When it comes to ketamine, dosing is not a one-size-fits-all approach. The transformational molecule is used for various purposes, from pain relief and anesthesia to the emerging field of psychedelic therapy. Let’s dive into the world of ketamine dosing, its effects at different doses, and, more specifically, the dosing used for ketamine-assisted therapy at Nushama.
What is Bioavailability?
First, it’s important to understand the concept of bioavailability. Bioavailability refers to the percentage of a substance that enters the bloodstream and becomes available to the body’s cells. The higher the bioavailability, the more effective the molecule will be. It’s crucial for medical providers to understand and consider bioavailability when determining the right doses for their patients.
Sedative or Anesthetic Dose: A Trusted Tool in Surgery
Ketamine was first approved as an anesthetic in 1970. Its sedative and anesthetic properties come into play at higher doses, with some overlap. Ketamine is commonly used as anesthesia for children and adults during medical procedures. For this purpose, it is usually administered via intravenously (IV) or intramuscularly (IM).
Ketamine has gained popularity as an anesthetic due to its unique properties. Unlike others in its class, ketamine does not suppress breathing or blood pressure. It has been used in various surgical procedures, including dental, orthopedic, and emergency surgeries.
Analgesic Dose: Pain Relief
Ketamine effectively treats various types of pain, including acute, chronic, and neuropathic pain. After the FDA approved the use of ketamine in 1970, Americans used it during the Vietnam War to treat deeply wounded soldiers. In the 1980s and 1990s, ketamine became widely used as an analgesic, particularly in subanesthetic doses, which could provide powerful pain relief without causing full dissociative effects. This quality makes it an attractive alternative to traditional opioids like hydrocodone, oxycodone, and morphine, which often come with a higher risk of addiction and other complications.
Therapeutic Doses: The Promise of Psychedelic Therapy
There are four primary routes of administration for therapeutic doses of ketamine to relieve symptoms of depression, anxiety, and other mood disorders. Bioavailability differs significantly depending on the route of administration.
- Intravenous Infusion (IV): IV infusions achieve 100% bioavailability as the gold standard of ketamine therapy.
- Intramuscular Infusion (IM): IM infusions require higher doses to achieve the same bloodstream concentration as IV infusions. This method of administration offers 93% bioavailability.
- Intranasal Sprays: Absorption of nasal administration varies depending on a number of factors, including nose shape and accuracy of aim. Bioavailability hovers at around 45-50%, making it more effective than oral lozenges but still far less so than IV or IM infusions. The dose and frequency of use may need to be adjusted to achieve the desired therapeutic effect.
- Oral Administration: The exact bioavailability of oral administration differs for everyone due to varying factors such as metabolism. One study indicates that oral ketamine is lower and less consistent than IV and IM, with a 23-38% bioavailability. Finding the right dose for a person using lozenges or other oral methods may require some experimentation.
Ketamine Dosing at Nushama
At Nushama, our protocol involves six ketamine infusions administered via IV over the course of 40 minutes to 1 hour. These sessions typically occur two times per week over three weeks. Dosing varies per member based on past psychedelic experience, body weight, and overall comfort. Doses range from 0.5 to 2 mg per kg.
Most commonly, Nushama doses its members starting at 0.8 mg per kg, increasing up to 0.2 mg per kg each session. Following this regimen, they would be dosed up to 1.8 mg per kg by their final session. Of course, dosage varies throughout treatment for each member. A discussion between our members and the Nushama provider occurs before each dose is determined and agreed upon by the member.
The world of ketamine dosing is complex and multifaceted. To ensure the best possible outcomes for people, it’s essential to work with a trusted medical professional who will take a tailored approach that works for you.