Nasal Ketamine: Relief for Chronic Pain and Depression
Understanding intranasal ketamine options — Spravato (esketamine), compounded nasal sprays, and how they compare to other routes.
The Nasal Route
Intranasal administration is one of several ways ketamine can be delivered. It offers a needle-free option with faster absorption than oral routes and a growing body of clinical evidence behind it.
Two main options exist: Spravato (FDA-approved esketamine) and compounded ketamine nasal sprays.
Spravato (Esketamine Nasal Spray)
Spravato is the S-enantiomer of ketamine, FDA-approved specifically for treatment-resistant depression. It's administered under medical supervision alongside an oral antidepressant.
How it works: Spravato acts quickly — often providing relief within hours to days, unlike traditional antidepressants that require weeks.
Treatment structure:
Insurance coverage: Spravato is often covered by insurance. Typical out-of-pocket costs for insured patients range from $10–$50 per session.
Side effects: Dizziness, dissociation, and nasal irritation are the most common. These differ in character from oral or IV administration.
Compounded Ketamine Nasal Sprays
For chronic pain management and off-label psychiatric use, compounded nasal sprays offer additional flexibility:
- As-needed use for pain flare-ups
- Customizable dosages tailored to individual response
- Home administration under medical supervision
- Typically not insurance-covered
These sprays use racemic ketamine (both R and S enantiomers), which has decades of clinical safety data.
How Nasal Compares to Other Routes
| Route | Bioavailability | Onset | Setting |
|---|---|---|---|
| IV | ~100% | 2–5 min | Clinic |
| Intramuscular | ~93% | 3–5 min | Clinic |
| Intranasal | 45–50% | 10–15 min | Clinic or home |
| Sublingual | 25–35% | 15–20 min | Home |
| Oral (swallowed) | 20–25% | 30–45 min | Home |
For a complete comparison, see all the ways ketamine can be given.
What We Offer
At Discreet Ketamine, we specialize in sublingual ketamine (orally disintegrating tablets) delivered through telemedicine. We do not offer Spravato. Our focus is on providing effective, private, at-home treatment with ongoing medical oversight.
If you're interested in exploring which route is right for you, the first step is checking your eligibility.
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Disclaimer: Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved. The information provided is for educational purposes only and should not be considered medical advice. Individual results may vary. Always consult with a qualified healthcare provider before starting any treatment.
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