Further information
- Ketamine uses and safety info
- Ketamine prescribing info & package insert (for Health Professionals)
- Side effects of Ketamine (detailed)
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