All the Ways Ketamine Can Be Given: Routes, Benefits, and Risks

Routes of Administration

Ketamine can be delivered through multiple routes, each with distinct pharmacokinetics, onset times, and practical considerations. Understanding your options helps you and your provider choose the approach that best fits your needs.

Intravenous (IV)

IV delivery offers the highest bioavailability and most precise dosing. The provider can titrate the dose in real time based on patient response. It's the most controlled and rapid-acting option — particularly valuable for acute depressive episodes.

Trade-off: Requires clinical visits, IV access, and continuous monitoring. Cost typically runs $400–800 per session.

Intramuscular (IM)

A single injection into muscle tissue. Simple, fast, and nearly as bioavailable as IV. Often used in ketamine-assisted psychotherapy (KAP) settings.

Trade-off: Dose cannot be adjusted mid-session once injected.

Subcutaneous (SQ)

Injection under the skin. Less invasive than IM but slower absorption. An alternative when IV access is difficult.

Intranasal (IN)

The FDA-approved Spravato (esketamine) nasal spray falls in this category. It's needle-free, often insurance-covered, but requires clinical supervision.

Compounded nasal sprays offer more dosing flexibility and can be used at home under medical guidance.

Sublingual/Buccal

The medication is placed under the tongue or against the cheek and absorbed through the oral mucosa. This is the route we use at Discreet Ketamine — either as orally disintegrating tablets (ODTs) or troches.

Why we prefer it: It balances effectiveness with convenience, affordability, and privacy. Home administration with telemedicine oversight makes treatment accessible without compromising safety.

Oral (Swallowed)

When ketamine is swallowed, it undergoes first-pass liver metabolism, significantly reducing bioavailability. Convenient but less predictable. Sublingual absorption is generally preferred.

Rectal

An alternative when oral or nasal routes aren't feasible. Limited patient acceptance.

Transdermal

Creams or patches applied to the skin. Still largely experimental with unproven dosing consistency. Not yet a standard clinical option.

FDA Status

Only Spravato (intranasal esketamine) is FDA-approved for depression. IV, IM, and sublingual racemic ketamine remain off-label but are well-established in clinical practice with decades of safety data.

Choosing Your Route

The right route depends on your clinical needs, lifestyle, and preferences. Key considerations:

• Severity and urgency — IV or IM for acute situations
• Convenience — Sublingual or oral for ongoing home treatment
• Cost — Sublingual home therapy is generally most affordable
• Insurance — Spravato is most likely to be covered

For a direct comparison of the two most common options, see IV vs. sublingual ketamine.