Oral ketamine

[PainBrain78]

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Why isn’t oral ketamine commercially available?

I use it, although quite sparingly mostly because it seems experimental at this point. I’m using it primarily for opioid resistant cancer pain, CRPS, neuropathic pain resistant to standard anti-epileptics, etc. I use a compounding pharmacy that makes it into sublingual troche or lozenge. Usually using 25 mg up to 100 mg BID. What are your experiences with oral ketamine?

 

[Ducttape]

1. It's considered a narcotic
2.it's generic
3. Because of 1and 2, there is a very small market.

What makes the situation less tenable for big pharma:
4. Iv bioavailability is 100%
5. Intranasal bioavailability is 45-50%. Oral is 30%.

So you won't see any big pharma market this

FWIW, there is the nasal esketamine (Spravato) available...

 

[MitchLevi]

...and private equity purchased a massive share of that market and wants you getting IV ketamine in their clinics. This decade is projected to produce 3B in profit.

 

[kstarm]

I have used it a few times. Usually my patients have a hard time paying for it. My one patient with neuropathic pain from a shoulder disarticulation/amputation got his life back with this and rotation to suboxone. My other few patients didn't really notice much. I think it is relatively safe. Usually people have tried the IV in the hospital and are let down by the results of the oral. I am a bit interested in the nasal version but haven't tried it yet.

 

[Ferrismonk]

In my opinion, Ketamine isn't a good drug to use outpatient anyway.

If you want to use it as an off-label adjunct for palliative patients, compounding pharmacy is the way to go. As stated previously, there is no money in making an oral version.