Intravenous vs intranasal ketamine — Is there a difference?

Intravenous vs intranasal ketamine — Is there a difference?

With the new arrival of FDA approved intranasal (IN) esketamine, one may ask why do we need intravenous (IV) ketamine? We’ve created a matchup for better understanding of the benefits of IV over IN.

Contender – intranasal ketamine

1. Convenience: It is much easier to spray into the nose than it is to start an IV and run an infusion.
2. Insurance: Unlike the IV form, IN esketamine should be covered by insurance companies. Although, it is still brand new and insurance companies have to yet to figure out how they are going to cover it. Additionally, providers are trying to figure out how they’re going to bill the insurance companies so they are compensated for providing the service. Right now, the cost ranges between $600 and $1,000 per dose!
3. Really, that’s about it. You will still have to show up to a provider’s office to receive the intranasal form. You will still have to remain at the provider’s office for two hours after it is administered. You will still have to get continuing doses regularly.

Contender – intravenous ketamine

1. Bioavailability: IV ketamine is 100% bioavailable. That means that every bit of medicine we give to you through the IV, your brain is receiving. As opposed to the intranasal route, which is only 25 to 50% bioavailable. This means that when you spray it in your nose you’re only getting 1/2 to 1/4 of the actual medicine.
2. Dose Precision: Related to number one, with IV we know exactly how much medication we are giving you. Based on your previous experiences, we can give you more less. Also, because it is a continuous infusion, we can dial the dose up or down based on how you are experiencing it. If it is too much, we can dial it back. If you’re not getting much benefit, we can dial it up. Also, if you have a cold or have allergies or are congested, you are less likely to receive the full intranasal dose. With IV you know you’re getting what you’re getting.
3. Consistency: Because we know exactly how much you have received it helps guide further treatment. When you receive subsequent treatments, you may need the same dose or you may need more. This helps us give you the exact right amount of medication for you.
4. Experience: IV ketamine has a proven track record. The overwhelming majority of research behind this was done with IV infusions. There’s much less research with the intranasal form.
5. Time: With the IV form, the protocols we use for mood disorders is an initial set of six infusions, over 3-4 weeks, followed by “booster” infusions as needed. This is usually about every 2-4 weeks, but some patients are able to go months between boosters. With the IN form, the dosing schedule is twice per week for 4 weeks, then once a week for 4 weeks, followed by every 1-2 weeks indefinitely.
6. Pain relief: Currently, the IN form is not indicated for chronic pain syndromes. However, IV ketamine has been used to relieve suffering from chronic pain with great results.

At the end of the day, the intranasal form will work just fine for many patients. However, ketamine in intravenous form is a more robust treatment modality delivering powerful relief, tailored to each person’s need, and is backed by years and years of research. Don’t just take our word for it. Intravenous ketamine is proven and the preferred mode of treatment by the Ketamine Advocacy Network, the patient advocate group who has the greatest amount of first-hand experience with all forms of ketamine.

Our goal at Alchemy Wellness is to give you the best treatment in the best manner possible while giving you the best service possible. Please feel free to reach out to us if you have any further questions. Want to take a deep dive on ketamine for mood disorders and pain without all the jargon? Read our comprehensive Ketamine Guide.