What is Ketamine Nasal Spray?

Ketamine is a complex molecule – while it can be taken orally, it decreases the efficacy considerably by traveling the through the stomach and the rest of the gastrointestinal (GI) track and is why it is almost always given through an IV or infusion.  Unfortunately, getting an IV every time a person is in pain is not a realistic solution…this is where intra-nasal ketamine (aka ketamine nose spray) comes in handy.  It is virtually the same exact medication, just reformulated to be able to be given through a spray in the nose the same way a cold or allergy medication would be used.  This treatment requires a doctor’s prescription and usually requires the medication to be filled by a specialty pharmacy.

Intravenous (IV) Ketamine infusions for pain have been around for over 20 years.  Some of the top academic hospitals in the world use them every single day to treat things like Complex Regional Pain Syndrome (CRPS), Fibromyalgia, and even Trigeminal Neuralgia.  The only issue is what to do for pain in between the infusions.  This where ketamine nose spray comes in handy.  This is not a substitute for IV Ketamine, however, the nose spray formulation allows patients the ability to have ketamine available for breakthrough pain while awaiting their next booster infusion.

There have been a number of advances in the treatment for depression over the last few years – Ketamine being one the most popular.  The FDA recently approved the medication Spravato (esketamine HCL) which is a nose spray formulation of ketamine designed specifically for treatment resistant depression or TRD.  This medication is administered BY A LICENSED HEALTHCARE PROVIDER, IN A PHYSICIAN’S OFFICE OR HOSPITAL SETTING OFFICE, AND UNDER DIRECT SUPERVISION A HEALTHCARE PROFESSIONAL.  These are not our rules; per FDA regulations, this treatment is not something that can be taken at home or used without direct supervision of a treating physician.

You will be in the office for a total of 2 hours, on a monitor where your vital signs will be taken and recorded for that period of time.  If any abnormalities are noted, they will be shared directly with the drug manufacturer (Janssen).  The treatment protocol is simple:

1) Induction (Weeks 1 through 4): Treatment is given TWICE per week
2) Maintenance (Weeks 5 through 8): Treatment is given ONCE per week
3) Boosters (Week 9 and after): Treatment is given ONCE every 2 weeks

Treatments for Post Traumatic Stress Disorder (aka PTSD) have come a long way in the last decade.  Previously, there were very few options available other than anti-depressants, anti-anxiety medications, and years and year of therapy.  Fortunately, that has changed.  Several years ago, doctors figured out that a simple injection called a stellate ganglion block can eliminate the effects of PTSD in matter of minutes.  For those that experience the lingering effects of PTSD beyond that injection, ketamine nose spray can offer effective relief.

Postpartum depression (PPD) can be scary.  The period right after childbirth is a stressful time under normal circumstances – adding in the effects of PPD can make things seem almost impossible.  That’s where ketamine nose spray comes in.  Conventional antidepressants can take weeks or even months to start working as it takes time for hormone levels to normalize from these medications.  Ketamine works in a matter of days or even hours.  IV Ketamine infusions are typically needed to “prime” your body to the effects of ketamine, and then the nose spray is used for maintenance.

Mast Cell Activation Syndrome (MCAS) is a complex condition that causes widespread pain, amongst other things, and the triggers are often things that are totally innocuous.  Mast cells are allergy cells that are responsible for the early part of an allergic reaction. They cause “allergy” symptoms by releasing molecules called “mediators” into the body. In an allergic reaction, these mediators are released when the body comes into contact with an “allergen.”  When the body encounters an allergen, IgE (the antibody responsible for allergic responses and is present on the surface of the mast cells) binds to the proteins of the allergen which in turn causes the mediators to spill out of the mast cell.  The triggering event is called “activation,” and the mass release of the mediatiors is called “degranulation.”  Some of these mediators are stored in granules inside mast cells and are released quickly while others are made slowly only after the mast cell has been triggered.

Mast cells can also be activated by allergens ranging from medications like penicillin and sulfa, infections, insect bites to substances like latex or nickel. These reactions are normal and come from normal mast cells. When this happens, it is called “secondary activation” because it is due to an external stimulus.

Sometimes mast cells can become “defective” because of a gene mutation which can cause them to release these mediators and create an allergic reaction from signals that are totally ordinary and normal.  These mutated cells can replicate leading to a large population of “clones” that overpopulate within the body leading to a reactions that can be felt all over.

Symptoms include:

• Widespread joint aches and pain,
• Hives
• Nausea & vomiting
• Abdominal pain
• Passing out
• Low blood pressure
• Racing pulse
• Flushing
• Swelling (angioedema)
• Even the feeling of one’s skin hurting.

Triggers for MCAS can range from warm water, cold weather, certain medications, and exercise.  Treatments for MCAS include antihistamines, aspirin, luekotriene inhibitors, and KETAMINE.

Ketamine can help alleviate the pain and discomfort associated with MCAS and should be used in conjunction with the aforementioned treatments.

Opioid dependence is a complicated situation for patients as the treatment has now become a problem.  While the medications are serving a purpose to relieve pain,  the body will inevitably develop a dependency to them.  The longer this goes on, the more tolerance builds up and the doses needed to provide relief get higher and higher until the amount of medication needed reaches an unsafe level that may cause one’s breathing to stop and cause an overdose.  Putting withdrawal aside, stopping the medications can be hard for patients with legitimate need as the pain they were treating is going to return.  That is were ketamine comes in – not only is it a powerful pain reliever, but it can help alleviate some of the symptoms associated with the body’s dependence on pain medications.

If you or someone you know is suffering from prescription drug dependency, the first step is getting help.  It is important to seek assistance from a trained medical professional immediately and make sure there is a current supply of Narcan readily available in the event of overdose.  Do not put off getting help – there are ways to treat pain without high-dose opioids and treatments available reduce or even eliminate withdrawal.  The Ainsworth Institute is here to help!